Carl A. Maida

Treatment Compliance in End-Stage Renal Disease Patients on Dialysis

This paper reviews the current knowledge concerning treatment compliance in patients with end-stage renal disease (ESRD). Adult hemodialysis patient noncompliance with the treatment regimen is very common. Objective and subjective measures of compliance, however, are often weakly correlated. In addition, the patients may be compliant with some aspects of the treatment regimen, but noncompliant with others. Unfortunately, no current model of predicting the degree of hemodialysis patient compliance is very accurate. In spite of this, behavioral approaches to increase regimen compliance do have at least short-term efficacy. There is a paucity of published data on compliance in adult peritoneal dialysis patients and an almost complete absence of systematic studies of compliance in children and adolescent dialysis patients. A multidimensional nosology of compliance behavior in ESRD patients is, therefore, proposed, as well as an approach to the diagnosis of noncompliance in ESRD patients and to possible interventions.

Calibration of self-reported oral health to clinically determined standards.

OBJECTIVE Self-report of oral health is an inexpensive approach to assessing an individuals oral health status, but it is heavily influenced by personal views and usually differs from that of clinically determined oral health status. To assist researchers and clinicians in estimating oral health self-report, we summarize clinically determined oral health measures that can objectively measure oral health and evaluate the discrepancies between self-reported and clinically determined oral health status. We test hypotheses of trends across covariates, thereby creating optimal calibration models and tools that can adjust self-reported oral health to clinically determined standards. METHODS Using National Health and Nutrition Examination Survey (NHANES) data, we examined the discrepancy between self-reported and clinically determined oral health. We evaluated the relationship between the degree of this discrepancy and possible factors contributing to this discrepancy, such as patient characteristics and general health condition. We used a regression approach to develop calibration models for self-reported oral health. RESULTS The relationship between self-reported and clinically determined oral health is complex. Generally, there is a discrepancy between the two that can best be calibrated by a model that includes general health condition, number of times a person has received health care, gender, age, education, and income. CONCLUSION The model we developed can be used to calibrate and adjust self-reported oral health status to that of clinically determined standards and for oral health screening of large populations in federal, state, and local programs, enabling great savings in resources used in dental care.

Ebola: translational science considerations

We are currently in the midst of the most aggressive and fulminating outbreak of Ebola-related disease, commonly referred to as “Ebola”, ever recorded. In less than a year, the Ebola virus (EBOV, Zaire ebolavirus species) has infected over 10,000 people, indiscriminately of gender or age, with a fatality rate of about 50%. Whereas at its onset this Ebola outbreak was limited to three countries in West Africa (Guinea, where it was first reported in late March 2014, Liberia, where it has been most rampant in its capital city, Monrovia and other metropolitan cities, and Sierra Leone), cases were later reported in Nigeria, Mali and Senegal, as well as in Western Europe (i.e., Madrid, Spain) and the US (i.e., Dallas, Texas; New York City) by late October 2014. World and US health agencies declared that the current Ebola virus disease (EVD) outbreak has a strong likelihood of growing exponentially across the world before an effective vaccine, treatment or cure can be developed, tested, validated and distributed widely. In the meantime, the spread of the disease may rapidly evolve from an epidemics to a full-blown pandemic. The scientific and healthcare communities actively research and define an emerging kaleidoscope of knowledge about critical translational research parameters, including the virology of EBOV, the molecular biomarkers of the pathological manifestations of EVD, putative central nervous system involvement in EVD, and the cellular immune surveillance to EBOV, patient-centered anthropological and societal parameters of EVD, as well as translational effectiveness about novel putative patient-targeted vaccine and pharmaceutical interventions, which hold strong promise, if not hope, to curb this and future Ebola outbreaks. This work reviews and discusses the principal known facts about EBOV and EVD, and certain among the most interesting ongoing or future avenues of research in the field, including vaccination programs for the wild animal vectors of the virus and the disease from global translational science perspective.

A Longitudinal Analysis of Unmet Need for Oral Treatment in a National Sample of Medical HIV Patients

This longitudinal study examines perceived unmet dental need in a nationally representative probability sample of HIV-infected persons in medical care. A logistic regression analysis modeled the relationship between unmet need and explanatory variables. We estimate that 40% of HIV/AIDS patients report an unmet need associated with being male, being unemployed, injecting drugs, being heterosexual, lacking dental insurance, and having less education. Disparities in unmet need are related to socioeconomic status rather than to disease stage or ethnicity.

Treating Multitraumatized, Socially Marginalized Children: Results of a Naturalistic Treatment Outcome Study

Although early-onset, repeated trauma is relatively common in socially marginalized populations and related to numerous negative outcomes, most empirically validated interventions are not especially well tailored to meet the complex and individualized needs of child and adolescent trauma survivors in such contexts. Integrative treatment of complex trauma (ITCT) was developed as a specialized treatment that is empirically informed, culturally sensitive, extendable beyond the short term, and customized to the specific social and psychological issues of each child. This article examines the potential effectiveness of ITCT in assisting 151 traumatized children living in an economically deprived environment. Results indicate significant reductions in anxiety, depression, posttraumatic stress, anger, dissociation, and sexual concerns as a function of time in treatment.

Oral health status and the epidemiologic paradox within latino immigrant groups

BackgroundAccording to the United States census, there are 28 categories that define “Hispanic/Latinos.” This paper compares differences in oral health status between Mexican immigrants and other Latino immigrant groups.MethodsDerived from a community-based sample (N=240) in Los Angeles, this cross-sectional study uses an interview covering demographic and behavioral measures, and an intraoral examination using NIDCR epidemiologic criteria. Descriptive, bivariate analysis, and multiple regression analysis were conducted to examine the determinants that are associated with the Oral Health Status Index (OHSI).ResultsMexican immigrants had a significantly higher OHSI (p<.05) compared to other Latinos. The multilinear regression showed that both age and gender (p<.05), percentage of untreated decayed teeth (p<.001), number of replaced missing teeth (p<.001), and attachment loss (p<.001) were significant.ConclusionsCompared with the other Latino immigrants in our sample, Mexican immigrants have significantly better oral health status. This confirms the epidemiologic paradox previously found in comparisons of Mexicans with whites and African Americans. In this case of oral health status the paradox also occurs between Mexicans and other Latinos. Therefore, when conducting oral health studies of Latinos, more consideration needs to be given to differences within Latino subgroups, such as their country of origin and their unique ethnic and cultural characteristics.

Project-Based Learning: a critical pedagogy for the twenty-first century

John Deweys notion of the school as a ‘social laboratory’ influenced educational policy a century ago when the United States underwent a ‘great transformation’ in its educational history toward mass schooling, resulting partly from the ‘high school movement’, where the focus was on ‘schooling for life’. Project-based learning, which builds on Deweys work on experiential, hands-on, student-directed learning, is ultimately delivered within a student-teacher relationship, and the structure of this relationship and that of the school itself were shaped by an industrial culture that developed during a period of rapid industrialization when the dual revolutions of technology and information processing were transforming the country. During the earlier transition from craft to mass production, schools provided a social context for the task of renegotiating and refraining occupational techniques and world orientations in light of dramatic technological changes. So, too, have the challenges of the current technological revolution shifted the emphasis of education toward students actively using what they know to explore, negotiate, interpret, and create. As a potentially ‘disruptive innovation’ to the traditional schooling model, project-based learning challenges students by acknowledging their roles as participants engaged in producing knowledge. Students also perceive the value of project-based learning, experience this form of learning, and are rewarded through the responses of others to their projects within a community of practice.

Viral immune evasion in dengue: toward evidence-based revisions of clinical practice guidelines.

Dengue, a leading cause of illness and death in the tropics and subtropics since the 1950׳s, is fast spreading in the Western hemisphere. Over 30% of the world׳s population is at risk for the mosquitoes that transmit any one of four related Dengue viruses (DENV). Infection induces lifetime protection to a particular serotype, but successive exposure to a different DENV increases the likelihood of severe form of dengue fever (DF), dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS). Prompt supportive treatment lowers the risk of developing the severe spectrum of Dengue-associated physiopathology. Vaccines are not available, and the most effective protective measure is to prevent mosquito bites. Here, we discuss selected aspects of the syndemic nature of Dengue, including its potential for pathologies of the central nervous system (CNS). We examine the fundamental mechanisms of cell-mediated and humoral immunity to viral infection in general, and the specific implications of these processes in the regulatory control of DENV infection, including DENV evasion from immune surveillance. In line with the emerging model of translational science in health care, which integrates translational research (viz., going from the patient to the bench and back to the patient) and translational effectiveness (viz., integrating and utilizing the best available evidence in clinical settings), we examine novel and timely evidence-based revisions of clinical practice guidelines critical in optimizing the management of DENV infection and Dengue pathologies. We examine the role of tele-medicine and stakeholder engagement in the contemporary model of patient centered, effectiveness-focused and evidence-based health care. Abbreviations BBB - blood-brain barrier, CNS - central nervous system, DAMP - damage-associated molecular patterns, DENV - dengue virus, DF - dengue fever, DHF - dengue hemorrhagic fever, DSS - dengue shock syndrome, DALYs - isability adjusted life years, IFN-g - interferon-gamma, ILX - interleukinX, JAK/STAT - janus kinase (JAK) / Signal transducer and activator of transcription (STAT), LT - Escherichia coli heat-labile enterotoxin formulations deficient in GM1 binding by mutation (LT[G33D]), MCP-1 - monocyte chemotactic protein 1, M-CSF - macrophage colony-stimulating fact, MHC - major histocompatibility complex, MIF - macrophage migration inhibitory factor, [MIP-1]-α / -β - macrophage inflammatory protein-1 alpha and beta, mAb - monoclonal antibody, NS1 - non-structural protein 1 of dengue virus, NK - natural killer cells, PAMP - pathogen-associated molecular patterns, PBMC - peripheral blood mononuclear cells, TBF-b - transforming growth factor-beta, TNF-α - tumor necrosis-alpha, VHFs - virus hemorrhagic fevers, WHO - World Health Organization.

Enhancing national capacity to conduct child and family disaster mental health research

ABSTRACT A substantial number of children and families experience emotional difficulties in the aftermath of disasters and terrorist events. Only recently has training in disaster preparedness and response been systematically incorporated into the curricula of mental health disciplines. The goal of the Child & Family Disaster Research Training & Education Program is to enhance the nations capacity and infrastructure needed to conduct rigorous disaster mental health research on children and families. This article describes the creation and training of 10 specialized research teams, curriculum development, implementation of the program, and progress to date as well as lessons learned and challenges to sustainability.

Social-Network Considerations in the Alcohol Field

This chapter reviews the literature on social networks in the alcohol field. The review focuses on the dynamics of the social-network system and network analysis. Stressors to recently urbanized persons are also examined in a discussion of social adaptation, social identity, and networks. The findings of several studies that are summarized indicate that there is a crisis in changing cultural styles and social values that develops after migration and resettlement. An aspect of this review suggests that social networks may be utilized as stress-buffering strategies in both a constructive and a destructive fashion during these periods of crisis. The author describes these networks as pathways to care and illustrates how they might play a significant role in alcoholism-treatment and recovery programs. Finally, the author concludes with some possible directions for future research on the systematic study of social bonds.