Millions Of Children, Seniors And Minorities Not Receiving Essential Dental Care, USA

4.6 million children in America in 2008 did not see a dentist because their parents did not have enough money to pay, and only 38% of seniors had dental coverage in 2006, says a new report by the Institute of Medicine (IoM) and National Research Council. The authors say that 'persistent and systemic' obstacles undermine people's access to oral health care.

These obstacles need to be removed, the authors insist, and suggest the following should occur: The funding and reimbursement for dental care should changeTraining for doctors, nurses and other non-dental professionals should be expanded so that signs of oral diseases may be better identifiedAdministrative, educational and regulatory practices should be revamped Chair of the committee that wrote the report, Frederick Rivara, said:

"The consequences of insufficient access to oral health care and resultant poor oral health - at both the individual and population levels - are far-reaching. As the nation struggles to address the larger systemic issues of access to health care, we need to ensure that oral health is recognized as a basic component of overall health."

The problem is exacerbated by a combination of cultural, geographic, structural and economic factors, the report explains. For example, 33.3 million Americans live in areas where there are not enough dentists.

People who do not look after their teeth and gums properly have a greater risk of developing: Respiratory diseaseCardiovascular diseaseDiabetes Focusing more on the prevention of oral diseases combined with more emphasis on oral health care promotion would result in improved overall public health.

Although children have to receive comprehensive dental benefits if they are enrolled in CHIP (Children's Health Insurance Program) or Medicaid from state funds, this is not the case for adults.

As underserved populations rely on publicly-funded programs as their primary source of health cover, authorities should include dental cover for all Medicaid beneficiaries as well, the authors state.

The authors wrote:

"Toward that end, the committee recommended that the Centers for Medicare and Medicaid Services fund and evaluate state-based demonstration projects that cover essential oral health benefits for adult Medicaid beneficiaries. In addition, Medicaid and CHIP reimbursement rates for providers should be increased and administrative practices need to be streamlined to increase use by both dental providers and patients."

In order to improve dental health care access, state laws should be altered so that hygienists, assistants and other dental professionals can work to their full extent in a variety of situations under suitable evidence-based supervision levels.
Even though the USA has national accreditation standards for training and education of oral health professionals, regulations regarding what they can and cannot do vary widely across states.

Dentists should be allowed to supervise work being done using current conferencing technology, the writers add.

The report explains that the geographic variations in available dentists and specializations are a "long-recognized challenge". Recently graduated dental students say they are ill-equipped to treat older patients, as well as individuals with special needs.

The authors write that:

"Efforts should be made to increase recruitment and support for dental students from minority, lower-income, and rural populations, as well as to boost the number of dental faculty with expertise caring for underserved and vulnerable populations.
In addition, the Health Resources and Services Administration should dedicate Title VII funding to aid and expand opportunities for dental residencies in community-based settings. These residencies should take place in geographically underserved areas and include clinical experiences with young children, individuals with special health care needs, and older adults.


"Improving Access to Oral Health Care for Vulnerable and Underserved Populations"
Frederick Rivara (Chair), Paul C. Erwin, Caswell Evans, Jr., Theodore G. Ganiats, Shelly Gehshan, Kathy Voigt Geurink, Paul Glassman, Jane Perkins, Margaret A. Potter, Renee Samelson, Phyllis Sharps, Linda H. Southward, Maria Rosa Watson, Barbara Wolfe
Institute of Medicine of the National Academies, National Research Council of the National Academies

Bigger Bites Means Eating Less, So Go For A Bigger Fork

The larger your fork and the bigger your bite when you eat, the less you will probably end up eating when you are in a restaurant, say researchers from the University of Utah in the Journal of Consumer Research. They used two sizes of forks in a popular Italian restaurant to measure how much people ate, and found that the participants who used the larger forks ate less than those with smaller ones.

Authors Arul Mishra, Himanshu Mishra, and Tamara M. Masters wrote:

"In this research we examined the influence of small versus large bite-sizes on overall quantity of food consumed."

They then set out to determine why their findings went against other studies that had focused on portion sizes.

The researchers wrote:

"We observe that diners visit the restaurant with a well-defined goal of satiating their hunger and because of this well-defined goal they are willing to invest effort and resources to satiate their hunger goal."

A diner is able to satisfy his/her hunger by selecting, consuming and paying for their food. All these steps require an investment of effort on their part.

Arul Mishra said:

"The fork size provided the diners with a means to observe their goal progress. The physiological feedback of feeling full or the satiation signal comes with a time lag. In its absence diners focus on the visual cue of whether they are making any dent on the food on their plate to assess goal progress."

In order to test this supposition, they altered the quantities of food. They found that when presented with a plate loaded with food, those with large forks ate considerably less than those with small ones.

However, the amount of food consumed was not influenced by fork size when they were given small servings.

When they tried this out with volunteers in a laboratory, their results were the opposite - those with small forks ate less than the ones with the larger forks. The researchers think this is because the people in the lab did not have the same hunger satiating goals as the individuals in the restaurant.

We need to have a better understanding of hunger cues if we want to avoid overeating, they added.

They wrote:

"People do not have clear internal cues about the appropriate quantity to consume. They allow external cues, such as fork size, to determine the amount they should consume."

"The Influence of Bite-size Quantity on Food Consumed: A Field Study
Arul Mishra, Himanshu Mishra, and Tamara M. Masters
Journal of Consumer Research

Schizophrenia

Schizophrenia is a psychiatric diagnosis that describes a mental disorder characterized by abnormalities in the perception or expression of reality. Distortions in perception may affect all five senses, including sight, hearing, taste, smell and touch, but most commonly manifest as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social or occupational dysfunction. Onset of symptoms typically occurs in young adulthood, with approximately 0.4–0.6% of the population affected. Diagnosis is based on the patient's self-reported experiences and observed behavior. No laboratory test for schizophrenia currently exists.

Studies suggest that genetics, early environment, neurobiology, psychological and social processes are important contributory factors; some recreational and prescription drugs appear to cause or worsen symptoms. Current psychiatric research is focused on the role of neurobiology, but no single organic cause has been found. As a result of the many possible combinations of symptoms, there is debate about whether the diagnosis represents a single disorder or a number of discrete syndromes. For this reason, Eugen Bleuler termed the disease the schizophrenias (plural) when he coined the name. Despite its etymology, schizophrenia is not the same as dissociative identity disorder, previously known as multiple personality disorder or split personality, with which it has been erroneously confused. Increased dopamine activity in the mesolimbic pathway of the brain is consistently found in schizophrenic individuals. The mainstay of treatment is antipsychotic medication; this type of drug primarily works by suppressing dopamine activity. Dosages of antipsychotics are generally lower than in the early decades of their use. Psychotherapy, and vocational and social rehabilitation are also important. In more serious cases - where there is risk to self and others - involuntary hospitalization may be necessary, although hospital stays are less frequent and for shorter periods than they were in previous times. The disorder is thought to mainly affect cognition, but it also usually contributes to chronic problems with behavior and emotion.

People with schizophrenia are likely to have additional (comorbid) conditions, including major depression and anxiety disorders; the lifetime occurrence of substance abuse is around 40%. Social problems, such as long-term unemployment, poverty and homelessness, are common. Furthermore, the average life expectancy of people with the disorder is 10 to 12 years less than those without, due to increased physical health problems and a higher suicide rate.St. Elizabeth's Hospital. Wall of room in Ward Retreat 1. Reproductions made by a patient, a disturbed case of dementia precox [praecox?]; pin or fingernail used to scratch paint from wall, top coat of paint buff color, superimposed upon a brick red coat of paint.

Pictures symbolize events in patient's past life and represent a mild state of mental regression. Undated, but likely early 20th century. Schizophrenia occurs equally in males and females, although typically appears earlier in men - the peak ages of onset are 20–28 years for males and 26–32 years for females. Onset in childhood is much rarer, as is onset in middle- or old age. The lifetime prevalence of schizophrenia - the proportion of individuals expected to experience the disease at any time in their lives - is commonly given at 1%. However, a 2002 systematic review of many studies found a lifetime prevalence of 0.55%. Despite the received wisdom that schizophrenia occurs at similar rates worldwide, its prevalence varies across the world, within countries, and at the local and neighbourhood level. One particularly stable and replicable finding has been the association between living in an urban environment and schizophrenia diagnosis, even after factors such as drug use, ethnic group and size of social group have been controlled for. Schizophrenia is known to be a major cause of disability. In a 1999 study of 14 countries, active psychosis was ranked the third-most-disabling condition after quadriplegia and dementia and ahead of paraplegia and blindness.

Accounts of a schizophrenia-like syndrome are thought to be rare in the historical record prior to the 1800s, although reports of irrational, unintelligible, or uncontrolled behavior were common. There has been an interpretation that brief notes in the Ancient Egyptian Ebers papyrus may imply schizophrenia, but other reviews have not suggested any connection.

A review of ancient Greek and Roman literature indicated that although psychosis was described, there was no account of a condition meeting the criteria for schizophrenia. Bizarre psychotic beliefs and behaviors similar to some of the symptoms of schizophrenia were reported in Arabic medical and psychological literature during the Middle Ages. In The Canon of Medicine, for example, Avicenna described a condition somewhat resembling the symptoms of schizophrenia which he called Junun Mufrit (severe madness), which he distinguished from other forms of madness (Junun) such as mania, rabies and manic depressive psychosis. However, no condition resembling schizophrenia was reported in Şerafeddin Sabuncuoğlu's Imperial Surgery, a major Islamic medical textbook of the 15th century. Given limited historical evidence, schizophrenia (as prevalent as it is today) may be a modern phenomenon, or alternatively it may have been obscured in historical writings by related concepts such as melancholia or mania.A detailed case report in 1797 concerning James Tilly Matthews, and accounts by Phillipe Pinel published in 1809, are often regarded as the earliest cases of schizophrenia in the medical and psychiatric literature. Schizophrenia was first described as a distinct syndrome affecting teenagers and young adults by Bénédict Morel in 1853, termed démence précoce (literally 'early dementia').

The term dementia praecox was used in 1891 by Arnold Pick to in a case report of a psychotic disorder. In 1893 Emil Kraepelin introduced a broad new distinction in the classification of mental disorders between dementia praecox and mood disorder (termed manic depression and including both unipolar and bipolar depression). Kraepelin believed that dementia praecox was primarily a disease of the brain, and particularly a form of dementia, distinguished from other forms of dementia, such as Alzheimer's disease, which typically occur later in life. Kraepelin's classification slowly gained acceptance. There were objections to the use of the term "dementia" despite cases of recovery, and some defence of diagnoses it replaced such as adolescent insanity.The word schizophrenia - which translates roughly as "splitting of the mind" and comes from the Greek roots schizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-, "mind") - was coined by Eugen Bleuler in 1908 and was intended to describe the separation of function between personality, thinking, memory, and perception. Bleuler described the main symptoms as 4 A's: flattened Affect, Autism, impaired Association of ideas and Ambivalence.

Bleuler realized that the illness was not a dementia as some of his patients improved rather than deteriorated and hence proposed the term schizophrenia instead.The term schizophrenia is commonly misunderstood to mean that affected persons have a "split personality". Although some people diagnosed with schizophrenia may hear voices and may experience the voices as distinct personalities, schizophrenia does not involve a person changing among distinct multiple personalities.

The confusion arises in part due to the meaning of Bleuler's term schizophrenia (literally "split" or "shattered mind"). The first known misuse of the term to mean "split personality" was in an article by the poet T. S. Eliot in 1933.In the first half of the twentieth century schizophrenia was considered to be a hereditary defect, and sufferers were subject to eugenics in many countries. Hundreds of thousands were sterilized, with or without consent - the majority in Nazi Germany, the United States, and Scandinavian countries. Along with other people labeled "mentally unfit", many diagnosed with schizophrenia were murdered in the Nazi "Action T4" program.In the early 1970s, the diagnostic criteria for schizophrenia was the subject of a number of controversies which eventually led to the operational criteria used today. It became clear after the 1971 US-UK Diagnostic Study that schizophrenia was diagnosed to a far greater extent in America than in Europe. This was partly due to looser diagnostic criteria in the US, which used the DSM-II manual, contrasting with Europe and its ICD-9. David Rosenhan's 1972 study, published in the journal Science under the title On being sane in insane places, concluded that the diagnosis of schizophrenia in the US was often subjective and unreliable. These were some of the factors in leading to the revision not only of the diagnosis of schizophrenia, but the revision of the whole DSM manual, resulting in the publication of the DSM-III in 1980. Since the 1970s more than 40 diagnostic criteria for schizophrenia have been proposed and evaluated.

In the Soviet Union the diagnosis of schizophrenia has also been used for political purposes. The prominent Soviet psychiatrist Andrei Snezhnevsky created and promoted an additional sub-classification of sluggishly progressing schizophrenia. This diagnosis was used to discredit and expeditiously imprison political dissidents while dispensing with a potentially embarrassing trial. The practice was exposed to Westerners by a number of Soviet dissidents, and in 1977 the World Psychiatric Association condemned the Soviet practice at the Sixth World Congress of Psychiatry. Rather than defending his theory that a latent form of schizophrenia caused dissidents to oppose the regime, Snezhnevsky broke all contact with the West in 1980 by resigning his honorary positions abroad.Social stigma has been identified as a major obstacle in the recovery of patients with schizophrenia. In a large, representative sample from a 1999 study, 12.8% of Americans believed that individuals with schizophrenia were "very likely" to do something violent against others, and 48.1% said that they were "somewhat likely" to.

Over 74% said that people with schizophrenia were either "not very able" or "not able at all" to make decisions concerning their treatment, and 70.2% said the same of money management decisions. The perception of individuals with psychosis as violent has more than doubled in prevalence since the 1950s, according to one meta-analysis.

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