Objectives: The study objectives were to (1) determine the types and frequency of off-label (OL) or unlicensed (UL) medications used in a pediatric emergency department (PED) and before admission, (2) describe OL/UL-associated adverse drug events (ADEs) resulting in admission to the PED and those occurring during patient care in PED, and (3) determine the outcomes of these ADEs. Methods: Medical records of patients 18 years or younger admitted to the PED over a 5-month period were reviewed. Off-label/UL use of medications was determined based on Food and Drug Administration-approved labeling. The Adverse Drug Reaction Probability Scale was used to determine ADE causality. Data were analyzed using descriptive statistics. Results: A total of 2191 patients with 6675 medication orders were evaluated. About 26.2% (n = 1712) of medication orders were considered as OL/ UL use; 70.5% (n = 1208) of these medications were ordered as part of treatment in the PED, and the remaining 29.5% (n = 504) were home medications before their PED evaluation. Inhaled bronchodilators (30.4%), antimicrobials (14.8%), and antihistamines/antiemetics (9.1%) were the most common OL/UL medication classes. The frequency of ADEs among licensed medication use was greater compared with OL/UL use by 2-fold. Reported overall rate of ADEs was 0.6% (n = 40). Of these 40 ADEs, 5 resulted from the use of an OL/UL medication, 3 from home medication use, and 2 from PED-prescribed medications. Conclusions: The frequency of reported ADEs associated with OL/UL medications was less than the frequency of ADEs from licensed medication use, with overall ADE frequency of less than 1%.

To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p<.0001). ACEs’ exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.

OBJECTIVE: To examine association between Adverse Childhood Experiences (ACE) and teeth extracted due to dental caries or periodontitis among young and middle-aged US adults. METHODS: Study sample included 15,474 and 17,430 respondents aged 18-64 completing 2010 and 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey respectively. Outcome was any self-reported tooth extraction due to caries or periodontitis. Primary predictor were self-reported 11 ACE answers (categorized into none, 1, 2, and 3+) before 18 years of age. Covariates included smoking, heavy alcohol consumption, diabetes, health coverage and access to dental care. Odds ratios were computed from unadjusted and adjusted logistic regression models. RESULTS: Overall ACE prevalence was 66.5% and 64.9% in BRFSS 2010 and 2012 study sample respectively. In unadjusted models we observed a graded association wherein adults reporting experienced 2 and 3+ ACE were more likely to experience tooth extractions compared to those reporting no ACE exposure. (BRFSS 2010 OR = 1.47,1.48; BRFSS 2012 OR = 1.33, 1.54 respectively; p<0.05). We found similar results in multivariate models after adjusting for covariates (BRFSS 2010 OR = 1.56,1.34; BRFSS 2012 OR = 1.36, 1.42 respectively; p<0.05). CONCLUSIONS: This study suggests potential long lasting impact of early adverse life events on oral health in young and middle adulthood. Young and middle-aged adults experiencing multiple ACE had significantly more extractions compared to adults who reported not experiencing any ACE. Multidisciplinary efforts between dentists, physicians and social therapists are needed to raise awareness about ACE as means of identifying and reducing dental health inequities. / 2020-06-13T00:00:00Z

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Regenerative endodontic therapy in immature teeth with necrotic pulps triggers continued root development thereby improving the prognosis of these teeth. Several agents are under consideration for the disinfection and conditioning phases of this therapy. Triple antibiotic paste (TAP, i.e. equal parts of ciprofloxacin, metronidazole, minocycline) is used for canal disinfection and 17% EDTA solution is used for dentin conditioning. However, TAP and EDTA cause demineralization and their effect on surface loss and surface roughness of radicular dentin during regenerative procedures has not been quantified. Surface loss may be correlated with reduced tooth strength and surface roughness may be correlated with stem cell attachment. Objectives: The aim of this in vitro study was to quantitatively investigate the surface loss and surface roughness on human radicular dentin after treatment with two concentrations of TAP followed by EDTA. Materials and Methods: Human radicular dentin specimens were prepared from extracted human anterior teeth and randomized into six experimental groups. Group 1: saline control; Group 2: 17% EDTA; Group 3: TAP 1 mg/mL; Group 4: TAP 1 mg/mL and 17% EDTA; Group 5: TAP 1,000 mg/mL; Group 6: TAP 1,000 mg/mL and 17% EDTA for 5 minutes. After TAP is applied to Groups 3-6, all groups were incubated for 4 weeks. Then, groups 2, 4, and 6 were treated with EDTA for 5 minutes. Dentin surface loss (μm) and surface roughness (Ra, μm) were quantified after various treatments using non-contact and contact profilometry, respectively. Data were analyzed by one-way analysis of variance (α = 0.05) Hypothesis: It was hypothesized that there would be a significant difference in surface loss or surface roughness between at least two treatment groups. Results: All treatment groups showed significantly higher surface loss compared to untreated control. Dentin treated with 1g/mL TAP caused significant increase in surface loss and surface roughness compared to dentin treated with 1 mg/mL TAP. However, only 1g/mL TAP treated dentin showed significantly higher surface roughness compared to untreated control. The use of EDTA after both concentrations of TAP did not have significant additive effect on surface loss and surface roughness of dentin. Conclusion: The use of 1 mg/mL TAP can minimize surface loss and surface roughness of radicular dentin compared to higher concentrations. The use of EDTA after TAP may not cause additional surface loss and surface roughness of dentin.

No description available.

Alcohol is a major public health problem globally. According to the World Health Organization (WHO) report, alcohol accounts for 2.5 million deaths (4% of total) and 69.4 million (4.5% of total) of Disability-Adjusted Life Years (DALYs), (WHO, 2002, 2011). In South Africa, alcohol was found to be the third highest contributor to death and disability (Parry, 2007/8). Among the many far-reaching consequences of alcohol use in South Africa, Fetal Alcohol Syndrome (FAS) in certain regions in the country, rates among the highest in the world (May et al., 2007). Despite higher comparative levels of FAS in rural areas, almost one third of the population in urban sites (Gauteng) demonstrates that FAS is not exclusively a problem of South African rural areas. This study hypothesized that higher knowledge levels about the effects of alcohol on pregnancy may deter use among women. Employing secondary data analysis from a 2006 cross-sectional household survey, this study explored the prevalence of alcohol use among urban women (18-44 years) in the Tshwane Municipality, in general and in pregnancy. It also examined the relationship between knowledge of alcohol effects on pregnancy and alcohol use. A significant association was found between employment status, pregnancy outcome and general alcohol use among women. An almost significant association was found between knowledge of alcohol effects on pregnancy and past month alcohol use, knowledge levels and alcohol use during pregnancy. Findings partially support the hypothesis. However, knowledge of alcohol effects on pregnancy alone cannot deter women from using alcohol. Multiple influencing factors should be considered in planning prevention programmes for urban women’s alcohol use. Further research with larger sample sizes of pregnant women is suggested to explore the associations conclusively.

No description available.

Adverse childhood experiences (ACEs) are traumatic and stressful events during a person’s early life that can influence their later mental health, physical health, and wellbeing. Internalizing symptoms such as anxiety and depression are common mental health outcomes associated with ACEs. Two factors, religiosity/spirituality (R/S) and mindfulness, are possible protective factors that may help lessen the effects of ACEs on later mental health. This study hopes to examine whether R/S and mindfulness are protective factors in the relationship between ACEs from childhood and internalizing symptoms in adulthood. Further, this study examines whether the protective impact of R/S is further strengthened by an individual’s mindfulness (moderated moderation). Participants (N = 769, age M = 20.43, SD = 4.51) for this study were recruited through the SONA research platform at East Tennessee State University as a part of the REACH (Religion, Emotions, and Current Health) self-report survey. We used a retrospective measure, the Adverse Childhood Experiences (ACE) questionnaire, to assess childhood adversity. We used the Brief Multidimensional Measure of Religiosity and Spirituality (BMMRS) to assess current religiosity/spirituality of participants and the Five Facet Mindfulness Questionnaire (FFMQ) to assess current overall mindfulness of participants. To examine internalizing symptoms of the sample, we used the Generalized Anxiety Disorder-7 (GAD-7) questionnaire to assess anxiety symptoms, and the Center for Epidemiologic Studies Depression Scale Revised (CESD-R-20) to assess depression symptoms. The analyses for this project were conducted using the Statistical Package for the Social Sciences (SPSS). Bivariate analyses for this project will be conducted using Pearson’s correlations and the moderated moderation model will be tested using the Hayes Process Macro (version 3.0, Model 3). We predict that ACEs will be related to internalizing symptoms as is commonly demonstrated in the literature, such that more ACES are associated with more symptoms of anxiety and depression. Further, we expect that both R/S and mindfulness will weaken (i.e. moderate) this relationship. Additionally, we propose that mindfulness will impact the moderating (protective) effect of R/S on this relationship, such that the protective effect of R/S is greatest for those with high levels of mindfulness.

Children naturally seek support and comfort from birth on, especially when faced with negative life events. Support that comes from the primary care givers is necessary and useful but is not always available or the only considerably influential support the child receives. Other places support could come from include peers, school resources or religious resources and beyond. Religion and the support received from faith-based groups has been used in many ways to aid in coping with experienced trauma and times of adversity. Observing the perceived religious support that children feel they have allows for the support systems in a child’s life to understand the potentially useful practices in the resilience of adverse experiences faced by youth. Focusing on the relationship between how much religious support is perceived and the number of adverse childhood experiences (ACE) scores could lead to further research endeavors on religiosity’s role in coping with trauma and adversity. It is hypothesized that the more religious socialization support perceived by participants as children, the fewer ACE scores will be reported. Data collected from the REACH (Religion, Emotions, and Current Health) survey style study of the ARCH (Affect, Regulation, Coping and Health) research lab will be used. The college aged participant’s (N = 766) responses on reflective views of support perceived during youth in faith communities using the ARCH lab adapted version Faith Activities in the Home scale (FAITHS; Lambert & Dollahite, 2010) and number of ACEs will be analyzed. The proposed analysis to be conducted is a Pearson’s r correlation using SPSS. It is expected that there will be a negative correlation where the more religious support that is perceived during childhood, the fewer ACEs will be reported. Previous research has not directly observed the relationship of retrospective religious support and ACEs, so this study could direct to new investigations of coping through religious support for children. If the results are not statistically significant, past perceived religious support may not affect ACEs directly, and would lead to other ways of investigating the relationship of coping through religious means during adverse experiences.

Fostering a Trauma Informed Mindset in the Criminal Justice System Lauren Ledford, Mary Jo Oliver M.S., Meredith Jordan, Chloe Salyer, Adam Walker, Andrea D. Clements Ph.D. The presence of early childhood adversity and trauma is disproportionately high in individuals involved with the criminal justice system compared to the non-criminally involved population. Childhood adversity and trauma is consistently linked to many adverse lifelong outcomes such as increased mortality, increased risk of mental illness, and increased risk of substance use disorder. In order to respond to this increased risk, empathy and community-wide interventions have emerged as effective means of responding and resisting re-traumatization. Community and empathy-based training of law enforcement officials may assist in understanding trauma and combatting its effects as they are often some of the first people to come in contact with individuals experiencing the effects of childhood adversity and trauma. This study sought to evaluate the effectiveness of Trauma-Informed Care (TIC) training for police officers in their ability to have knowledge of, believe to be relevant, understand, feel confident implementing, and apply TIC principles. We hypothesized knowledge, relevance, understanding, implementation confidence, and application of TIC would all increase from pre-assessment to post-assessment. As part of an initiative to increase TIC awareness and implementation, 64 police officers participated in a one-day training that began with a pre-survey and ended with a post-survey. Both surveys contained measures concerning TIC knowledge, relevance, understanding, implementation confidence, and application. The post survey also included an additional measure regarding training quality satisfaction. The sample consisted primarily of White (N = 44), middle-aged males (M = 42.27, SD = 8.588). There was a significant difference between TIC knowledge t(56) = -4.593, p<.001, d = 1.096, TIC relevance t(56) = -2.488, p = .016, d = .912, TIC understanding t(56) = -8.611, p <.001, d = 2.932, and implementation confidence t(56)= -5.942, p <.001, d = 1.326 from the pre to post assessment. However, there was not a significant difference between TIC application t(56) = -1.826, p = .073, d = .585 from pre to post assessment. The consistently significant increase in TIC scores indicate that a TIC training is an effective means of improving officer perception of trauma and willingness to implement TIC practices.