Chitin-calcium alginate composite fibers for wound care dressings spun from ionic liquid solution.

Chitin-calcium alginate composite fibers were prepared from a solution of high molecular weight chitin extracted from shrimp shells and alginic acid in the ionic liquid 1-ethyl-3-methylimidazolium acetate by dry-jet wet spinning into an aqueous bath saturated with CaCO3. The fibers exhibited a significant proportion of the individual properties of both calcium alginate and chitin. Ultimate stress values were close to values obtained for calcium alginate fibers, and the absorption capacities measured were consistent with those reported for current wound care dressings. Wound healing studies (rat model, histological evaluation) indicated that chitin-calcium alginate covered wound sites underwent normal wound healing with re-epithelialization and that coverage of the dermal fibrosis with hyperplastic epidermis was consistently complete after only 7 days of treatment. Using a single patch per wound per animal during the entire study, all rat wounds achieved 95-99% closure by day 10 with complete wound closure by day 14.

Tobacco counseling practices of dentists compared to other health care providers in a midwestern region.

Tobacco counseling practices of dentists and other health care professionals in a predominantly rural region in the Upper Midwest were assessed to determine the need for professional education. A survey was mailed to all dentists, physicians, chiropractors, nurse practitioners, physician assistants, and public health nurses in a 16-county region. Half (51.9 percent) of providers returned usable surveys (n = 614). While dentists were more likely than physicians and other health professionals to accurately estimate their patients' tobacco use, they were less consistent than other professions in tobacco assessment and intervention, less supportive of tobacco intervention, less likely to report having strong tobacco cessation skill/knowledge levels, and more likely to perceive barriers to tobacco intervention. Three out of five dentists (61.1 percent) reported desire for further tobacco education. For dentists to effectively counsel patients regarding tobacco use, it is essential to integrate tobacco intervention education into dental school curricula and to offer continuing education regarding tobacco use intervention to practicing dentists. Recent state settlements with tobacco companies could provide funding for such education.

Evolution, growth, and status of managed care in the United States.

While under attack in the United States, managed care/competition is being viewed by a number of European and other countries as a remedy in their struggle to control rising health care costs. While many fundamentals of American managed care have their roots in the British health system, significant differences exist between the two systems. While managed care, which can be loosely defined as any system of delivering health services in which care is delivered by a specified network of providers who agree to comply with the care approaches established through a case management process, has had a 100-year history in the United States, it wasn't until the mid-1970's that it began to gain national recognition. All health maintenance organizations (HMOs) are managed care organizations (MCOs) but not all MCOs are HMOs. The two other categories of MCOs are, preferred provider organizations (PPOs) and point of service plans (POS). Currently, three-quarters of Americans with health insurance are enrolled in managed care plans and there are 160 million Americans enrolled in such plans. A major on-going debate occurring in the United States is in regard to the comparative quality of care provided by MCOs and traditional fee-for-service plans. The study results to date have been equivocal. Another controversial managed care issue is the use of gag clauses in contracts between the MCOs and their providers. These clauses limit providers from being totally open and honest with patients about, for example, alternative treatment possibilities or the details of provider reimbursement. Since the failure of U.S. health care reform in 1994, there has been a more focused turn to the marketplace to provide the impetus for reducing costs. As a result, health care plans and providers have become more like traditional businesses which must focus on the bottom line to survive. In a marketplace where purchasers of care look for low bidders, it should be remembered that the level and quality of care a society receives is usually commensurate with the level of resources that it is willing to expend.

A new paradigm for increasing access to dental care: the Oregon Health Plan.

The Oregon Health Plan, one of the most controversial health care proposals to emerge in recent years, was implemented on February 1, 1994. The plan's intent was to control cost and increase access to health care for Oregon's low-income and Medicaid population. A key feature was limiting covered services to a state-approved list created by an open public process. Services were ranked from most important to least important, with covered services to be determined by available funding. For the first time, the listing included a merged set of medical and dental services, with many dental services ranked higher than medical services. Oregon's Medicaid program, which previously did not cover any adult dental care, now has one of the most generous set of Medicaid dental benefits in the United States. From the perspective of increasing access to dental care, this article suggests that the dental profession should re-examine its current policy supporting the separation of medical and dental benefit packages.

Dental licensure in the European Economic Community: implications for the United States.

The formation of the European Economic Community is resulting in historic changes. By the end of 1992, the European Community is expected to be operating as a single market of more than 320 million consumers, the largest in the world. The fundamental assumption underlying the creation of the European Community is that the best method to increase the general prosperity is a free market. The free market included services as well as goods and required the elimination of restrictions on the movement of people, goods and services among the 12 nations. In dentistry, this has already meant the elimination of licensure restriction for dentists in good standing who are citizens of the EEC and trained in approved educational programs within the EEC, but commercial barriers still remain to be eliminated by the end of 1992. The events occurring in Europe indicate that the outcome of the controversy regarding movement of dentists among states in the United States will be determined by larger societal considerations outside of the profession. The free market principle which underlies the changes in Europe is the fundamental economic philosophy in the United States. To the extent that limitation on the movement of health professionals is seen to contribute to higher costs for health care services in the United States, there may be increased efforts to license by credentials. Similarly, factors such as the need of families for greater freedom of movement between states and court challenges based on constitutionally protected rights may determine the outcome of licensure of dentists rather than issues which are of concern within the professional dental community.

Antifluoridationists persist: the constitutional basis for fluoridation.

The controversy surrounding fluoridation persists. In recent years opponents of fluoridation have resorted to the courts with increasing frequency and have achieved a few victories in the trial courts. To date, however, no appellate court has ruled against fluoridation. This article discusses the constitutional basis for the court decisions upholding fluoridation and the main arguments put forth by the antifluoridationists. Five of the more recent cases are summarized, as is the first fluoridation case to be appealed to the US Supreme Court. The article concludes that the legal validity of fluoridation in the United States has been thoroughly tested in the courts and confirmed. It appears that the antifluoridationists will concentrate their future legal attacks on the "harmful effects" of fluoridation on health and the environment. If they can convince the courts that even a few people were truly harmed, the delicate balance between the rights of the state to fluoridate in order to protect the public's health and the rights of the individual not to be harmed could well shift. In closing, the question is raised whether the US Congress has the power to pass legislation either to mandate or forbid fluoridation.

Dental public health.

The dental profession has prime responsibility for the care of oral health problems in the U.S. Medicine has essentially relinquished responsibility for that part of the body. Dental public health primarily evolved from within the dental profession and it is unique in that a special area in public health was created to address the problems of a particular part of the body. Although one may not think of the major dental diseases--dental caries and periodontal disease--as particularly serious ones, the magnitude of the problem, as evidenced by the universality of the diseases and the extensive levels of untreated pathology, results in a public health problem of major proportions. The field has been expanding in scope and complexity with more emphasis being placed on the total dental care delivery system and its impact on oral health status. The concept of oral health has a very different meaning and value for people in different cultures and socio-economic classes. The prevalent philosophy in the U.S. places the prime responsibility for dental health on the individual.

The effect of the new federalism on education for dental public health.

The interest of this paper was to explore the effects of the "New Federalism" on the future dental public health training. It has indicated that there is a need for an immediate source of funding in order to avoid curtailment of dental public health training programs, and an adverse change in the composition of future students. Further, the national character of public health training was recognized and the federal level of government was looked to anxiously in order to observe what will happen with the training and general purpose monies. Only with a definite and long-term commitment from government, whether it be centrally or regionally located, can dental public health programming flourish once again.

Educational program n dental public health at schools of public health as of fall 1973.

A letter of inquiry from a fictious dentist, requesting applications and information regarding training in dental public health, was sent to each of the 19 accredited Schools of Public Health. The purpose of the survey was to determine the manner in which the schools respond to a letter of inquiry from a dentist and to determine, from the material included in the response, what type of program in dental public health, if any, each school had. All 19 schools responded, but the type and quality of the responses varied greatly. Some schools answered the questions fully and others ignored them. From the bulletins of the schools and other material contained in the responses, seven schools were determined to have what could be termed viable programs in dental public health. Two of the seven programs are administratively independent with full-time faculty as directors of their programs; three of the programs receive their major input in dental public health from an affiliated dental school; one program's input of dental public health is provided by the school of public health; and one program has an affiliation with a dental school, but the major portion of the input for dental public health during the year of preparation for the degree of MPH is provided in the school of public health. There are seven schools of public health with eight full-time faculty who are public health dentists, although only three of the faculty spend a substantial portion of their time in activities related to dental public health. Five schoolshave no public health dentist on the faculty and they have a total of 33 part-time faculty at the rank of assistant professor or higher and a total of 36 part-time faculty with a rank lower than instructor. Twelve of the schools of public health still require only a minimum of an academic year for a dentist to receive the degree of MPH and only one school requires more than a calendar year. Only five schools require field-experience in order for a dentist to receive his degree of MPH. Most schools, it appears, do not provide a program for dentists which meets the standards established by the American Public Health Association or the American Board of Dental Public Health. It is time to question the blanket acceptance by the Council on Dental Education of the American Public Health Association's accreditation of Schools of Public Health for meeting the academic requirements in the specialty of dental public health.