This systematic review (SR) evaluated the influence of reminder therapy on the plaque index (PI), gingival index (GI) and the occurrence of white spots in orthodontic patients. The conclusion claimed to be based on high-quality evidence that reminder therapy may contribute to improvements in these outcomes. The SR was mainly well done, but there are concerns regarding the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE), which should evaluate outcomes, not individual studies. For the risk of bias (RoB), the authors report that blinding was considered not applicable because it is impossible to blind the individual who administered the treatment. As the participants were not blinded, there may be performance bias. If the outcome can potentially be influenced by knowledge regarding randomization, there is a serious problem with RoB. Moreover, there are different types of reminders (messages, phone calls and others). Thus, the evidence for all reminders is limited, which is a problem of indirectness. Finally, the forest plots for PI and GI clearly show problems of inconsistency: the effect estimates are not similar, confidence intervals do not overlap and there is high heterogeneity, with significant p-values. The certainty of evidence should be rated down due to RoB, indirectness and inconsistency for white spots as well as RoB and indirectness for PI and GI. The conclusion should be that the effectiveness of reminders at reducing the PI, GI and white spots in orthodontic patients has a low to very low certainty of evidence.
Citing the SEARCH for diabetes in youth study (SEARCH) and the US Census Bureau population demographic projections, the latest practice paper published by AADE, “Pediatric Diabetes: The Role of the Diabetes Educator Based on Etiology of the Diagnosis,” addresses the rapidly rising incidence rates of both type 1 and type 2 diabetes in the pediatric population. Diabetes education is critical for this age group as educators work closely with both children and their families and must address developmental stages, family dynamics, and health literacy. The different forms of diabetes require unique educational strategies for approaching the disease, and the variability in educational approach from one form to another can have a positive impact on health outcomes for children with diabetes. In this article, we outline the highlights for addressing each form of the condition. For more detailed information on addressing the diabetes educational needs in the pediatric population, please refer to the full practice paper.
Intermittent fasting encompasses various diets that cycle between periods of fasting and nonfasting; these diets don’t necessarily specify what to eat but when to eat. They range from fasting for whole days at a time to fasting for a matter of hours during the day. Historically, fasting was inevitable in times when food was not readily available, and many religious philosophies have practiced fasting for centuries; however, cyclically restricting or reducing calories has recently taken off as a popular way to lose weight and improve health outcomes. Although preliminary research shows intermittent fasting may be as effective for weight loss as continuous caloric restriction, more research is needed to determine the long-term effects of intermittent fasting on other pertinent diabetes clinical outcomes. Intermittent fasting is generally grouped into two main categories: whole-day fasting and time-restricted feeding. Both categories range in flexibility of time spent fasting. Whole-day fasting includes regular 24-hour time periods of fasting; the strictest form is alternate-day fasting where 24 hours of fasting are followed by 24 hours of nonfasting continuously. Less strict but similar is the alternate-day modified fasting in which fasting days are allowed the limited consumption of 500 to 600 calories. Probably the most popular type of whole-day fasting is 5:2, 5 days of nonfasting followed by 2 days of fasting or modified fasting allowing 500 to 600 calories. Instead of restricting full days of eating, time-restricted feeding involves fasting during specified hours of the day. Perhaps the most popular type of time-restricted feeding is 16:8, 16 hours of fasting followed by an 8-hour time period of nonfasting. More flexible and strict time restrictions exist such as 12:12 (12 hours fasting, 12 hours nonfasting) and eating 1 meal per day (about 23 hours of fasting). Generally, the idea behind intermittent fasting is to reduce total amount of calories consumed to lose excess weight and benefit from positive health benefits that may come along with weight loss. Intermittent Fasting for Weight Loss: Pros and Cons for People With Diabetes
Alec Raeshawn Smith. Shane Patrick Boyle. Antavia Lee Worsham. Seely Weatherell. Danielle DeShae Dunbar. What do these 5 people have in common? They’ve all lost their lives because of the outrageous cost of insulin in the United States. Sadly, these are just a few of the names of people who’ve died in recent years, as the cost of insulin continues to soar. When I was first diagnosed with type 1 diabetes in 1999 at the age of 13, my insulin cost around $20. Today, that same vial is around $340, and I go through 2 vials a month (I wear an insulin pump). And this is just ONE of my diabetes prescriptions. Over the years, I’ve become increasingly more passionate about this topic as the sticker shock has touched me personally and I’ve read the devastating stories of others who struggle to afford their insulin—including some that die because they can’t.
It is hard to be involved in diabetes care and not hear about population health. Some of us are deeply entrenched in “pop health,” and others feel far removed and may not even quite understand the concept. Most of us are probably somewhere in the middle. There is a whole vocabulary used in pop health (starting with the terms population health and pop health) that we may hear but don’t really understand. Given that diabetes is often the case study used when people talk about pop health, it is an area that we should all start to get comfortable with and embrace as we move forward. So, what is pop health? Put most simply, it is the health of populations. In the past, we generally worked in diabetes care with the sole focus on the individual rather than a population. We still focus on the individual during day-to-day encounters but now include the concept of thinking about the very big picture of how our work is related to the whole population. In this issue of AADE In Practice and in an upcoming issue of The Diabetes Educator journal, you will see articles that help you better understand pop health. If you’re new to the topic, you can start to develop a sense of how pop health affects your work and how you fit into it. I expect you will start to realize that without realizing it, you are naturally incorporating some of the key concepts of pop health into what you do. For example, let’s consider the concept of social determinants of health (SDOH), a term that comes into play in pop health. When working in diabetes education with an individual or a group, we must consider the influence the external environment has on diabetes care and self-management. This can include such things as access to health care, the physical environment, availability of food and places to be active, social support, education, and economic stability, to name a few. We might not think of the terminology of SDOH but do consider how these areas influence the health of the people we serve. The concept of pop health is weaved throughout our PROJECT VISION, AADE’s vision for the specialty. Let’s look at each strategy of the vision with a lens on pop health.
According to the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, unmanaged hypertension is responsible for more cardiovascular-related deaths in the United States than any modifiable risk factor except smoking. Its prevalence depends on the blood pressure used to classify patients. Estimates using ACC/AHA criteria of 130/80 mmHg now suggest 46% or nearly half the US population has high blood pressure. A study from the American Heart Journal found people with diabetes are twice as likely to have hypertension compared to others at the same age without diabetes and have an overall prevalence of 80%. The high prevalence of hypertension in people with diabetes elevates their risk for the development of microand macrovascular complications. Both contribute to morbidity and mortality in people with diabetes, but data from the UKPDS trial found the leading cause of death is due to macrovascular disease. The purpose of this article is to review the application of the 2017 ACC/AHA blood pressure guidelines to people with diabetes.
Peterson Center on Healthcare Announces New Initiative to Support States to Monitor and Control Healthcare Spending The Peterson Center on Healthcare announced a new $2.7 million grant to the Milbank Memorial Fund to support efforts to set and track healthcare spending targets at the state level. Sep 15, 2020 [13] Source: Peterson-Kaiser Health System Tracker How Does the Quality of the U.S. Healthcare System Compare to Other Countries? This chart collection provides a baseline of how the U.S. already compared to similarly large and wealthy countries prior to the onset of the coronavirus pandemic—exploring a number of different metrics used to look at health outcomes, quality of care and access to services. Aug 20, 2020 [14] Source: Peterson-Kaiser Health System Tracker How Private Insurers Are Using Telehealth to Respond to the Pandemic In this brief, we discuss how private insurance plans have taken a variety of steps to expand telemedicine uptake and access during the COVID-19 pandemic. Aug 6, 2020 [15] Source: STAT Science Alone Cannot Beat the Pandemic. We Also Need Outreach About a COVID-19 Vaccine Americans anxiously await two key benefits that a Covid-19 vaccine will deliver: freedom from fear and a return to normal. Jul 27, 2020 [16] Source: Peterson-Kaiser Health System Tracker COVID-19 Repercussions May Outweigh Recent Gains in U.S. Health System Performance In this brief, we look at the bigger picture of what the latest data convey about how well the U.S. health system is performing, and how the coronavirus pandemic may affect key indicators. Jul 23, 2020 [17] Source: Peterson-Kaiser Health System Tracker COVID-19 Test Prices and Payment Policy Our analysis of what large hospitals nationwide charge for out-of-network COVID-19 tests show a wide range of publicly posted prices—from $20 to $850 for a single test.
Authors Haroon Amir Katherine Baucom Jana Beckering Ektaa Brahmbhatt Sumner Brooks John Bucheit Andrew Bzowyckyj Jennifer Clements Marjorie Cypress Mary de Groot Victor Diaz Lorena Drago Shannon Eaves Amy Egras Megan Elavsky Angela Forfi a Benjamin Forrest Betsy Gillenwater Jasmine Gonzalvo Jay Hamm Rachel Head Felicia Hill-Briggs Kyle Holsinger Erin Horetski Diana Isaacs Karen Kemmis Janice MacLeod Dawn McCarter Amber McCulloch Kevin McMahon Karen Meadows Ashley Meredith Cynthia Munoz Quinn Nystrom Christopher Parkin Teresa Pearson Steven Ponder Charles Ponte Sara (Mandy) Reece Natalie Ritchie Kellie Rodriguez Lana Sherr Evan Sisson Toby Smithson Rachel Taft Patty Telgener Jessica Triboletti Victoria Trusty Miriam Tucker Geoff rey Twigg Andrew Wakefi eld Nancy Waldbillig Brenda Weedman Tara Whetsel Neva White Cheryl Williams Kirsten Yehl
News & Events The Peterson Center on Healthcare is dedicated to making the vision of better healthcare for lower cost a reality. Browse news from the Center, and read about our upcoming events. News Source: Peterson-Kaiser Health System Tracker Urban and Rural Differences in Coronavirus Pandemic Preparedness The novel coronavirus was slower to spread to rural areas in the U.S., but that appears to be changing, with new outbreaks becoming evident in less densely populated parts of the country. In this brief, we analyze variation in hospital bed capacity by region in the U.S. Apr 22, 2020 [13] Source: Peterson-Kaiser Health System Tracker How Health Costs Might Change With COVID-19 As the coronavirus spreads rapidly across the United States, private health insurers and government health programs could potentially face higher healthcare costs. Apr 15, 2020 [14] Source: The New England Journal of Medicine Ten Weeks to Crush the Curve If we take these six steps to mobilize and organize the nation, we can defeat Covid-19 by early June. Apr 1, 2020 [15] Source: American Enterprise Institute National Coronavirus Response: A Road Map to Reopening This report provides a road map for navigating through the current COVID-19 pandemic in the United States. Mar 29, 2020 [16] Source: Peterson-Kaiser Health System Tracker How Prepared Is the U.S. to Respond to COVID-19 Relative to Other Countries? The ongoing coronavirus pandemic has already overwhelmed the health systems of several countries and is projected to overburden the U.S. health system. Mar 27, 2020 [17] Source: The Hamilton Project A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market
