Glycemic control among patients with physician-managed type 2 diabetes.

Outcomes for treatment, overall oral health status, and periodontal disease progression in patients with type 2 diabetes mellitus (T2DM) have been associated with glycemic control as measured by hemoglobin A1c (HbA1c) levels. Due to the high prevalence of T2DM among patient populations in the United States, this study sought to assess baseline levels of glycemic control for patients with a known diagnosis of T2DM who were under the care of a physician and to identify management solutions for these patients. All patients included in this study were prescreened to ensure that they were dentate, had been diagnosed with T2DM at least 3 months previously, were under the care of a physician for diabetes management, and had no changes to their diabetes-related medications for 3 months or more (N = 822). The patients meeting those criteria were then screened in person, and those who had moderate to severe chronic periodontitis, had at least 20 teeth, and met other inclusion/exclusion criteria were qualified to participate in the study (N = 214). After the patients fasted, a whole blood sample was drawn and subjected to HbA1c testing. The mean (SD) HbA1c for the qualified patients was 7.76% (1.79%), and the values ranged from 5.1% to 18.8%. Among the 214 qualified individuals, 150 (70.1%) had HbA1c values greater than 6.5%. Of these 150 patients, 80 (53.3%, or 37.4% of the total screened sample) presented with HbA1c values greater than 8.0%. The majority of patients with periodontitis and physician-managed T2DM did not meet ideal standards for glycemic control. Dental healthcare providers should consider consultation and/or advanced screening for diabetic patients seeking dental care.

Decision Making in the Treatment of Patients With Rheumatoid Arthritis and Periodontitis: Scientific Evidence and Clinical Experience.

Focused Clinical Question: What are the key considerations for coordination of care for a patient with rheumatoid arthritis (RA) and chronic periodontitis (CP), and what are the clinical implications of RA on periodontal health? Summary: Both RA and CP involve hyper-immune response and osseous destruction. However, despite emerging evidence that RA and CP may have common etiologies and patients with RA have increased risk of CP, periodontal evaluation and treatment remain largely similar for patients with and without RA. More fully assessing inflammatory burden in patients with RA and CP may allow practitioners to more accurately assess the risk profile of a patient for RA and periodontal disease progression and to better evaluate adequate end points to periodontal therapy. Furthermore, coordination of care for patients with RA and CP with their rheumatologist or treating physician could allow for advanced screening and prophylactic care that may prevent disease development or progression. Conclusion: For patients with RA and CP, evaluation of their rheumatoid disease activity score and periodontal inflamed surface area score, rather than traditional periodontal clinical measurements, along with additional biologic sampling methods may be appropriate measures to more accurately assess inflammatory burden in these susceptible patients.

Factors associated with rapid failure in a Treatment Alternatives for Safer Communities (TASC) program.

OBJECTIVE: Identify factors associated with early treatment failure in a Treatment Alternatives for Safer Communities (TASC) program, a case management criminal justice diversion program for individuals under community corrections supervision. METHODS: Demographics, medication history, substance dependence, and criminal history variables for 21,419 individuals were used as predictor variables for successful treatment outcome in a Cox Proportional Hazards Survival analysis which was used to assess the relationship between predictor variables and the length of time before treatment failure. RESULTS: Early treatment failure was associated with a number of factors linked to social stability, including: being divorced separated or widowed, being less educated, being without insurance or on government insurance, and being unemployed. Regarding addiction and criminal history, being dependent on cocaine or opioids and being under supervision for person, property, or court offenses were risk factors. Being male and being a member of a racial minority were also risk factors for early treatment failure. Meeting criteria for sedative/hypnotic dependence and being under legal supervision for a substance offense were associated with a longer duration of time to treatment failure. CONCLUSIONS: Social stability, addiction history, and current criminal charges all appear to influence performance in TASC. Individuals with multiple risk factors may benefit from referral to a higher level of care upon admittance to TASC.

Cooperation and depressive symptoms.

BACKGROUND: Deficits in pro-social cooperation are common in many individuals with mental illnesses such as depression. For decades, researchers have used economic game paradigms to compare cross-cultural cooperative behavior. However, research using economic games to assess cooperative behavior in clinical populations is in the early stages. We hypothesized that individuals with greater depressive symptoms would struggle to maintain reciprocity in iterative games, but not in single-iteration games measuring personal values. METHODS: Participants (n=41) played four computer-based economic games (prisoner's dilemma, the public goods game, the ultimatum game, and the trust game) measuring different aspects of cooperation. Participants completed the Depression Anxiety and Stress Scale (DASS) and other measures of personality and demographics. Analyses assessed the relationships between game performance and psychological distress as measured by the DASS. RESULTS: Significant correlations were found between game performance and depressive symptoms, but not symptoms of anxiety or stress. Performance in the prisoner's dilemma and public goods game was significantly related to depression in a linear regression even when known associations with depressive affect such as age, gender, race, education, marital status, and neuroticism were controlled for. CONCLUSIONS: Depressive symptoms were associated with an inability to sustain reciprocal cooperation. Participants showed the predicted deficits in cooperation in these economic games. Economic games show the potential for assessing the social deficits associated with depressive symptoms.

Buprenorphine and medication management in a community corrections population: a pilot study.

AIMS: This project sought to demonstrate the feasibility and acceptability of providing on-site buprenorphine treatment to individuals under community corrections supervision. METHODS: Seventeen women and 13 men were enrolled on-site over a 2-week period at a community corrections location. Study participants received open-label study medication dispensed weekly over 12 weeks, weekly medication management therapy, and returned for a 1-month follow-up. RESULTS: Participants were predominantly female (56%) and white (90%) with an average age of 31.7 ± 7.4 years. More than half (53%) had hepatitis C virus infection and 75.9% reported intravenous use of opioids in the 30 days before treatment. Rates of illicit substance use was high, as 37.9% of urines were positive for benzodiazepines, 31.7% were positive for cocaine, and 13.7% were positive for alcohol across the time in the study. Although rates of positive urines for opiate use and sex with multiple partners did not change during treatment, rates of injection drug use significantly decreased during treatment. Overall, 86.7% of participants were retained through the 1-month follow-up with low rates of adverse events. CONCLUSIONS: Acceptability and feasibility of this approach were demonstrated by the ability to enroll and randomize the target sample of participants over 2 weeks with high retention and low rates of adverse events through 1-month follow-up. This pilot study demonstrated that this population could be successfully engaged in treatment and show reductions in risky behaviors. However, more intensive interventions may be needed to reduce opiate use to reach this vulnerable population at their point of contact with the criminal justice system.

Characterization of opioid overdose and response in a high-risk community corrections sample: a preliminary study.

Opiate overdose is an increasingly common cause of death, yet could be easily treated with available opioid antagonists. Opiate use is very common in criminal justice populations, and individuals recently released from prisons or jails are an especially vulnerable group for both overdose and death, particularly in the immediate postrelease period. Participants (N = 478) were individuals under community corrections supervision who were surveyed about their opioid use, overdose history, medical history, and demographics. Most participants were male (67.4 percent) and either African American (52.4 percent) or Caucasian (44.2 percent) with an average age of 35 years (SD = 11.1). Two hundred twenty participants (46 percent) reported lifetime use of opioids, whereas 88 (40 percent) reported experiencing an opioid-related overdose. Relative to those with no history of opioid overdose or lifetime opioid use, participants with a history of opioid overdose were more likely to be Caucasian, female, and report higher educational attainment; more likely to be willing to receive additional training about overdose; and reported double to triple the rates of witnessing an overdose or knowing someone who had died from overdose -78 percent and 69 percent, respectively. The rates of actions taken when witnessing overdose were relatively low: 59 percent had called 911, 33 percent had taken someone to a hospital with 23 percent providing no intervention, and only 4 percent having used an opioid antagonist, naloxone. These findings suggest that while opioid overdose is a significant problem in the criminal justice population, affected individuals are open to instruction in effective strategies, such as naloxone training, to prevent fatal opioid overdose.