Advanced general dentistry program directors' attitudes on physician involvement in pediatric oral health care.

Childhood oral disease is a significant health problem, particularly for vulnerable populations. Since a major focus of General Dentistry Program directors is the management of vulnerable populations, we wanted to assess their attitudes regarding the inclusion of physicians in the prevention, assessment, and treatment of childhood oral disease. A survey was mailed to all General Practice Residency and Advanced Education in General Dentistry program directors (accessed through the ADA website) to gather data. Spearman's rho was used to determine correlation among variables due to nonnormal distributions. Overall, Advanced General Dentistry directors were supportive of physicians' involvement in basic aspects of oral health care for children, with the exception of applying fluoride varnish. The large majority of directors agreed with physicians' assessing children's oral health and counseling patients on the prevention of dental problems. Directors who treated larger numbers of children from vulnerable populations tended to strongly support physician assistance with early assessment and preventive counseling.

Advanced general dentistry program directors' attitudes and behaviors regarding pediatric dental training for residents.

The oral health of children became a more prominent concern with the U.S. surgeon general's report on oral health in America in 2000. The purpose of our study was 1) to assess General Practice Residency (GPR) and Advanced Education in General Dentistry (AEGD) (here jointly referred to as advanced general dentistry [AGD] programs) directors' current behaviors with regard to pediatric training of residents and 2) to assess their attitudes about which components of pediatric oral health training should be included in AGD programs. A twenty-one item survey was mailed to all GPR and AEGD programs accessed through the American Dental Association website. Seventy percent of directors (N=187) completed and returned the survey. Responses indicated that AGD residents receive adequate clinical exposure to pediatric patients and provide much-needed services to uninsured, underinsured, and underserved people. Although clinical training in pediatric treatment was high, didactic hours focused on pediatric treatment did not seem commensurate with clinical activity. Program directors indicated strong attitudinal support for teaching residents many components of pediatric oral health care, although most directors have concerns over increasing didactic hours spent on pediatric oral health due to already crowded curricula. Approximately 88 percent of directors said that they would implement a pediatric oral health module in their curricula if they had access to one.

Using community ties to facilitate school-based prevention research.

One of the greatest obstacles to conducting school-based HIV/STD/pregnancy prevention research with adolescents is the reluctance of administrators or site-based decision-making councils to commit their teachers and students to participation in a project designed and managed by an outside group of researchers. A major concern is that researchers may not understand or agree with community sensitivities about such personal topics. By first establishing a collaborative relationship with health district educators currently working in Appalachian schools and residing in those communities, one finds a distinct advantage in terms of gaining admittance to area schools. The presence of local health educators at formative meetings also alloys many concerns of community members, as they view these local participants as monitors of outsider research efforts, thereby protecting the community culture from undue outside influence. During the course of the current study, health educators found they also learned more about their communities and about HIV prevention.

Rural-urban variation in breast-conserving surgery in Kentucky.

Recently researchers from the University of Kentucky published a study showing that, in the early 1990s, Appalachian women were less likely to receive breast-conserving surgery (BCS) in the treatment of early stage cancer, than other Kentucky women diagnosed with early stage breast cancer, and that poverty was the only predictor of lowered probability of receiving BCS. In that study, analyses were performed on a dataset of Kentucky Medicare beneficiary claims of treatment information that had been linked with data from the Kentucky Cancer Registry for staging information. County-level data were also used, from the 1990 census and other sources, on poverty and education rates for women, and hospital bed and physician ratios per population. While the findings of the study are significant, the study is generalizable only to women aged 65 years and older because a Medicare dataset was used. In addition, the study represented Kentucky practice seven to ten years ago, from 1992 through 1995, which raises interest in obtaining BCS rates for more current practice. In this article, we update the previous study with the most recent data on BCS, and include women of all ages, not just those over age 64 years. Access was obtained to the Kentucky Cancer Registry, which contains records of the initial treatment for breast cancer, as well as staging information about the extent of disease at diagnosis. Data from the 2000 census were not available for this analysis, however.