A Three Delays theoretical framework to describe social determinants as barriers to dental care.

OBJECTIVES: The Three Delays model is a well-established global public health framework for the utilization of obstetric services where each delay represents a series of factors affecting utilization: (1) Delay #1-Deciding to seek care, (2) Delay #2-Reaching an appropriate facility and (3) Delay #3-Receiving adequate care. The aim of this qualitative study was to explore the application of the Three Delays model to dental service utilization and describe factors attributed to delayed utilization within this framework. METHODS: This study utilized a framework analysis, underpinned by the Three Delays model, to examine delays in dental care utilization. A criterion purposive sample of English-speaking adults (18+ years) in Massachusetts and Florida, USA with limited dental care access was recruited. Data were collected via semi-structured interviews conducted in two phases: 17 individual interviews, followed by interviews with a subset of five participants over 3 months (a total of 18 interviews). The analysis involved inductive thematic coding and systematic organization within the framework. RESULTS: Major themes and subthemes were constructed from the participants' narratives, identified and categorized as factors in the Three Delays framework. Each of the delays was interrelated to the other two, and Delay #1 was the most common delay based on the participants' interviews. The themes and subthemes contributing to one or more delays included interpersonal communication, prior dental experience, financial considerations, childcare costs, social connection, technology literacy, time constraints, competing priorities, stressors such as eviction and immigration status and microaggressions including racism and stigma. CONCLUSION: The Three Delays model was applicable to the study of dental care utilization and factors that impact the decision to seek dental care, reaching an appropriate dental facility and receiving adequate dental care in this study context.

The Impacts of Periconceptional Alcohol on Neonatal Ovaries and Subsequent Adult Fertility in the Rat.

Maternal exposures during pregnancy can impact the establishment of the ovarian reserve in offspring, the lifetime supply of germ cells that determine a woman's reproductive lifespan. However, despite alcohol consumption being common in women of reproductive age, the impact of prenatal alcohol on ovarian development is rarely investigated. This study used an established rat model of periconceptional ethanol exposure (PCEtOH; 12.5% v/v ethanol) for 4 days prior to 4 days post-conception. Ovaries were collected from neonates (day 3 and day 10), and genes with protein products involved in regulating the ovarian reserve analyzed by qPCR. Adult offspring had estrous cycles monitored and breeding performance assessed. PCEtOH resulted in subtle changes in expression of genes regulating apoptosis at postnatal day (PN) 3, whilst those involved in regulating growth and recruitment of primordial follicles were dysregulated at PN10 in neonatal ovaries. Despite these gene expression changes, there were no significant impacts on breeding performance in adulthood, nor on F2-generation growth or survival. This contributes additional evidence to suggest that a moderate level of alcohol consumption exclusively around conception, when a woman is often unaware of her pregnancy, does not substantially impact the fertility of her female offspring.

The Guided Bone Regeneration of a Large, Non-Contained, Perforated Maxillary Anterior Perforation Defect: A Case Report.

The reconstruction of alveolar ridge defects can be challenging, especially when the lesion is large, non-contained, and located in the esthetic region. The present report describes the guided bone regeneration (GBR) procedure and prosthetic rehabilitation of a severe perforation defect in the anterior maxilla. Clinical and radiographic evaluation of the lesion indicated an endodontic-periodontal origin, and biopsy results confirmed the absence of malignancy. GBR was performed with the use of cortical mineralized freeze-dried bone allograft (FDBA) combined with recombinant human platelet derived growth factor BB (rhPDGF-BB) and a resorbable collagen membrane without the use of tenting or fixation screws. At six months post-GBR, cone beam computed tomography (CBCT) revealed adequate bone fill for the placement of 4.1 x 10 mm or 4.1 x 12 mm dental implants. The implant surgery was fully guided with a two-stage approach. After a ten-month of healing phase, the implants were loaded with a screw-retained porcelain bridge. The staged GBR approach using a combination of FDBA, rhPDGF-BB, and a resorbable membrane without the use of tenting or fixation screws resulted in significant bone fill, successful implant placement, and a functional and esthetic implant-supported prosthesis.

Reductions in movement-associated fear are dependent upon graded exposure in chronic low back pain: An exploratory analysis of a modified 3-item fear hierarchy.

OBJECTIVE: To explore the effectiveness of a modified fear hierarchy on measuring improvements in movement-associated fear in chronic low back pain. METHODS: A modified 3-item fear hierarchy was created and implemented based on principles of graded exposure. This study was an exploratory analysis of the modified 3-item fear hierarchy from a larger clinical trial data set. Both groups received pain education and exercise, either bodyweight or strength training. Both groups performed item one on the hierarchy, the squat. Only the strength training group performed item 2, the deadlift. Neither group performed item 3, the overhead press. Analysis of Covariance and stepwise linear regression were used to explore results. RESULTS: Improvement in movement-associated fear was conditional upon graded exposure. Both groups improved in the squat movement (p ≤ 0.05), which both performed. Only the strength training group improved in the deadlift (p ≤ 0.01), and neither improved in the overhead press (p ≥ 0.05). CONCLUSION: Reductions in movement-associated fear are conditional upon graded exposure, based on the use of a novel modified 3-item fear hierarchy. Further research is needed to understand the utility of this tool in a patient-led approach to co-designing a graded exposure-based intervention.

The management of an oral pyogenic granuloma around osseointegrated dental implants.

INTRODUCTION: Oral pyogenic granulomas (PGs) presenting in association with dental implants are uncommon occurrences. While tooth-associated PGs are well-documented in the literature, there are only seven case reports with biopsy-confirmed diagnoses of PG related to dental implants. This case report details the treatment of an intraoral PG related to dental implants that had been osseointegrated and asymptomatic for 10 years. CASE PRESENTATION: A 39-year-old female presented with a hyperplastic erythematous mass that encompassed the dental implants in the position of the maxillary central incisors. Surgical exploration of the site revealed nonintegrated, particulate bone material distributed throughout the peri-implant tissues approximating the granuloma. Treatment involved surgical excision of the lesion, elimination of all nonintegrated bone material, and implant surface debridement. Laser therapy was later used to manage a recurrence. Histology of the biopsied tissue confirmed the diagnosis of PG and described the presence of multiple exogenous, refractile, particulate materials in the specimen. CONCLUSION: The combination of surgical excision, implant debridement, and conservative laser therapy resulted in the elimination of a dental implant-related PG and successful soft tissue management. The localized presence of nonintegrated particulate bone material surrounding the granuloma appears to have functioned as a chronic irritant to the peri-implant soft tissues over time and is likely, along with oral bacteria, the primary etiological agents. KEY POINTS: Why is this case new information? There is a paucity of reports describing the management of dental implant-related pyogenic granulomas especially in the esthetic region. The present case demonstrates that particulate bone materials used in guided bone regeneration have the capacity to behave as a low-grade irritant to the gingival tissues. It also demonstrates the successful elimination of the tissues and management of the peri-implant soft tissues for an esthetic result. What are the keys to successful management of this case? The key to successful management of this case was adequate removal of the exogenous irritant, proper implant surface debridement, and decontamination and adequate gingivoplasty to remove all residual hyperplastic granulomatous tissues. Additionally, patient education and appropriate oral hygiene instructions were important to proper healing and maintenance of the area. What are the primary limitations to success in this case? The ambiguity of the clinical boundaries of PGs makes it challenging to guarantee complete excision beyond the base of the lesion, leading to recurrence.

The Problematic Concept of Native Speaker in Psycholinguistics: Replacing Vague and Harmful Terminology With Inclusive and Accurate Measures.

Though the term NATIVE SPEAKER/SIGNER is frequently used in language research, it is inconsistently conceptualized. Factors, such as age, order, and context of acquisition, in addition to social/cultural identity, are often differentially conflated. While the ambiguity and harmful consequences of the term NATIVE SPEAKER have been problematized across disciplines, much of this literature attempts to repurpose the term in order to include and/or exclude certain populations. This paper problematizes NATIVE SPEAKER within psycholinguistics, arguing that the term is both unhelpful to rigorous theory construction and harmful to marginalized populations by reproducing normative assumptions about behavior, experience, and identity. We propose that language researchers avoid NATIVE SPEAKER altogether, and we suggest alternate ways of characterizing language experience/use. The vagueness of NATIVE SPEAKER can create problems in research design (e.g., through systematically excluding certain populations), recruitment (as participants' definitions might diverge from researchers'), and analysis (by distilling continuous factors into under-specified binary categories). This can result in barriers to cross-study comparison, which is particularly concerning for theory construction and replicability. From a research ethics perspective, it matters how participants are characterized and included: Excluding participants based on binary/essentialist conceptualizations of nativeness upholds deficit perspectives toward multilingualism and non-hegemonic modes of language acquisition. Finally, by implicitly assuming the existence of a critical period, NATIVE SPEAKER brings with it theoretical baggage which not all researchers may want to carry. Given the issues above and how 'nativeness' is racialized (particularly in European and North American contexts), we ask that researchers consider carefully whether exclusion of marginalized/minoritized populations is necessary or justified-particularly when NATIVE SPEAKER is used only as a way to achieve linguistic homogeneity. Instead, we urge psycholinguists to explicitly state the specific axes traditionally implied by NATIVENESS that they wish to target. We outline several of these (e.g., order of acquisition, allegiance, and comfort with providing intuitions) and give examples of how to recruit and describe participants while eschewing NATIVE SPEAKER. Shifting away from harmful conventions, such as NATIVE SPEAKER, will not only improve research design and analysis, but also is one way we can co-create a more just and inclusive field.

Periconceptional ethanol exposure alters hypothalamic-pituitary-adrenal axis function, signalling elements and associated behaviours in a rodent model.

Alcohol consumption throughout pregnancy has been associated with mental illness, hyperactivity and social difficulties in offspring. This may be due in part to programmed disruption of the hypothalamic-pituitary-adrenal axis (HPA) activity and responsiveness. However, it is unknown if the HPA is affected and similar behavioural outcomes occur following alcohol exposure limited to the time around conception, the periconceptional (PC) period. Female Sprague-Dawley rats were treated with PC:EtOH (12.5 % v/v EtOH liquid diet) or a control diet from four days before conception, until embryonic day 4. Offspring at 3-months of age underwent the forced swim test (FST) and social interaction test. HPA reactivity tests (combined dexamethasone suppression test (DST) and corticotropin-releasing hormone test (CST), 30-minute restraint stress) were performed at 5 months of age and then pituitary and adrenal glands were collected for expression of genes involved in HPA regulation. PC:EtOH exposure significantly increased immobility (p < 0.05) in both sexes in the FST. PC:EtOH also increased the duration of affiliative behaviour (p < 0.05) within the social interaction test in female offspring. PC:EtOH programmed HPA hyperactivity in both sexes during the DST/CST test (p < 0.05); however, there was no impact of PC:EtOH on plasma corticosterone concentration in response to restraint stress. There was no significant impact of PC:EtOH on mRNA expression in glucocorticoid signalling genes in the pituitary gland or the steroidogenic pathway in the adrenal gland. This study suggests that alcohol exposure, even when limited to a short period around conception, can program mental illness-like phenotypes, and this was associated with alterations in HPA responsiveness. This study further highlights that consumption of alcohol even prior to implantation may impact the long-term health of offspring.

Prenatal alcohol exposure and developmental programming of mental illness.

It is well established that high-dose alcohol consumption during pregnancy increases the risk for a plethora of adverse offspring outcomes. These include neurodevelopmental, cognitive and social deficits, as well as psychiatric illnesses, such as depression and anxiety. However, much less evidence is available on the effects of low- and early-dose alcohol exposure on mental health outcomes, regardless of the accumulating evidence that mental health outcomes should be considered in the context of the Developmental Origins of Health and Disease hypothesis. This review will discuss the evidence that indicates low-dose and early prenatal alcohol exposure can increase the risk of mental illness in offspring and discuss the mechanistic pathways that may be involved.

Periconceptional ethanol exposure alters the stress axis in adult female but not male rat offspring.

Ethanol consumption during pregnancy alters offspring hypothalamus-pituitary-adrenal (HPA) axis regulation. However, little is known about the outcomes of alcohol consumption confined to the periconceptional period. This study investigated the effects of periconceptional ethanol (PC:EtOH) exposure on corticosterone concentrations, response to restraint stress and gene expression of adrenal, hypothalamic, and hippocampal glucocorticoid-related pathways in rat offspring. Female Sprague-Dawley rats were treated with PC:EtOH (12.5% v/v EtOH liquid diet) or a control diet from four days before conception, until embryonic day 4. At 6 (adult) and 12-14 (aged) months of age, basal corticosterone concentrations were measured, while in a separate cohort of aged rats, blood pressure, heart rate, and plasma corticosterone concentrations were measured during a 30-minute restraint stress. Adrenal gland, hypothalamic and hippocampal tissue from aged rats were subjected to transcriptomic analysis. PC:EtOH exposure reduced basal plasma corticosterone concentrations in adult and aged female but not male offspring (p < .05). The corticosterone and pressor response were significantly reduced in aged PC:EtOH female offspring following restraint (p < .05). Expression of adrenal steroidogenesis genes (Mc2r, Cyp11a1, Cyp21a1, 11bhsd2, and Nr3c1) and hypothalamic genes (Crh, Crh-r1, Nr3c1, and Hsp90a1) was not affected by PC:EtOH. In aged female offspring exposed to PC:EtOH, adrenal mRNA expression of Hsp90a1 was significantly elevated, and within the hippocampus, mRNAs for glucocorticoid receptor (Nr3c1) and Hsp90a1 were increased (p < .05). This study supports the hypothesis that prenatal alcohol exposure programs sex-specific alterations in the HPA axis and provides the first evidence that the periconceptional period is a critical window for programing of this axis. Lay summary This study investigated the impact of alcohol consumption around the time of conception on offspring stress reactivity in a rat model. Offspring exposed to alcohol displayed altered cardiovascular responses to stress and had reduced circulating concentrations of the stress hormone corticosterone both under basal conditions and following a stressful challenge. This study also identified altered expression of key genes in an important part of the brain known to be involved in stress responsiveness; the hippocampus. If similar outcomes occur in humans, these results would suggest that alcohol consumption, even before a woman knows she is pregnant, may significantly impact stress-related outcomes in children.

Non-Surgical Therapy Reduces Presence of JP2 Clone in Localized Aggressive Periodontitis.

BACKGROUND: Previous studies have provided substantial evidence of the association of Aggregatibacter actinomycetemcomitans, and its highly leukotoxic JP2 genotype, with localized aggressive periodontitis (LAgP). The present study aims to evaluate presence of JP2 in individuals with LAgP after periodontal treatment. METHODS: Sixty African-American patients with LAgP, aged 5 to 25 years, were examined. At baseline, probing depth (PD), clinical attachment level (CAL), bleeding on probing, and plaque index were measured, and subgingival plaque was collected from LAgP diseased and healthy sites for each participant. Patients received whole-mouth ultrasonic debridement, scaling and root planing, and a 7-day prescription of amoxicillin and metronidazole. Participants were reevaluated and resampled and received regular maintenance therapy at 3, 6, and 12 months after treatment. Polymerase chain reaction was used to detect presence of the JP2 genotype before and after treatment. RESULTS: At baseline, the JP2 sequence was identified in 75% of LAgP diseased sites and in 56.67% of healthy sites. At 3, 6, and 12 months after treatment, the number of patients was 40, 31, and 31, respectively, and JP2 detection decreased to 17.5%, 6.45%, and 3.23%, respectively, in diseased sites (P <0.001) and to 2.5%, 3.23%, and 0%, respectively, in healthy sites (P <0.001). Clinical parameters of disease were also significantly reduced after therapy (P <0.001). Additionally, significant correlations were observed between JP2 presence and mean PD (P <0.002) and CAL (P <0.001), after therapy. CONCLUSION: Periodontal therapy was successful in reducing clinical parameters of LAgP and subgingival presence of JP2 in diseased and healthy sites.

A Randomized Controlled Study Comparing the National Cancer Institute's Original and Revised Consent Form Templates.

Since 1998, the National Cancer Institute (NCI) has mandated that researchers use its consent form template in developing consent forms for their NCI-funded clinical trials. The template was substantially revised in 2013 to aid in the development of simpler, more concise consent forms. The NCI conducted a randomized controlled trial with cancer survivors (N = 153) to assess the revised template's effect on individuals' knowledge, satisfaction, clarity, and likelihood of joining a trial in the future. We found that the revised template resulted in equally high knowledge and satisfaction scores as the original template, but with fewer words and pages. The likelihood that an individual would participate in a trial diminished after he or she reviewed either the original or revised consent form, yet having knowledge about trials before reviewing the consent forms resulted in increased satisfaction. To ensure an informed decision-making process, we recommend using the revised NCI consent form template along with using educational interventions aimed at increasing the understanding potential participants have of a trial before they receive a consent form.

Immigrant Health in Toronto, Canada: Addressing Food Insecurity as a Social Determinant of Tuberculosis.

In Canada, tuberculosis is 20 times more likely to be experienced by new immigrants than by Canadian citizens. Food insecurity, which has implications for developing tuberculosis, is linked to poverty and immigration status and has costly implications for individuals and public health. This article explores the history of the Ontario government's failure to adequately address poverty and food insecurity and the role of social work in addressing these issues. Recommendations for addressing food insecurity at a policy level include increasing the rate and goals of the Ontario Works program. Implications for new immigrants, tuberculosis and public health are explored.

Maternal corticosterone exposure in the mouse programs sex-specific renal adaptations in the renin-angiotensin-aldosterone system in 6-month offspring.

Short-term maternal corticosterone (Cort) administration at mid-gestation in the mouse reduces nephron number in both sexes while programming renal and cardiovascular dysfunction in 12-month male but not female offspring. The renal renin-angiotensin-aldosterone system (RAAS), functions in a sexually dimorphic manner to regulate both renal and cardiovascular physiology. This study aimed to identify if there are sex-specific differences in basal levels of the intrarenal RAAS and to determine the impact of maternal Cort exposure on the RAAS in male and female offspring at 6 months of age. While intrarenal renin concentrations were higher in untreated females compared to untreated males, renal angiotensin II concentrations were higher in males than females. Furthermore, basal plasma aldosterone concentrations were greater in females than males. Cort exposed male but not female offspring had reduced water intake and urine excretion. Cort exposure increased renal renin concentrations and elevated mRNA expression of Ren1, Ace2, and Mas1 in male but not female offspring. In addition, male Cort exposed offspring had increased expression of the aldosterone receptor, Nr3c2 and renal sodium transporters. In contrast, Cort exposure increased Agtr1a mRNA levels in female offspring only. This study demonstrates that maternal Cort exposure alters key regulators of renal function in a sex-specific manner at 6 months of life. These finding likely contribute to the disease outcomes in male but not female offspring in later life and highlights the importance of renal factors other than nephron number in the programming of renal and cardiovascular disease.

A Saccharomyces cerevisiae cell-based quantitative beta-galactosidase assay compatible with robotic handling and high-throughput screening.

Reporter-gene assays that employ the Escherichia coli lacZ gene are ubiquitously employed in biological research. However, we were not able to readily identify a quantitative method that worked reliably with yeast (Saccharomyces cerevisiae) cells and that was compatible with high-throughput screening and robotic liquid handling tools. We have therefore adapted a commercially available assay employing a 6-O-beta-galactopyranosyl-luciferin substrate to provide the required sensitivity with minimal sample handling times. Our assay uses only one-tenth of the reagents suggested by the reagent manufacturer (Promega) for equivalent assays with mammalian cell cultures and produces rapid, sensitive and reproducible analysis with as little as 1 microl yeast cell culture and with < 100 cells. We demonstrate that the assay is compatible with yeast strains generated by the systematic yeast deletion project and functions equally well with genomically integrated or plasmid-encoded lacZ reporters and with cells grown in complex or defined media. The high-sensitivity, miniaturized format reduced sample handling required will make this assay useful for a wide range of applications.