Emerging Regional and Racial Disparities in the Lifetime Risk of Human Immunodeficiency Virus Infection Among Men who Have Sex With Men: A Comparative Life Table Analysis in King County, WA and Mississippi.

BACKGROUND: Little is known about the lifetime risk of human immunodeficiency virus (HIV) diagnosis among US men who have sex with men (MSM), trends in risk and how risk varies between populations. METHODS: We used census and HIV surveillance data to construct life tables to estimate the cumulative risk of HIV diagnosis among cohorts of MSM born 1940 to 1994 in King County, Washington (KC) and Mississippi (MS). RESULTS: The cumulative risk of HIV diagnosis progressed in 3 phases. In phase 1, risk increased among MSM in successive cohorts born 1940 to 1964. Among men born 1955 to 1965 (the peak risk cohort), by age 55 years, 45% of white KC MSM, 65% of black KC MSM, 22% of white MS MSM, and 51% of black MS MSM had been diagnosed with HIV. In phase 2, men born 1965 to 1984, risk of diagnosis among KC MSM declined almost 60% relative to the peak risk cohort. A similar pattern of decline occurred in white MS MSM, with a somewhat smaller decline observed in black MS MSM. In phase 3, men born 1985 to 1994, the pattern of risk diverged. Among white KC MSM, black KC MSM, and white MS MSM, HIV risk increased slightly compared with men born 1975 to 1984, with 6%, 14%, and 2% diagnosed by age 27 years, respectively. Among black MS MSM born 1985 to 1994, HIV risk rose dramatically, with 35% HIV diagnosed by age 27 years. CONCLUSIONS: The lifetime risk of HIV diagnosis has substantially declined among MSM in KC and among white MSM in MS, but is rising dramatically among black MSM in MS.

Engaging the dental workforce in disaster mitigation to improve recovery and response.

Natural disasters may strike quickly and without warning and cause long-term health consequences beyond the immediate loss of lives and property. Dental professionals have a social responsibility to participate in community emergency preparedness planning and response to mitigate prolonged recovery of the dental care infrastructure in the affected areas. Public health and emergency management agencies should plan for access to emergent dental care as part of a multidisciplinary local emergency response to mitigate the impact of devastation on the primary oral health needs of persons in the affected geographic areas. State dental associations should work with government agencies and emergency management groups to increase awareness of the importance for collaborative emergency response health services in the aftermath of natural disasters.

Dental care as a vital service response for disaster victims.

Hurricane Katrina's impact on the infrastructure of public health and the health care system in the affected areas was unprecedented in the United States. Many dental offices were flood-bound in New Orleans and over 60% of dental practices were partially or completely damaged in affected counties in Mississippi. Most needs assessments conducted during the initial recovery operations did not include questions about access to oral health care. However, the extent of the destruction of the health care infrastructure demonstrated the need for significant state and federal support to make dental treatment accessible to survivors and evacuees. The Katrina response is one of the few times that state and federal government agencies responded to provide dental services to victims as part of disaster response and recovery. The purpose of this paper is to share our experiences in Mississippi and the District of Columbia providing urgent dental care to disaster victims as part of a crisis response.

Impact of increasing Medicaid dental reimbursement and implementing school sealant programs on sealant prevalence.

UNLABELLED: We examined the impact of two financing strategies--increasing Medicaid dental reimbursements and providing school sealant programs--on dental sealant? prevalence (number of children with at least one sealant) among 7- to 9-year-olds in Alabama and Mississippi counties from 1999 to 2003. METHODS: We used Medicaid claims data in a linear regression model. We regressed number of children sealed per county onto eligible children, median family income, dentist-to-population ratio, and indicator variables for reimbursement increase, presence of community health center (CHC) or school sealant program, and interaction between reimbursement increase and presence of school program or CHC. We also calculated the average incremental cost per sealant from increasing the Medicaid reimbursement rate and then disaggregated it into cost to provide additional sealants and cost to provide the same number of sealants under the higher rate. RESULTS: Increasing the sealant reimbursement rate was associated with a 102 percent increase and a 39 percent increase in sealant prevalence in Mississippi and Alabama, respectively. Introducing school sealant programs more than doubled sealant prevalence in both states. In Mississippi, 85 percent of the average incremental cost from implementing the higher reimbursement rate was due to providing new sealants and 15 percent was due to paying a higher rate for sealants that likely would have been delivered at the old rate. CONCLUSION: Depending on supply and demand conditions in dental markets, both strategies can be effective in increasing sealant prevalence.

HIV-positive patients: dental management considerations.

HIV infection in humans occurs primarily by mucosal infection during unprotected sexual activity or inoculation during intravenous drug use. HIV infection causes a progressive deterioration of protective cell-medicated immunity, specifically due the destruction of thymus-derived lymphocytes, called T-cell, during viral replication. Highly active antiretroviral therapy (HAART) reduces HIV viral replication and improves immune function against opportunistic infections, but it does not offer a cure for disease. Dental professionals should be able to recognize those with HIV infection by identifying the oral manifestations of fungal, viral, and bacterial infections or neoplasms that occur with immunodeficiency. Dental care providers should understand the adverse effects of HAART and communicate the importance of good oral health in managing disease.

Interprofessional educational partnerships in school health for children with special oral health needs.

Dental caries is an infectious yet preventable disease that is rampant in some subpopulations in the United States, in particular among individuals with neurodevelopmental/intellectual disabilities (ND/ID). This article reports on the implementation and evaluation of the Louisiana State University Health Sciences Center (LSUHSC) School of Dentistry interprofessional school health educational model to improve oral health assessment and referral for children with ND/ID in an inner-city school system. During this project, dental hygiene students and elementary school nurses were paired to assess the oral health status of 255 inner-city children with developmental disabilities, improve referral/access to dental care for those identified as having need, and propose dental hygiene curriculum changes that would incorporate participation in a "real-life public health setting" for those with ND/ID. Following the program, 66 percent of dental hygiene students said their likelihood of participating in future oral health programs had increased and 75 percent of school nurses rated the educational process as very good or excellent. Modifications in dental hygiene curricula that provide students with training and experience in oral health risk assessment and referral for people with ND/ID is recommended to address the new Commission on Dental Accreditation educational standards 2-18 and 2-26 (implemented January 1, 2005) and dental standard 2-26 (implemented January 1, 2006), which state that dental hygiene and dental graduates must be competent in assessing the treatment needs of patients with special needs.