Kooperation von Kieferorthopädie, Kieferchirurgie und Prothetik bei der umfassenden Rehabilitation von DysgnathiepatientInnen. Teil 2: Fallbeispiel Klasse-II-Malokklusion, Tiefbiss, Hypodontie.

Dental aplasia of heterogenous etiology may cause jaw growth disturbance, malocclusion, esthetic discontent and psychosocial impairment. By a case report of a young patient suffering from hypodontia, class II malocclusion and a deep bite the intricate interdisciplinary diagnosis- and treatment-protocol targeting the functional and esthetic rehabilitation is illustrated.

Kooperation von Kieferorthopädie, Kieferchirurgie und Prothetik bei der umfassenden Rehabilitation von DysgnathiepatientInnen. Teil 1: Fallbeispiel Klasse-III-Malokklusion, Unterkiefer-Schaltlücken.

In a case report the stomatognathic rehabilitation of a patient with class III malocclusion and mandibular bilateral interdental gaps from the diagnosis and treatment planning through to the stepwise realization of the orthodontic, surgical and prosthetic treatment is presented. Explicit information about the proposed treatment, risks and the prospective outcome beforehand ensured the patient’s compliance during the extensive procedure.

Rural populations and early periodic screening, diagnosis, and treatment services: challenges and opportunities for local public health departments.

OBJECTIVES: We examined geographic differences in Early Periodic Screening, Diagnosis, and Treatment (EPSDT) visits as the South Carolina Department of Health and Environmental Control (SCDHEC) transitioned from direct service provision (DSP) to assuring delivery within the larger health care system. METHODS: We examined infant cohorts with continuous Medicaid coverage and normal birth weights from 1995 to 2010. Outcome variables included any EPSDT visit and the ratio of observed to expected visits. Change in SCDHEC market share over time by residence was the primary variable of interest. We used growth curve models to examine changes in EPSDT visits by rural areas and levels of DSP over time. RESULTS: A small proportion of the study population (10%) resided in rural counties that were more dependent on SCDHEC for DSP. The trajectory of not having visits among counties with high DSPs was steeper in rural areas (0.208; P = .001) compared with urban areas (0.145; P = .002). In counties with high DSPs, the slope of the predicted ratio in rural areas (-0.033; P < .001) was steeper than that of urban areas (-0.013; P < .001). CONCLUSIONS: Health departments operations continue to transition from DSP, which might decrease access to well-child care in rural communities. Health care reform provides opportunities for health departments to work with community partners to facilitate DSP from public to private sectors.

Association between clinical decision support system use and rural quality disparities in the treatment of pneumonia.

PURPOSE: To determine whether there is an association between clinical decision support system (CDSS) use and quality disparities in pneumonia process indicators between rural and urban hospitals. METHODS: Data were used from the FY 2009 American Hospital Association electronic health record (EHR) adoption survey (3,616 responding hospitals) to identify hospitals that used CDSS for clinical guidelines and reminders. This was linked to the 2009 Hospital Compare data set from the Centers for Medicare and Medicaid Services (3,805 reporting hospitals). The merged data set contained 2,405 hospitals: 1,330 were noncritical in metropolitan ZIP Code Tabulation Areas (ZCTAs), 692 were noncritical in rural ZCTAs, and there were 383 critical access hospitals (CAHs; 359 in rural ZCTAs, 24 in urban ZCTAs). The dependent variable was a pneumonia composite quality score, composed of 6 pneumonia process indicators calculated for each hospital. Adjusted analysis controlled for a hospital's propensity to use CDSS. FINDINGS: While quality was lower in rural institutions, unadjusted pneumonia quality scores varied modestly, from 90.08% in CAHs to 93.38% in urban hospitals. Hospitals that used CDSS had higher unadjusted pneumonia process composite scores than their non-CDSS counterparts. After controlling for CDSS use, the propensity for CDSS use, and hospital and community characteristics, hospitals in rural ZCTAs did not have significantly different process composite scores than their metropolitan counterparts. CONCLUSIONS: CDSS was positively associated with quality of care for pneumonia. Adoption of EHRs with CDSS functionality in rural hospitals may serve to reduce quality gaps. Costs of EHR implementation may be a barrier to this process.

Edentulism in high poverty rural counties.

PURPOSE: To examine the differences in oral health status among residents of high-poverty counties, as compared to residents of other rural or urban counties, specifically on the prevalence of edentulism. METHODS: We used the 2005 Behavioral Risk Factor Surveillance System (BRFSS) and the 2006 Area Resource File (ARF). All analyses were conducted with SAS and SAS-callable SUDAAN, in order to account for weighting and the complex sample design. FINDINGS: Characteristics significantly related to edentulism include: geographic location, gender, race, age, health status, employment, insurance, not having a usual source of care, education, marital status, presence of chronic disease, having an English interview, not deferring care due to cost, income, and dentist saturation within the county. CONCLUSIONS: Significant associations between high-poverty rural and other rural counties and edentulism were found, and other socioeconomic and health status indicators remain strong predictors of edentulism.

Long-term impact of environmental public health disaster on health system performance: experiences from the Graniteville, South Carolina chlorine spill.

OBJECTIVES: In the aftermath of an environmental public health disaster (EPHD) a healthcare system may be the least equipped entity to respond. Preventable visits for ambulatory care-sensitive conditions (ACSCs) may be used as a population-based indicator to monitor health system access postdisaster. The objective of this study was to examine whether ACSC rates among vulnerable subpopulations are sensitive to the impact of a disaster. METHODS: We conducted a retrospective analysis on the 2005 chlorine spill in Graniteville, South Carolina using a Medicaid claims database. Poisson regression was used to calculate change in monthly ACSC visits at the disaster site in the postdisaster period compared with the predisaster period after adjusting for parallel changes in a control group. RESULTS: The adjusted rate of a predisaster ACSC hospital visit for the direct group was 1.68 times the rate for the control group (95% confidence interval [CI] 1.47-1.93), whereas the adjusted ACSC hospital rate postdisaster for the direct group was 3.10 times the rate for the control group (95% CI 1.97-5.18). For ED ACSC visits, the adjusted rate among those directly affected predisaster were 1.82 times the rate for the control group (95% CI 1.61-2.08), whereas the adjusted ACSC rate postdisaster was 2.81 times the rate for the control group (95% CI 1.92-5.17). CONCLUSIONS: Results revealed that an increased demand on the health system altered health services delivery for vulnerable populations directly affected by a disaster. Preventable visits for ACSCs may advance public health practice by identifying healthcare disparities during disaster recovery.

Secondary surge capacity: a framework for understanding long-term access to primary care for medically vulnerable populations in disaster recovery.

Disasters create a secondary surge in casualties because of the sudden increased need for long-term health care. Surging demands for medical care after a disaster place excess strain on an overtaxed health care system operating at maximum or reduced capacity. We have applied a health services use model to identify areas of vulnerability that perpetuate health disparities for at-risk populations seeking care after a disaster. We have proposed a framework to understand the role of the medical system in modifying the health impact of the secondary surge on vulnerable populations. Baseline assessment of existing needs and the anticipation of ballooning chronic health care needs following the acute response for at-risk populations are overlooked vulnerability gaps in national surge capacity plans.

The impact of disasters on populations with health and health care disparities.

CONTEXT: A disaster is indiscriminate in whom it affects. Limited research has shown that the poor and medically underserved, especially in rural areas, bear an inequitable amount of the burden. OBJECTIVE: To review the literature on the combined effects of a disaster and living in an area with existing health or health care disparities on a community's health, access to health resources, and quality of life. METHODS: We performed a systematic literature review using the following search terms: disaster, health disparities, health care disparities, medically underserved, and rural. Our inclusion criteria were peer-reviewed, US studies that discussed the delayed or persistent health effects of disasters in medically underserved areas. RESULTS: There has been extensive research published on disasters, health disparities, health care disparities, and medically underserved populations individually, but not collectively. CONCLUSIONS: The current literature does not capture the strain of health and health care disparities before and after a disaster in medically underserved communities. Future disaster studies and policies should account for differences in health profiles and access to care before and after a disaster.