ANNAPOLIS, MD—In light of last week’s announcement of the first documented patient-to-patient transmission of hepatitis C virus (HCV) in a dental practice, the Organization for Safety, Asepsis and Prevention (OSAP) is offering some members-only resources to the broader dental community to help support compliance efforts for safe infection prevention practices.

The HCV case stems from the public health investigation of a Tulsa, Oklahoma oral surgical clinic in which current and former patients of the practice may have been exposed to bloodborne viruses. The Oklahoma State Department of Health and Tulsa Health Department released an interim status report on September 18 on the results of their public health investigation.

“This is the first documented report of patient-to-patient transmission of hepatitis C virus associated with a dental setting in the United States,” said Dr. Kristy Bradley, Oklahoma State Epidemiologist. Dr. Bradley spoke at OSAP’s 2013 Infection Prevention Symposium in June. “While dental procedures are generally safe, this reinforces the importance of adhering to strict infection control procedures in dental settings.”

With the amount of media coverage this case is receiving, OSAP believes the time is right for the dental team to have a conversation about infection control and bloodborne pathogens, especially hepatitis C. OSAP has developed a free downloadable hepatitis C toolkit featuring relevant regulations and guidelines, best practices, instructional resources and patient resources available to its members. It can now be accessed by every dental professional at www.osap.org/?page=Issues_HepC.

Also available are videos in English and Spanish, fact sheets, online training and many other resources.

A summary of Dr. Bradley’s June lecture describing the investigative process in this case that includes key takeaways, implementation steps and hyperlinked resources can be found on pages 2-3 of the 2013 OSAP Symposium Proceedings, available at the following link, https://c.ymcdn.com/sites/osap.site-ym.com/resource/resmgr/Symposium_2013/OSAP.2013Symp.Proceedings.pdf.

The Oklahoma State Department of Health’s announcement can be found at the link below:

https://www.ok.gov/health/Organization/Office_of_Communications/News_Releases/2013_News_Releases/Public_Health_Investigation_of_Tulsa_Dental_Practice.html

Additional resources are available through OSAP’s website, www.OSAP.org, the Centers for Disease Control and Prevention (CDC) at www.CDC.gov and the American Dental Association at www.ADA.org.

About OSAP

The Organization for Safety, Asepsis and Prevention is the world’s leading membership association exclusively dedicated to preventing disease transmission and ensuring the safe and infection-free delivery of oral healthcare for all. As a nonprofit organization, OSAP helps dental practitioners close the gap between policy and practice. Its members include dental and other healthcare professionals, consultants, researchers and non-governmental organizations, manufacturing and distribution companies, policy makers, and academia. For more information, visit www.OSAP.org.

New York, NY—Access to affordable health care and quality of care vary greatly for low-income people based on where they live, according to a new Commonwealth Fund scorecard. The Scorecard provides the first state-by-state comparison of the health care experiences of the 39 percent of Americans with incomes less than 200 percent of the federal poverty level, or $47,000 a year for a family of four and $23,000 for an individual. Low-income people account for at least 25 percent of total state populations, and as much as nearly half (47%) in some states—including Arkansas, Louisiana, Mississippi, and New Mexico.

The report also compares the health care experiences of those with low incomes to those with higher incomes—over 400 percent of poverty, or $94,000 for a family of four—and finds striking disparities by income within each state. Yet, the wide differences by geography often put higher-income as well as low-income families at risk. The report finds that higher-income people living in states that lag far behind are often worse off than low-income people in states that rank at the very top of the scorecard. For example, low-income elderly Medicare beneficiaries in Connecticut and Wisconsin are less likely to receive high-risk medications than are higher-income elderly in Mississippi, Louisiana, and Alabama.  

The stark differences in health care access, quality, and outcomes detailed in the report add up to substantial loss of lives and missed opportunities to improve health and quality of care. According to the Scorecard, if all states could reach benchmarks set by the leading states for their more advantaged populations: 

• an estimated 86,000 fewer people would die prematurely each year,

• 750,000 fewer low-income Medicare beneficiaries would be prescribed potentially dangerous medications,

• tens of millions of adults and children would receive needed preventive care like vaccines, check-ups, and cancer screenings,

• nearly 9 million fewer low-income adults under age 65 would lose six or more teeth because of tooth decay, infection, or gum disease, and

• 30 million more low-income adults and children would have health insurance coverage, reducing the number of uninsured by more than half. 

“We found repeated evidence that we are often two Americas, divided by income and geography when it comes to opportunities to lead long and healthy lives. These are more than numbers,” said Cathy Schoen, Commonwealth Fund Senior Vice President and lead author of the report. “We are talking about people’s lives, health, and well-being. Our hope is that state policymakers and health care leaders use these data to target resources to improve access, care, and the health of residents with below-average incomes.”

The report, Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, and online interactive map rank states on 30 indicators covering issues such as access to affordable health care, preventive care and quality, potentially avoidable hospital use, and health outcomes. The report also examines how well the top-performing state in each category does for its high-income residents and sets that as a benchmark in order to assess the potential if all states could do as well. 

Income-Related Health Disparities Exist Within and Among States

The report finds substantial variation in health care and health outcomes for low-income people—a two- to five-fold difference. While there was room for every state to improve, states in the Upper Midwest, Northeast, and Hawaii performed best, while Southern and South Central states often lagged. 

Some findings of wide geographic disparities and gaps in care include: 

• The percentage of uninsured low-income adults ranged from a low of 12 percent in Massachusetts to a high of 55 percent in Texas.

• Only 32 percent of low-income adults ages 50 or older received recommended preventive care, such as cancer screenings and vaccines, ranging from 26 percent or less in Idaho, Oklahoma, and California, to 42 percent in Massachusetts, the top-ranked state for this indicator. 

• In eight states, 40 percent or more of Medicare beneficiaries received medications considered high-risk for the elderly—rates more than double that of states with safer prescribing. 

• Asthma-related hospitalizations among children from low-income communities in New York were eight times higher than in Oregon, the state with the lowest rate. (477 per 100,000 in New York compared to 56 per 100,000 in Oregon.)  

• At least one of four low-income adults under 65 in West Virginia, Tennessee, Alabama, Mississippi, and Kentucky lost six or more teeth due to decay or disease, compared to less than 10 percent in Connecticut, Hawaii, and Utah, the states with the lowest rates. 

Demonstrating the potential to improve, the report finds that in top-performing states, low-income people often fared better than the national average, and even better than higher-income people in the worst-performing states. On nearly half of the indicators, including potentially preventable hospitalizations, infant mortality, smoking, and obesity, lower-income or less-advantaged people in high-performing states did better than more-advantaged people in low-performing states.  

Low-Income Families Suffer from Lack of Access to Affordable, Timely Health Care 

The report finds that low-income people were more likely to be uninsured or underinsured than those with higher incomes. In 2010-2011 nearly 57 million low-income people were uninsured or underinsured, ranging from a low of 36 percent in Massachusetts to a high of more than 60 percent in Alaska, Colorado, Florida, Idaho, Montana, Nevada, New Mexico, Texas, Utah, and Wyoming. 

Insurance and access to health care are closely linked: the report finds that insured low-income people have similar rates of having a usual source of care and receiving recommended care as insured high-income people. However, insurance alone doesn’t guarantee receipt of high-quality, safe care, as demonstrated by the varied experience of low- and higher-income Medicare beneficiaries, all of whom are insured.  

The report findings point to the need to strengthen primary care to ensure timely access, reduce reliance on emergency rooms, and improve care for those with chronic disease. The Scorecard finding that those living in low-income communities often fare worse points to the need for targeted efforts focused on “hot spots,” or communities with very high rates of hospital or emergency room use, to act early, prevent complications and improve population health. 

Improvement Is Possible

According to the report, the Affordable Care Act represents a historic opportunity for states to provide better health care to economically vulnerable people by providing resources to overcome the geographic and income divide—especially for states with high rates of poverty. The authors note that investing those resources well has the potential to improve the health and productivity of the entire state.  The scorecard offers targets to improve as well as a way of tracking progress by state over time. 

“The Scorecard’s startling findings show us where our bright and weak spots are when it comes to providing health care to millions of Americans living on modest or low incomes,” said Commonwealth Fund President David Blumenthal, M.D. “And the timing is important. We are at an unprecedented moment in the history of our nation. We have the potential to raise the bar, unite the country, and realize the promise of a more equal opportunity to thrive by expanding health care coverage and innovating to find the most effective ways to deliver high-quality, safe care for everyone.”

Data and Resources Available

The report and additional resources, including an interactive map, state profiles, an infographic, and a slide show explainer, “A Tale of Two States: The Health Care Income Divide Visualized,” is available at: www.commonwealthfund.org/Publications/Fund-Reports/2013/Sep/Low-Income-Scorecard.aspx.

The Centers for Disease Control and Prevention's 2013 Tips From Former Smokers campaign produced more than 150,000 additional calls to 1-800-QUIT NOW, a number that links callers to their state quitlines, according to a report in this week's Morbidity and Mortality Weekly Report. The campaign also generated almost 2.8 million additional visitors to the campaign website, www.cdc.gov/tips. The website features information on the campaign, as well as information on how to quit smoking from the National Cancer Institute's www.smokefree.gov website.

These figures represent a 75 percent increase in call volume and a nearly 38-fold increase in unique website visitors, compared with the four weeks before the campaign began. The analysis also found that average weekly calls fell by 41 percent and website visitors fell by 96 percent during the four weeks after the campaign ended.

The 2013 campaign's television component included national ads in all 210 U.S. television markets and additional local ads in 67 of these markets. The television buy used a "pulsing" strategy in which the national televisions ads aired on a 1-week-on, 1-week-off basis for the first 12 weeks of the campaign, while the local television ads ran continuously throughout the campaign. The number of calls fell by 38 percent during the six weeks when the national television ads were off the air, compared with the six weeks when the national ads were airing. These findings suggest that a longer campaign with sustained broad reach could produce even greater benefits, including more quit attempts and successful long-term quits.

"The TIPS campaign continues to be a huge success, saving tens of thousands of lives and millions of dollars; I wish we had the resources to run it all year long," said CDC Director Tom Frieden, M.D., M.P.H. "Most Americans who have ever smoked have already quit, and most people who still smoke want to quit. If you smoke, quitting is the single most important thing you can do for your health – and you can succeed!"

The 2013 campaign ran for 16 weeks, from March 4 through June 23. It featured a variety of ads of real people who are living with smoking-related diseases and disabilities. The graphic, emotional ads show how the health effects from their smoking or exposure to secondhand smoke changed their lives forever.

A study published September 9th in The Lancet reported that the 2012 Tips campaign likely resulted in 1.6 million additional smokers making a quit attempt and over 100,000 sustained quitters. It further showed the 2012 campaign added between 300,000 and 500,000 years of life to those Americans who quit smoking.

"This week, Terrie Hall, the only ad participant featured in the Tips campaign in both 2012 and 2013, lost her 13 year battle with smoking-related cancer," said Tim McAfee, M.D., M.P.H., director of CDC's Office on Smoking and Health. "Terrie's desire to share her story in efforts to help others know the dangers of smoking is truly a public health inspiration."

The Tips From Former Smokers campaign is an important counter to the more than $8.3 billion spent annually by the tobacco industry to make cigarettes more attractive and more available, particularly to youth and young adults. The 2013 campaign cost $48 million dollars to develop and implement – less than the amount the tobacco industry spends on promoting and marketing cigarettes in just three days.

This January will mark the 50th anniversary of the first Surgeon General's Report linking cigarette smoking to lung cancer. Smoking remains the leading cause of preventable death and disease in the United States, killing more than 1,200 Americans every day. More than 8 million Americans live with a smoking-related disease. Each day, over 1,000 youth under 18 become daily smokers. Smoking-related diseases cost Americans $96 billion a year in direct health care expenses, a substantial portion of which come in taxpayer-supported payments.

Through the Affordable Care Act, more Americans than ever will qualify to get health care coverage that fits their needs and budget, including important preventive services such as services to quit smoking that are covered with no additional costs. Get ready today for the new Health Insurance Marketplace. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more. Open enrollment in the Marketplace begins October 1 for coverage starting as early as Jan. 1, 2014.

For more information on the Tips From Former Smokers campaign, including profiles of the former smokers, other campaign resources, and links to the ads, visit www.cdc.gov/Tips.

TULSA, OK – The Oklahoma State Department of Health and Tulsa Health Department this week released an interim status report on results of their public health investigation of the W. Scott Harrington dental surgical practice.

On March 28, public health officials announced they were notifying current and former patients of the practice that they may have been exposed to blood-borne viruses at Harrington’s Tulsa and Owasso offices. Health officials recommended these patients have their blood drawn for testing for hepatitis B, hepatitis C and HIV infection at free screening clinics established at the Tulsa Health Department, Oklahoma City-County Health Department and other county health departments in the state. The free screening clinics were available through June 28.

In total, the Oklahoma Public Health Laboratory completed testing for 4,202 persons. Eighty-nine patients tested positive for hepatitis C, 5 for hepatitis B, and 4 for HIV. An unknown number of persons also sought testing through their private health care provider.

Findings of the epidemiological investigation of former patients testing positive for hepatitis C indicate that one event of patient-to-patient transmission of hepatitis C virus occurred in the practice. Genetic-based testing of patient specimens by the Centers for Disease Control and Prevention (CDC) provided laboratory confirmation of this finding.

“This is the first documented report of patient-to-patient transmission of hepatitis C virus associated with a dental setting in the United States,” said State Epidemiologist Dr. Kristy Bradley. “While dental procedures are generally safe, this reinforces the importance of adhering to strict infection control procedures in dental settings.”   

Based on current Oklahoma disease prevalence data for hepatitis B and C and HIV, health officials recognized some of the screening results would be positive for infection not related to dental procedures at the Harrington practice.  

The CDC recommends one-time screening of hepatitis C for all Baby Boomers – persons born between 1945 and 1965 – even if they do not have symptoms of liver disease or feel sick. Among the former dental patients who were screened and newly identified as having hepatitis C, 56 percent were over the age of 50. Early identification and treatment of hepatitis C is important to prevent liver damage, cirrhosis and even liver cancer and can prevent the further spread of disease.

“For every new infection prevented by this public health response, $30,000 to $40,000 will be saved in associated health care costs,” said Tulsa Health Department Director Dr. Bruce Dart. “Infectious disease control is a core function of the public health system, and when transmission of disease is apparent, it is our job to identify the problem and reduce the chance that other people will get sick.”

Public health costs associated with this infectious disease response to date total more than $710,000, including a combination of federal, state and local public health resources.  Both the Tulsa Health Department and the Oklahoma State Department of Health indicate they will continue to explore opportunities to recover costs associated with the recommended screening and laboratory testing.         

Genetic testing of the HIV specimens for potential connection to the Harrington practice is ongoing at the CDC. “While our investigation documents the transmission of hepatitis C, we have no reason to believe the hepatitis B cases resulted from exposure in this dental practice,” said Bradley.

Test results of the HIV specimens are due over the next several weeks. A final report summarizing the oral healthcare-associated public health investigation and response will be published after all aspects of the investigation have been completed. 

Patients Who Were Recommended to Return for Follow-up Testing

Patients with negative test results who had dental procedures in the Harrington clinic between Sept. 20, 2012, and March 20, 2013, were recommended to return for follow-up testing at least six months past the last dental clinic date at the Harrington practice. Those patients will still receive follow-up testing at no cost. Screenings after June 28 will be provided Monday-Thursdays by appointment only. Please call the North Regional Health and Wellness Center directly at (918) 595-4380 to schedule an appointment.

 Location:   North Regional Health and Wellness Center

                5635 N. Martin Luther King Jr. Blvd

                Tulsa, OK 74126

                View map to the clinic here

                *If you are using a GPS to find the clinic, Martin Luther King Jr. Blvd was formerly called Cincinnati Ave.

Directions: If coming from Tulsa: Take HWY-75 N to the 56th St N exit. Head West on 56th St. N for approx. 3 miles until you reach Martin Luther King Jr Blvd (formerly Cincinnati Ave) and turn North.  Destination is on your right.

CHICAGO – The American Dental Association (ADA) is deeply concerned about the first confirmed report of patient to patient transmission of hepatitis C in a dental practice setting linked to improper infection control practices. The ADA wishes to assure the public that patient health and safety are top priorities for the Association.  

“This is a highly atypical and disconcerting case,” states ADA President Robert A. Faiella, D.M.D., M.M.Sc. “Every day, hundreds of thousands of dental procedures are performed safely and effectively thanks to the diligence of dentists who follow standard infection control precautions developed by the Centers for Disease Control.”

Dr. Faiella added, “While this is an isolated case, it understandably raises questions about infection control in the dental office. The ADA encourages people to talk with their dentists, who will be glad to explain or demonstrate their infection control procedures.”

The statement issued today is part of an interim status report from the Oklahoma State Department of Health and the Tulsa Health Department on the results of their joint investigation of the dental surgical practice with offices in Tulsa and Owasso. The oral surgeon involved in the case voluntarily surrendered his license to practice.

The investigation began March 28 when public health officials notified the practice’s former patients that they may have been exposed to blood-borne viruses.

An epidemiological investigation indicated that one case of transmission of the virus occurred in the dental practice. The transmission was described as “patient-to-patient” because improper infection control procedures caused the virus to be passed from one patient to another. Genetic-based testing of patient specimens by the Centers for Disease Control and Prevention (CDC) provided laboratory confirmation of the finding.

The ADA has long recommended that all practicing dentists, dental team members and dental laboratories use standard precautions as described in the Centers for Disease Control and Prevention’s (CDC) Guidelines for Infection Control in Dental Health Care-Settings.

Standard precautions protect patients and health care workers by preventing the spread of disease. Examples of infection control in the dental office include the use of masks, gloves, surface disinfectants and sterilizing reusable dental devices.

Before any patient enters the examining room, all surfaces, such as the dental chair, dental light, instrument tray, drawer handles and countertops, have been cleaned and decontaminated. Some offices may cover this equipment with protective covers, which are replaced after each patient.

Non-disposable items like dental instruments are cleaned and sterilized between patient appointments. Disposable dental instruments and needles are never re-used. Infection control precautions also require all dental staff involved in patient care to use appropriate protective garb such as gloves, masks, gowns and eyewear. After each patient, all disposable wear items, such as gloves, are discarded. Before seeing the next patient, the members of the treatment team cleanse their hands and put on new gloves.

More information on infection control in dental offices is available online on the ADA consumer website Mouthhealthy.org.

COLUMBIA, Mo. – Individuals often turn to others for advice when making choices. Perhaps, it seems fitting then, that individuals would seek out others when they are faced with important health decisions. Yet, health communicators have debated whether stories should be included in patient decision-aids (which are informational materials designed to help patients make educated choices about their health) because they worry stories are too biased. Now, an MU researcher has found that stories used in decision-aids don’t necessarily bias patients’ decision-making; rather, certain types of stories can help patients confidently make informed decisions that fit their individual health needs.

“Stories are not all the same, and they don’t all have the same effect on patients’ decision-making; therefore, calls to avoid using stories in patient decision-aids is not advisable,” said Victoria Shaffer, an assistant professor of health sciences and psychological sciences at MU. “Different types of narratives have different effects on patients’ decision-making processes. The question isn’t whether it’s good or bad to include patient stories in decision aids; rather, the question is what type of stories should health communicators use to have the intended effect?”

Shaffer and her colleagues examined two types of stories in their study: process narratives and experience narratives. Process narratives are stories that include details about how a patient made a particular health care decision. Experience narratives include details about what it is like to have particular treatments or procedures.

The researchers told more than 300 healthy women to imagine they had received diagnoses of early-stage breast cancer. The women randomly were assigned to a process narrative condition, an experience narrative condition or a control condition with no patient stories. Participants in the narrative conditions then viewed four videotaped stories. Afterward, the women were asked to choose a treatment option: mastectomy, which includes complete removal of the breast tissue, or radiation and lumpectomy, which includes partial removal of the breast tissue.

“We found that neither type of story affected patients’ treatment decisions,” Shaffer said. “About two-thirds of the women chose lumpectomy and radiation and one-third of the women chose mastectomy regardless of which type of narrative they viewed.”

In addition, the researchers found that women who viewed process narratives spent more time searching for information. Women who viewed experience narratives reported they could better envision what it would be like to undergo the treatments, and the women also evaluated their decisions more favorably.

Both early-stage breast cancer treatment options have similar survival rates, which means patients’ treatment options really depend on the patients’ individual preferences and lifestyles, Shaffer said.

“Previous research has shown that people make healthcare decisions based on their predictions about how these choices will affect their lives in the future,” Shaffer said. “The problem is that most of us aren’t very good at predicting how we’ll feel in the future, which can lead us to make poor decisions or decisions that we later regret. Our results suggest that experience narratives increased patients’ confidence in their treatment decisions. Perhaps, using experience narratives in future decision-aids can help patients make more confident health decisions.”

Most of the controversy related to using stories in patient decision-aids focuses on outcome narratives, which are stories that evaluate the results of individuals’ decisions. Previous research has shown that outcome stories are persuasive. However, process and experience narratives can inform patients’ decision-making without biasing their treatment decisions, Shaffer said.

“After receiving a cancer diagnosis, patients may focus on survival or recurrence while making their treatment decisions and don’t always consider the long-term tradeoffs associated with different treatment choices,” Shaffer said. “Process narratives, in these instances, might help patients consider other treatment attributes, such as appearance, they wouldn’t have otherwise considered.”

Shaffer is an assistant professor in the Department of Health Sciences in the MU School of Health Professions and in the Department of Psychological Sciences in the MU College of Arts and Science. The study, “The Effects of process-focused versus experience-focused narratives in a breast cancer treatment decision task,” was published online earlier this month by Patient Education and Counseling. Co-authors included Lukas Hulsey from Wichita State University and Brian Zikmund-Fisher from the University of Michigan. The Informed Medical Decisions Foundation and the American Cancer Society funded the research.

CHICAGO, IL – Hu-Friedy, a global leader in dental instrument manufacturing, announced today the launch of the new Streamline Direct Flow  ultrasonic insert family. Adding to Hu-Friedy’s magnetostrictive line, the new Streamline Direct Flow inserts were designed to offer efficient scaling at a great price. 

Each of the seven Streamline Direct Flow inserts feature a comfortable, wide diameter handle to reduce finger pinching and ensure clinician comfort. The through-tip water delivery offers a targeted water flow, reduces excess spray and increases visibility of the treatment site. Finally, Hu-Friedy’s proprietary stainless steel alloy ensures the highest level of scaling efficiency.

Hu-Friedy now manufactures three lines of ultrasonic inserts with Streamline Direct Flow, original Streamline® and Swivel™ inserts. Hu-Friedy entered the market in 1996 with Streamline inserts that deliver water through the tip’s base. In 2002, Hu-Friedy introduced Swivel inserts that offer 360° rotation to reduce the drag of the handpiece cord for hassle-free scaling.  Each line of inserts was designed for comfort and performance, and clinicians are able to choose the particular style that meets their needs.

 “We know that each of our customers seek a wide variety of product and technology options to deliver the highest level of care to the patients and they see every day,” says Ken Serota, President of Hu-Friedy Mfg. Co. “At Hu-Friedy, we want to provide clinicians with several high-quality options within a product category so that they can make the best choice for their practice. Bringing the new Streamline Direct Flow insert family to our product portfolio allows us to offer three different solutions for magnetostrictive scaling, all of which feature the Hu-Friedy quality steel and craftsmanship that our customers expect from us.”

Streamline Direct Flow inserts are currently available in 30 kHz configurations with Universal, Thin, Triple Bend, XT, Left, Right and Straight tip patterns. For more information on Hu-Friedy’s Streamline Direct Flow and other ultrasonic inserts, visit www.Hu-Friedy.com.

About Hu-Friedy

Founded in Chicago in 1908, Hu-Friedy Manufacturing Company helps dental professionals perform at their best by producing dental instruments and products designed to function as an extension of each practitioner's particular skill. Its products, hand-crafted by highly-skilled artisans, are known for their precision, performance, longevity, reliability and quality. Headquartered in Chicago, Hu-Friedy products are distributed in more than 75 countries and the company maintains offices in Rotterdam, Tuttlingen, Germany, Milan, Shanghai and Tokyo.

Life-Like Cosmetic Solutions, a worldwide supplier of dental products and dental supplies, will use a Facebook donation campaign to raise awareness for Oral Health America. Life-Like believes that every child in America should have access to affordable dental care. For every new person who “LIKES” the Life-Like Facebook page https://www.facebook.com/teethbleach by September 30, Life-Like will donate $1 to Oral Health America.

The company currently has 140 fans on its Facebook page, so any “LIKES” above and beyond that amount will translate into dollars for Oral Health America. Life-Like has also agreed that if they receive more than 200 likes by the September 30th deadline, they will pledge an additional $1,000.

Oral Health America’s (OHA) Smiles Across America (SAA) program links local governments, businesses, and funders with care providers and schools to help fight untreated oral disease. SAA offers resources and technical assistance to help communities build infrastructure for school oral health services, particularly those that provide dental sealants. The program supports services to over 90,000 children annually and helps communities respond to the critical need for oral disease prevention and oral health promotion.

Launched in partnership with public schools and community oral health providers in 2004, SAA has provided over $1.1 million in grant support to programs in Maine, New York, Philadelphia, Chicago, Minnesota, Las Vegas, and Santa Barbara/Ventura Counties (CA). SAA funding for oral disease prevention services to uninsured and under insured children allows communities to leverage resources and expand programs. The program includes communications and marketing strategies to underscore the message that oral health is critical to overall health.

Life-Like’s donation is intended to help Oral Health America assist dental care providers by providing essential material resources such as dental care products, supplies and equipment. “Our company concentrates primarily on providing teeth bleaching and tooth whitening products to cosmetic dentists,” commented Life-Like’s founder, Dr. Rodney Ogrin. “But we know that dental whitening takes a back seat to basic oral health. That’s why we’re proud to support Oral Health America in its work of making sure that children have the healthiest teeth possible.”

Life-Like is requesting that patients, friends, neighbors and family members support its campaign by visiting its Facebook page https://www.facebook.com/teethbleach and clicking the “LIKE” button at the top right of the page. The company urges everyone to then tell all of their colleagues, friends and family who use Facebook to “LIKE” their page, too.

Every year, more than two million people in the United States get infections that are resistant to antibiotics and at least 23,000 people die as a result, according to a new report issued by the Centers for Disease Control and Prevention. The report, Antibiotic Resistance Threats in the United States, 2013, presents the first snapshot of the burden and threats posed by antibiotic-resistant germs having the most impact on human health. The threats are ranked in categories: urgent, serious, and concerning. 

Threats were assessed according to seven factors associated with resistant infections: health impact, economic impact, how common the infection is, a 10-year projection of how common it could become, how easily it spreads, availability of effective antibiotics, and barriers to prevention. Infections classified as urgent threats include carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile, a serious diarrheal infection usually associated with antibiotic use. C. difficile causes about 250,000 hospitalizations and at least 14,000 deaths every year in the United States.

“Antibiotic resistance is rising for many different pathogens that are threats to health,” said CDC Director Tom Frieden, M.D., M.P.H. “If we don’t act now, our medicine cabinet will be empty and we won’t have the antibiotics we need to save lives.”

In addition to the toll on human life, antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. health care system. Studies have estimated that, in the United States, antibiotic resistance adds $20 billion in excess direct health care costs, with additional costs to society for lost productivity as high as $35 billion a year. The use of antibiotics is the single most important factor leading to antibiotic resistance. Up to 50 percent of all the antibiotics prescribed for people are not needed or are not prescribed appropriately. 

 Antibiotics are also commonly used in food-producing animals to prevent, control, and treat disease, and to promote growth. As in humans, it is important to use antibiotics in animals responsibly. To help ensure that medically important antibiotics are used judiciously in food-producing animals, the U.S. Food and Drug Administration recently proposed guidance describing a pathway for using these drugs only when medically necessary and targeting their use to only address diseases and health problems.

“Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed,” said Steve Solomon, M.D., director of CDC’s Office of Antimicrobial Resistance. “These drugs are a precious, limited resource—the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow.”

The loss of effective antibiotic treatments will also undermine treatment of infectious complications in patients with other diseases. Many medical advances—joint replacements, organ transplants, cancer therapy, rheumatoid arthritis therapy – are dependent on the ability to fight infections with antibiotics. If the ability to effectively treat those infections is lost, the ability to safely offer people many of the life-saving and life-improving modern medical advances will be lost with it.

 To combat this serious health threat, CDC has identified four core actions critical to halting resistance:

1. Preventing Infections, Preventing the Spread of Resistance: Avoiding infections reduces the amount of antibiotics that have to be used and reduces the likelihood that resistance will develop. Drug-resistant infections can be prevented by immunization, infection prevention actions in healthcare settings, safe food preparation and handling, and general hand washing.

2. Tracking: CDC gathers data on antibiotic-resistant infections, causes of infections, and whether there are particular reasons (risk factors) that cause some people to get a resistant infection. With that information, experts can develop strategies to prevent those infections and prevent the resistant bacteria from spreading.

3. Improving Antibiotic Use/Stewardship: Perhaps the most important action needed to greatly slow the development and spread of antibiotic-resistant infections is to change the way antibiotics are used. Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary. The commitment to always use antibiotics appropriately and safely—only when they are needed to treat disease – and to choose the right antibiotics and to administer them in the right way in every case is known as antibiotic stewardship.  

4. Developing Drugs and Diagnostic Tests: Because antibiotic resistance occurs as part of a natural process in which bacteria evolve, it can be slowed but not completely stopped. Therefore, new antibiotics always will be needed to keep up with resistant bacteria, as will new tests to track the development of resistance.

To see the full report, please visit www.cdc.gov/drugresistance/threat-report-2013/. For more information about drug resistance and the serious impacts it has on human health, visit www.cdc.gov/drugresistance. 

ANN ARBOR, Mich. — Getting treatment for a common sleep problem may do more than help you sleep better – it may help you look better over the long term, too, according to a new research study from the University of Michigan Health System and Michigan Technological University.

The findings aren’t just about “looking sleepy” after a late night, or being bright-eyed after a good night’s rest.

It’s the first time researchers have shown specific improvement in facial appearance after at-home treatment for sleep apnea, a condition marked by snoring and breathing interruptions. Sleep apnea affects millions of adults – most undiagnosed -- and puts them at higher risk for heart-related problems and daytime accidents.

Using a sensitive “face mapping” technique usually used by surgeons, and a panel of independent appearance raters, the researchers detected changes in 20 middle-aged apnea patients just a few months after they began using a system called CPAP to help them breathe better during sleep and overcome chronic sleepiness.

While the research needs to be confirmed by larger studies, the findings may eventually give apnea patients even more reason to stick with CPAP treatment – a challenge for some because they must wear a breathing mask in bed. CPAP is known to stop snoring, improve daytime alertness and reduce blood pressure.

Sleep neurologist Ronald Chervin, M.D., M.S., director of the U-M Sleep Disorders Center, led the study, which was funded by the Covault Memorial Foundation for Sleep Disorders Research and published in the Journal of Clinical Sleep Medicine.

Putting anecdote to the test

Chervin says the study grew out of the anecdotal evidence that sleep center staff often saw in sleep apnea patients when they came for follow-up visits after using CPAP.  The team, including research program manager Deborah Ruzicka, R.N., Ph.D., sought a more scientific way to assess appearance before and after sleep treatment.

“The common lore, that people ‘look sleepy’ because they are sleepy, and that they have puffy eyes with dark circles under them, drives people to spend untold dollars on home remedies,” notes Chervin, the Michael S. Aldrich Collegiate Professor of Sleep Medicine and professor of Neurology at the U-M Medical School. “We perceived that our CPAP patients often looked better, or reported that they’d been told they looked better, after treatment. But no one has ever actually studied this.”

They teamed with U-M plastic and reconstructive surgeon Steven Buchman, M.D., to use a precise face-measuring system called photogrammetry to take an array of images of the patients under identical conditions before CPAP and a few months after. Capable of measuring tiny differences in facial contours, the system helps surgeons plan operations and assess their impact.

“One of the breakthroughs in plastic surgery over the last decade has been our aim to get more objective in our outcomes,” says Buchman. “The technology used in this study demonstrates the real relationship between how you look and how you really are doing, from a health perspective.”

The research team also included longtime collaborators at the Michigan Tech Research Institute, led by signal analysis expert and engineer Joseph W. Burns, Ph.D., who developed a way to precisely map the colors of patients’ facial skin before and after CPAP treatment.

The researchers also used a subjective test of appearance: 22 independent raters were asked to look at the photos, without knowing which were the “before” pictures and which the “after” pictures of each patient. The raters were asked to rank attractiveness, alertness and youthfulness – and to pick which picture they thought showed the patient after sleep apnea treatment.

Results show improvement

About two-thirds of the time, the raters stated that the patients in the post-treatment photos looked more alert, more youthful and more attractive. The raters also correctly identified the post-treatment photo two-thirds of the time.

Meanwhile, the objective measures of facial appearance showed that patients’ foreheads were less puffy, and their faces were less red, after CPAP treatment. The redness reduction was especially visible in 16 patients who are Caucasian, and was associated with the independent raters’ tendency to say a patient looked more alert in the post-treatment photo. The researchers also perceived, but did not have a way to measure, a reduction in forehead wrinkles after treatment.

However, the researchers note, they didn’t see a big change in facial characteristics that popular lore associates with sleepiness. “We were surprised that our approach could not document any improvement, after treatment, in tendency to have dark blue circles or puffiness under the eyes,” says Chervin. “Further research is needed, to assess facial changes in more patients, and over a longer period of CPAP treatment.”

He notes that this initial study wouldn’t have been possible without the generosity of donors who have supported U-M sleep research as a way of honoring the memory of Jonathan Covault, a promising attorney who died young, and whose undertreated sleep apnea may have contributed to his premature death. The Covault family was aware of the research study, and of the importance of research that might encourage others to seek and stay with apnea treatment.

Chervin and his colleagues hope to continue to study the effect of sleep apnea treatment on many aspects of a person’s life, including further research on appearance. “We want sleep to be on people’s minds, and to educate them about the importance of getting enough sleep and getting attention for sleep disorders,” he says.