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This study estimates the association between Medicare eligibility and support for recent proposals to expand program participation and benefits.

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The expansion of Medicaid under the Affordable Care Act (ACA) increased access to health care for many low-income children. However, the impact of this expansion on the timing of primary cleft lip and palate repair remains unclear. This study aimed to evaluate whether Medicaid expansion improved access to timely cleft lip and palate repair and whether it reduced preexisting ethnoracial disparities. Using a quasi-experimental design, the study analyzed data from 44 pediatric surgical centers across the United States. The results showed that Medicaid expansion was associated with a 9.0 percentage-point increase in delayed cleft lip repairs, resulting in an average delay of 16 days. Non-White patients were disproportionately affected by this delay, experiencing a 14.8 percentage-point increase compared with a 4.9 percentage-point increase for White patients. In contrast, Medicaid expansion had no significant effect on the timing of palate repair or on ethnoracial disparities in palate repair. The study underscores the importance of monitoring unintended consequences of large-scale health system changes, especially those affecting disadvantaged populations. Delayed cleft lip repair can lead to worse outcomes for patients, and the disproportionate impact on non-White patients is concerning. Further research is needed to identify the reasons for this delay and to mitigate its effects. Overall, the study highlights the need for ongoing vigilance to ensure that health care policies and interventions do not inadvertently worsen health disparities.

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Periodontitis is a disease characterized by tooth-associated microbial biofilms that drive chronic inflammation and destruction of periodontal-supporting tissues. In some individuals, disease progression can lead to tooth loss. A similar condition can occur around dental implants in the form of peri-implantitis. The immune response to bacterial challenges is not only influenced by genetic factors, but also by environmental factors. Epigenetics involves the study of gene function independent of changes to the DNA sequence and its associated proteins, and represents a critical link between genetic and environmental factors. Epigenetic modifications have been shown to contribute to the progression of several diseases, including chronic inflammatory diseases like periodontitis and peri-implantitis. This review aims to present the latest findings on epigenetic influences on periodontitis and to discuss potential mechanisms that may influence peri-implantitis, given the paucity of information currently available.

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Importance: COVID-19 lockdowns may affect economic and health outcomes, but evidence from low- and middle-income countries remains limited. Objective: To assess the economic security, food security, health, and sexual behavior of women at high risk of HIV infection in rural Kenya during the COVID-19 pandemic. Design, Setting, and Participants: This survey study of women enrolled in a randomized trial in a rural county in Kenya combined results from phone interviews, conducted while social distancing measures were in effect between May 13 and June 29, 2020, with longitudinal, in-person surveys administered between September 1, 2019, and March 25, 2020. Enrolled participants were HIV-negative and had 2 or more sexual partners within the past month. Surveys collected information on economic conditions, food security, health status, and sexual behavior. Subgroup analyses compared outcomes by reliance on transactional sex for income and by educational attainment. Data were analyzed between May 2020 and April 2021. Main Outcomes and Measures: Self-reported income, employment hours, numbers of sexual partners and transactional sex partners, food security, and COVID-19 prevention behaviors. Results: A total of 1725 women participated, with a mean (SD) age of 29.3 (6.8) years and 1170 (68.0%) reporting sex work as an income source before the COVID-19 pandemic. During the pandemic, participants reported experiencing a 52% decline in mean (SD) weekly income, from $11.25 (13.46) to $5.38 (12.51) (difference, -$5.86; 95% CI, -$6.91 to -$4.82; P < .001). In all, 1385 participants (80.3%) reported difficulty obtaining food in the past month, and 1500 (87.0%) worried about having enough to eat at least once. Reported numbers of sexual partners declined from a mean (SD) total of 1.8 (1.2) partners before COVID-19 to 1.1 (1.0) during (difference, -0.75 partners; 95% CI, -0.84 to -0.67 partners; P < .001), and transactional sex partners declined from 1.0 (1.1) to 0.5 (0.8) (difference, -0.57 partners; 95% CI, -0.64 to -0.50 partners; P < .001). In subgroup analyses, women reliant on transactional sex for income were 18.3% (95% CI, 11.4% to 25.2%) more likely to report being sometimes or often worried that their household would have enough food than women not reliant on transactional sex (P < .001), and their reported decline in employment was 4.6 hours (95% CI, -7.9 to -1.2 hours) greater than women not reliant on transactional sex (P = .008). Conclusions and Relevance: In this survey study, COVID-19 was associated with large reductions in economic security among women at high risk of HIV infection in Kenya. However, shifts in sexual behavior may have temporarily decreased their risk of HIV infection.

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INTRODUCTION: In response to the COVID-19 pandemic, governments have implemented social distancing measures to slow viral transmission. This work aims to determine the extent to which socioeconomic and political conditions have shaped community-level distancing behaviors during the COVID-19 pandemic, especially how these dynamics have evolved over time. METHODS: This study used daily data on physical distancing from 15‒17 million cell phone users in 3,037 U.S. counties. County-level changes in the average distance traveled per person were estimated relative to prepandemic weeks as a proxy for physical distancing. Pooled ordinary least squares regressions estimated the association between physical distancing and a variety of county-level demographic, socioeconomic, and political characteristics by week from March 9, 2020 to January 17, 2021. Data were collected until January 2021, at which point the analyses were finalized. RESULTS: Lower per capita income and greater Republican orientation were associated with significantly reduced physical distancing throughout nearly all the study period. These associations persisted after adjusting for a variety of county-level demographic and socioeconomic characteristics. Other county-level characteristics, such as the shares of Black and Hispanic residents, were associated with reduced distancing at various points during the study period. CONCLUSIONS: These results highlight the importance of dynamic socioeconomic and political gradients in preventive behavior and imply the need for nimble policy responses.

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INTRODUCTION: Head and neck cancer is a deadly cancer that ranks among the six most common cancers worldwide. The HPV vaccine has been used to prevent head and neck cancer of the oropharynx, and changes in health policies and state law are impacting the role of dental professionals in HPV vaccination. However, relatively little is known about dental professionals' attitudes regarding the vaccine. OBJECTIVES: Our study assesses dental professionals' willingness to administer the HPV vaccine, their confidence discussing HPV with patients, beliefs about the vaccine's efficacy, perceived barriers to administering it, and sites of referral. METHODS: We surveyed 623 dental professionals, including dentists, hygienists, dental students, and hygiene students across Michigan. Attitudes toward the vaccine and predictive characteristics were evaluated by logistic regression, ANOVAs, and t-tests. RESULTS: The majority of the respondents (51% of dentists, 63% of hygienists, 82% of dental students, and 71% of hygiene students) were willing to administer the HPV vaccine if allowed by law. The role of dental and dental hygiene students would be one of advocacy, educating and recommending the vaccine, and the dental students administering it once licensed. Dental professionals were variably confident discussing HPV with patients and generally believed it enhanced patients' health. Stronger confidence and beliefs were associated with greater willingness to administer the vaccine. Barriers among professionals opposing the HPV vaccine included lack of knowledge on the subject, liability concerns, and personal beliefs. CONCLUSION: Dental professionals can become leaders in preventing HPV-related cancers. Training and continuing education courses could enhance their confidence and willingness to recommend and administer the HPV vaccine. POLICY IMPLICATIONS: Legislation that permits dental professionals to administer the vaccine could increase the vaccine's accessibility to patients, improve vaccination rates, and population health.

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INTRODUCTION: Interventions informed by behavioural economics, such as planning prompts, have the potential to increase HIV testing at minimal or no cost. Planning prompts have not been previously evaluated for HIV testing uptake. We conducted a randomised clinical trial to evaluate the effectiveness of low-cost planning prompts to promote HIV testing among men. METHODS: We randomised adult men in rural Ugandan parishes to receive a calendar planning prompt that gave them the opportunity to make a plan to get tested for HIV at health campaigns held in their communities. Participants received either a calendar showing the dates when the community health campaign would be held (control group) or a calendar showing the dates and prompting them to select a date and time when they planned to attend (planning prompt group). Participants were not required to select a date and time or to share their selection with study staff. The primary outcome was HIV testing uptake at the community health campaign. RESULTS: Among 2362 participants, 1796 (76%) participants tested for HIV. Men who received a planning prompt were 2.2 percentage points more likely to test than the control group, although the difference was not statistically significant (77.1% vs 74.9%; 95% CI -1.2 to 5.7 percentage points, p=0.20). The planning prompt was more effective among men enrolled ≤40 days before the campaigns (3.6 percentage-point increase in testing; 95% CI -2.9 to 10.1, p=0.27) than among men enrolled >40 days before the campaigns (1.8 percentage-point increase; 95% CI -2.3 to 5.8, p=0.39), although the effects within the subgroups were not significant. CONCLUSION: These findings suggest that planning prompts may be an effective behavioural intervention to promote HIV testing at minimal or no cost. Large-scale studies should further assess the impact and cost-effectiveness of such interventions.

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The reconstruction of alveolar bone defects associated with teeth and dental implants remains a clinical challenge in the treatment of patients affected by disease or injury of the alveolus. The aim of this review was to provide an overview on advances made in the use of personalized scaffolding technologies coupled with biologics, cells and gene therapies that offer future clinical applications for the treatment of patients requiring periodontal and alveolar bone regeneration. Over the past decade, advancements in three-dimensional (3D) imaging acquisition technologies such as cone-beam computed tomography (CBCT) and precise scaffold fabrication methods such as 3D bioprinting have resulted in personalized scaffolding constructs based on individual patient-specific anatomical data. Furthermore, 'fiber-guiding' scaffold designs utilize topographical cues to guide ligamentous fibers to form in orientation towards the root surface to improve tooth support. Therefore, a topic-focused literature search was conducted looking into fiber-guiding and image-based scaffolds and their associated clinical applications.

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Periodontal disease destroys supporting structures of teeth. However, tissue engineering strategies offer potential to enhance regeneration. Here, the strategies of patterned topography, spatiotemporally controlled growth factor gene delivery, and cell-based therapy to repair bone-periodontal ligament (PDL) interfaces are combined. Micropatterned scaffolds are fabricated for the ligament regions using polycaprolactone (PCL)/polylactic-co-glycolic acid and combined with amorphous PCL scaffolds for the bone region. Scaffolds are modified using chemical vapor deposition, followed by spatially controlled immobilization of vectors encoding either platelet-derived growth factor-BB or bone morphogenetic protein-7, respectively. The scaffolds are seeded with human cells and delivered to large alveolar bone defects in athymic rats. The effects of dual and single gene delivery with and without micropatterning are assessed after 3, 6, and 9 weeks. Gene delivery results in greater bone formation at three weeks. Micropatterning results in regenerated ligamentous tissues similar to native PDL. The combination results in more mature expression of collagen III and periostin, and with elastic moduli of regenerated tissues that are statistically indistinguishable from those of native tissue, while controls are less stiff than native tissues. Thus, controlled scaffold microtopography combined with localized growth factor gene delivery improves the regeneration of periodontal bone-PDL interfaces.

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