Background Two reports by the U.S. surgeon general noted the disproportionate impact of oral disease on and lack of oral health information regarding people with disabilities. Methods In this retrospective study, the authors used clinical and demographic data (from April 1, 2009, through March 31, 2010) from electronic dental records of 4,732 adults with intellectual and developmental disabilities (IDDs) who were receiving dental care through a state-supported system of dental clinics. The authors used these data to investigate the oral health status of, and associated risk factors for, adults with IDD. Results The prevalence of untreated caries in the study population was 32.2 percent, of periodontitis was 80.3 percent and of edentulism was 10.9 percent. The mean (standard deviation) numbers of decayed teeth; missing teeth; and decayed, missing and filled teeth were 1.0 (2.2), 6.7 (7.0) and 13.9 (7.7), respectively. Conclusions Management of oral health presents significant challenges in adults with IDD. Age, ability to cooperate with dental treatment and type of residence are important considerations in identifying preventive strategies. Clinical Implications The study population demonstrated a high burden of dental disease. Further research is required to identify effective interventions to improve oral health in adults with IDD.
Evidence-based interventions to reduce substance misuse among adolescents are resource and time intensive. We conducted a pilot RCT to evaluate a novel, adaptable, and resource-efficient substance misuse preventive intervention for parents/guardians, focusing on talking with children about substance use and on eating family meals. We randomized 70 parents of children in third-through-sixth grades within a large, urban public school system in New England to the intervention or control condition. Over a six-month follow-up period, we assessed feasibility and acceptability of the intervention and examined frequency of parent-child conversations about alcohol, marijuana, and other drugs, and frequency and duration of family meals. A total of 29 parents were assigned to the intervention and 35 to the control condition. The intervention was found to be feasible and acceptable to participants as evidenced by high recruitment and retention rates and positive feedback from qualitative exit interviews. At three- and six-month follow up, 64.3% and 44.5% of parents in the intervention condition were talking “a lot” to their children about alcohol, compared to 8.7% and 8.7% of the parents in the control condition, respectively (p<0.01 and p=0.03). Patterns in frequency and duration of family meals between the two conditions were not significantly different over time. In conclusion, a higher percentage of parents randomized to the intervention condition spoke with their children about alcohol, marijuana, and other drugs, but the frequency and duration of meals was not impacted. Further testing of the brief intervention with a larger sample to assess efficacy is warranted.
Background Little is known about effective at-home oral care methods for people with developmental disabilities (DDs) who are unable to perform personal preventive practices themselves and rely on caregivers for assistance. Methods A convenience sample of 808 caregivers (84.5 percent paid, 15.5 percent family members) who accompanied adults with DDs (20 years or older) to appointments at a specialized statewide dental care system completed computer-assisted personal interview surveys. The authors used these data to investigate caregivers’ at-home oral care experiences and to explore differences between caregivers who were paid and those who were family members. Results Caregivers reported that a high proportion (85 percent) of dentate adults with DDs received assistance with tooth cleaning. They also reported a high prevalence of dental problems, and low adherence to brushing (79 percent) and flossing (22 percent) recommendations. More caregivers reported that they felt confident assisting with brushing than with flossing (85 percent versus 54 percent). Family members and paid caregivers differed with respect to confidence and training. Conclusions At-home oral care, particularly flossing, presents substantial challenges for adults with DDs. Solutions must be tailored to address the different experiences and distinct needs of the family members and paid caregivers who assist these adults. Practical Implications Caregivers play an important role in providing at-home oral care, and they must be included in efforts to improve oral health outcomes for people with DDs.
Objective: Scalable, efficiently delivered treatments are needed to address the needs of women Veterans with PTSD. This randomized clinical trial compared an online, coach-assisted cognitive behavioral intervention tailored for women Veterans with PTSD to phone monitoring only. Method: Women Veterans who met diagnostic criteria for PTSD were randomized to an 8-week web-based intervention, called DElivery of Self TRaining and Education for Stressful Situations (DESTRESS)-Women Veterans version (WV), or to phone monitoring only (N = 102). DESTRESS-WV consisted of online sessions and 15-min weekly phone calls from a study coach. Phone monitoring included 15-min weekly phone calls from a study coach to offer general support. PTSD symptom severity (PTSD Symptom-Checklist-Version 5 [PCL-5]) was evaluated pre and posttreatment, and at 3 and 6 months posttreatment. Results: More participants completed phone monitoring than DESTRESS-WV (96% vs. 76%, p = 0.01), although treatment satisfaction was significantly greater in the DESTRESS-WV condition. We failed to confirm the superiority of DESTRESS-WV in intent-to-treat slope changes in PTSD symptom severity. Both treatments were associated with significant reductions in PTSD symptom severity over time. However, post hoc analyses of treatment completers and of those with baseline PCL ≥ 33 revealed that the DESTRESS-WV group had greater improvement in PTSD symptom severity relative to phone monitoring with significant differences at the 3-month follow-up assessment. Conclusions: Both DESTRESS-WV and phone monitoring resulted in significant improvements in women Veterans' PTSD symptoms. DESTRESS-WV may be an appropriate care model for women Veterans who can engage in the demands of the treatment and have higher baseline symptoms. Future research should explore characteristics of and the methods of reliably identifying women Veterans who are most likely to benefit. Public Health Significance StatementWomen Veterans have a high prevalence of PTSD, unique barriers to care, and underutilize evidencebased PTSD treatments. Findings support further exploration of both DESTRESS-WV and alternative active comparators as low-cost, feasible strategies to enhance access to PTSD care for women Veterans who are otherwise unable to access traditional mental health care.
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