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Our objective was to compare patterns of dental antibiotic prescribing in Australia, England, and North America (United States and British Columbia, Canada).
Population-level analysis of antibiotic prescription.
Outpatient prescribing by dentists in 2017.
Patients receiving an antibiotic dispensed by an outpatient pharmacy.
Prescription-based rates adjusted by population were compared overall and by antibiotic class. Contingency tables assessed differences in the proportion of antibiotic class by country.
In 2017, dentists in the United States had the highest antibiotic prescribing rate per 1,000 population and Australia had the lowest rate. The penicillin class, particularly amoxicillin, was the most frequently prescribed for all countries. The second most common agents prescribed were clindamycin in the United States and British Columbia (Canada) and metronidazole in Australia and England. Broad-spectrum agents, amoxicillin-clavulanic acid, and azithromycin were the highest in Australia and the United States, respectively.
Extreme differences exist in antibiotics prescribed by dentists in Australia, England, the United States, and British Columbia. The United States had twice the antibiotic prescription rate of Australia and the most frequently prescribed antibiotic in the US was clindamycin. Significant opportunities exist for the global dental community to update their prescribing behavior relating to second-line agents for penicillin allergic patients and to contribute to international efforts addressing antibiotic resistance. Patient safety improvements will result from optimizing dental antibiotic prescribing, especially for antibiotics associated with resistance (broad-spectrum agents) or C. difficile (clindamycin). Dental antibiotic stewardship programs are urgently needed worldwide.
Child and adolescent mental health is understood to be highly embedded in the family system, particularly the parent-child relationship. Indeed, models of risk pathways to psychopathology emphasize interactions and transactions between the family environment and individual differences at the child level, including gene-environment interplay. Therapist knowledge regarding the role of the family in these pathways is central to the clinical competencies involved in the evidence-based treatment of children and adolescents. This chapter provides an overview of current theory regarding family contributions to the major forms psychopathology seen among children and adolescents. Attention is given to key family and parenting variables as they are conceptualized in the current literature, the mechanisms by which these variables contribute to the emergence and maintenance of psychopathology and the origins and determinants of parenting.
The training of mental health practitioners has seen a growing focus on core competencies in recent years in response to the need for guidance in the implementation of evidence-based treatment of mental disorders. This chapter outlines the aims and advantages of a competency-based approach and describes existing models of competencies in the treatment of adults, children and adolescents. For the most part, existing models have focused on cognitive behavioural therapy (CBT) to the exclusion of other evidence-based approaches and on individual therapy at the expense of treatment in which family members are actively involved. We present a novel model of the therapist competencies needed for the effective delivery of evidence-based family interventions for common child and adolescent mental health disorders. The proposed framework provides a potential foundation for curricula planning and assessment in practitioner training and stands to inform evidence-based practice guidelines and future research into professional development.
ABSTRACT IMPACT: This research shows that physical intimate partner violence was associated with never testing for HIV while verbal intimate partner violence was associated with increased testing for HIV suggesting that HIV testing interventions should consider intimate partner violence prevention. OBJECTIVES/GOALS: HIV incidence is higher among women who experience intimate partner violence (IPV). However, few studies have assessed the association between HIV testing (regardless of the result) and the experience of IPV. Our objective was to assess the relationship between IPV and HIV testing among women from rural southwestern Uganda. METHODS/STUDY POPULATION: We conducted a whole-population, cross-sectional study including women ?18 years of age who
were permanent residents in 8 villages of Rwampara District, southwestern Uganda from 2011-2012 who reported having a primary partner in the past 12 months. We surveyed participants to assess their exposure to 12 different forms of verbal, physical, and/or sexual IPV, and whether they had ever been tested for HIV. We used three separate modified Poisson regression models, clustering by village, to estimate the association between each type of IPV and ever testing for HIV, adjusting for categorical age, completion of more than primary education, and any food insecurity measured by the nine-item Household Food Insecurity Access Scale. RESULTS/ANTICIPATED RESULTS: Among 496 women with a primary partner (>95% response rate), 64 (13%) had never tested for HIV, 297 (60%) reported verbal IPV, 81 (16%) reported physical IPV, and 131 (26%) reported sexual IPV. Further, among these women, 208 (42%) were aged <30 years, 378 (76%) had a primary or no education, and 390 (79%) experienced food insecurity. Never having been tested for HIV was positively associated with physical IPV (adjusted risk ratio (ARR): 1.61, 95% confidence interval (CI): 1.02-2.56) and negatively associated with verbal IPV (ARR: 0.67, 95% CI: 0.44-0.99), but not sexual IPV (ARR: 1.05, 95% CI: 0.51-2.12). DISCUSSION/SIGNIFICANCE OF FINDINGS: Among this population of adult women with partners in Uganda, physical IPV was associated with never testing for HIV while verbal IPV was associated with increased testing for HIV. Evidence suggests that HIV testing interventions should consider IPV prevention, and future studies should focus on why certain IPV types impact HIV testing rates.
The most effective treatments for child and adolescent psychopathology are often family-based, emphasising the active involvement of family members beyond the referred individual. This book details the clinical skills, knowledge, and attitudes that form the core competencies for the delivery of evidence-based family interventions for a range of mental health problems. Offering practical case studies to illustrate treatment principles, and discussing barriers to treatment and problem-solving in relation to common difficulties. Covers topics such as anxiety, attention-deficit hyperactivity disorder, sleep, and eating disorders. Therapist competencies are thoroughly examined, from the role they play in severe/complex cases and in achieving successful outcomes to commonly misunderstood aspects of family-based interventions and how they can be enhanced. Clinical approaches to working with diverse families, and those of children affected by parental psychopathology, child maltreatment and family violence are also explored. Essential reading for psychologists, psychiatrists, paediatricians, mental health nurses, counsellors and social workers.
The purpose of this exploratory study was to examine the attitude towards food prescriptions (FRx) interventions among clinicians and identify potential barriers to their use in clinical practice.
The current study employed an exploratory research design using in-depth semi-structured interviews. Research participants were selected from primary care facilities, family practice offices and obesity clinics located in Mississippi and Louisiana.
Providers selected for participation in the current study serve predominantly rural, low-income communities in the US South.
From an original population of fifty healthcare providers that included physicians, registered dieticians and nurse practitioners, from Oxford, Tupelo, Batesville, Jackson, and Charleston, MS and New Orleans, LA. Fifteen healthcare providers agreed to participate, including three physicians, four registered dieticians, three nurses and three nurse practitioners.
The current study found that while healthcare providers expressed a desire to use FRx interventions, there was a universal lack of understanding by healthcare providers of what FRx interventions were, how they were implemented and what outcomes they were likely to influence.
The current study identified key bottlenecks in the use of FRx interventions at the clinic level and data provided evidence for two key recommendations: (1) development and validation of a screening tool to be used by clinicians for enrolling patients in such interventions and (2) implementation of nutrition education in primary professional training, as well as in continuing education.
The Fontan Outcomes Network was created to improve outcomes for children and adults with single ventricle CHD living with Fontan circulation. The network mission is to optimise longevity and quality of life by improving physical health, neurodevelopmental outcomes, resilience, and emotional health for these individuals and their families. This manuscript describes the systematic design of this new learning health network, including the initial steps in development of a national, lifespan registry, and pilot testing of data collection forms at 10 congenital heart centres.
Time is of the essence to continue the pandemic disaster cycle with a comprehensive post-COVID-19 health care delivery system RECOVERY analysis, plan and operation at the local, regional and state level.The second wave of COVID-19 pandemic response are not the ripples of acute COVID-19 patient clusters that will persist until a vaccine strategy is designed and implemented to effect herd immunity. The COVID-19 second wave are the patients that have had their primary and specialty care delayed. This exponential wave of patients requires prompt health care delivery system planning and response.
Between 1934 and the time of the 1940 Census, the US government built and leased 30,151 units of public housing, but we know little about the residents who benefited from this housing. We use a unique methodology that compares addresses of five public housing developments to complete-count data from the 1940 Census to identify residents of public housing in New York City at the time of the census. We compare these residents to the larger pool of residents living in New York City in 1940 who were eligible to apply for the housing to assess how closely housing authorities adhered to the intent of the National Industrial Recovery Act (1933) and the Housing Act of 1937. This comparison produces a picture of whom public housing administrators considered deserving of this public benefit at the dawn of the public housing program in the United States. Results indicate a shift toward serving households with lower incomes over time. All the developments had a consistent preference for households with a “nuclear family” structure, but policies favoring racial segregation and other discretion on the part of housing authorities for tenant selection created distinct populations across housing developments. Households headed by a naturalized citizen were favored over households headed by a native-born citizen in nearly all the public housing projects. This finding suggests a more nuanced understanding of who public housing administrators considered deserving of the first public housing than archival research accounts had previously indicated.