Faculty Bibliography

OBJECTIVES/OBJECTIVE:Second-hand smoke (SHS) exposure has been identified as a risk factor for several childhood health problems including dental caries. The purpose of this study was to examine the association of postbirth SHS exposure and dental caries and to determine whether the association is independent of prenatal tobacco exposure, sugar consumption and dental utilization. METHODS:NHANES 2013-2014 and 2015-2016 were used to examine the research question in 1733 children, 4-11 years old with full primary or mixed dentition and serum cotinine levels below 10 ng/mL. Weighted multivariable logistic regression models were developed to examine the independent association between SHS exposure and the prevalence of (i) any dental caries experience and (ii) any decayed teeth. RESULTS:Children exposed to postbirth SHS differed from children not exposed regarding decayed teeth prevalence in the total sample (OR = 1.80, 95% CI: 1.20, 2.71) and mixed dentition (OR = 1.86, 95% CI: 1.20, 2.90) after confounder adjustment. However, no association was found in the primary dentition or between SHS exposure and total caries experience. CONCLUSIONS:The findings partially show that postbirth SHS is associated with dental caries in children. However, the inconsistencies in findings across the three samples and between the two outcome measures, dental caries experience and decayed teeth prevalence raise questions regarding the validity of the hypothesis. Further, the findings suggest that postbirth SHS is likely a marker for true causes of dental caries and the association is likely confounded with other factors associated with dental caries.

The Hispanic population has one of the highest levels of untreated oral disease of any linguistic or ethnic population in the United States. Research examining the factors leading to such outcomes is limited. Since health literacy has been identified as a mediator of health disparities, it is important to identify the most appropriate tool to assess it. The Knowledge Related to Oral Health Literacy model for Spanish speakers (KROHL-S) is an inclusive framework to evaluate oral health knowledge and other modifiable factors at the individual level among the Hispanic population as related to oral health literacy. KROHL-S intends to provide concrete, practical information to help customize interpersonal interactions and educational experiences to individuals' needs and capabilities. The questionnaire that will allow the creation of the KROHL-S scale consists of orally administered open-ended questions to measure knowledge that is condition specific (caries, periodontal disease, oral cancer, tooth loss, and malocclusion) and domain that is knowledge specific (identification of condition, causes, prevention, treatment, general knowledge). Implementation of the KROHL-S framework will provide in depth information that could be shared among health care providers and the creation of patient-centred initiatives.

OBJECTIVE:The primary purpose of this study was to develop an operational definition of the oral condition of ankyloglossia (also called tongue-tie) that occurs in newborns (i.e., age birth-6 months) and that could consistently be used in research studies. STUDY DESIGN/METHODS:This 4-round Delphi survey developed the consensus New York University-Tongue-Tie Case Definition (NYU-TTCD) by using a panel of ankyloglossia treatment experts. RESULTS:This tongue-tie case definition (TTCD) was carefully created in a step-wise manner from the bottom up by expert panelists over 4 rounds of inquiry. As a functioning case definition, it offers the diagnostician 2 separate pathways to identifying a newborn as being tongue tied. One pathway requires but a single pathognomonic anatomic feature, and the other pathway requires a single functional deficit accompanied by at least 2 of 12 other diagnostic items (functional, anatomic, or behavioral). CONCLUSIONS:This Delphi survey, as administered to a panel of ankyloglossia treatment experts, produced the first consensus case definition of tongue-tie for newborns (i.e., age birth-6 months) for use in epidemiologic research studies ranging from descriptive prevalence studies to clinical trials. Next-step studies should establish the validity, reliability, and utility of this novel NYU-TTCD case definition for epidemiologic and clinical purposes.

The purpose of this follow-up Delphi survey was to have an expert panel of 31 academic geriatric physicians, geriatric nurses, and medical directors of nursing homes evaluate the original timeline set to avoid oral neglect of nursing home residents. The Oral Neglect in Institutionalized Elderly (ONiIE) timelines defined oral neglect as having occurred when >7 days for acute oral diseases/conditions or >34 days for chronic oral disease/conditions had passed between initial diagnosis and offering access to dental care to the long-term care (LTC) nursing home resident. The results of this follow-up Delphi survey validated those originally defined ONiIE timelines as 90% of this panel agreed with the original timelines. This ONiIE definition adds a broad-based validation for the ONiIE timelines for setting an oral health standard of care for institutionalized elderly residents of nursing homes and should now be used to protect the vulnerable elderly residing in LTC nursing homes.

This review presents the first detailed presentation of the parallelism between the Tuskegee Syphilis Study and the Captain America graphic novel 'TRUTH: Red, White and Black', published as a graphic novel by Marvel Comics in 2004 as a paperback, and then in 2009 as a hardcover. First written, published and distributed monthly in 2003 as pre-sequel seven comic book series to tell the story of the origins of the WWII superhero Captain America. In 2003, Marvel Comics chose to tell a 'very dark story' to explain the origins of Captain America, a half century after the initial introduction of Captain America as a WWII action hero in 1940. By detailing-for the first time-nine parallel aspects between these two storylines, this review demonstrates how Marvel Comics brought the tragic Tuskegee Syphilis Study story into the popular press, thus reaching an audience far beyond traditional bioethics academicians. This review is intended to stimulate and guide classroom discussions on the ethical issues at the core of the infamous Tuskegee Syphilis Study allowing bioethical issues to be made more accessible to the general public, via school curriculums, by the use of graphic novels.

OBJECTIVES/UNASSIGNED:To determine the frequency and severity of 17 requests for inappropriate analysis and reporting of data that biostatisticians received from researchers in statistical consultations, as indirectly experienced (i.e., either heard about or observed being asked of other biostatisticians). METHODS/UNASSIGNED:A randomly drawn sample of 522 members of the American Statistical Association who self-identified as consulting biostatisticians were selected to participate in an online survey with the Bioethical Issues in Biostatistical Consulting Questionnaire, specifically developed for this study. RESULTS/UNASSIGNED:Of the 522 consulting biostatisticians contacted, 390 (74.7%) completed the survey. The top 4 most frequently reported indirectly experienced inappropriate requests rated as "high severity" by at least 50% of the respondents were as follows: 1) proposing a study with a flawed design, including insufficient power; 2) setting aside values when the outcome turns on a few outliers; 3) reporting results of data analysis from only subsets of the data; and 4) overstating the statistical findings well beyond what the data support so that readers are misled. CONCLUSIONS/UNASSIGNED:This article is a follow-up report to our recently published article on 18 directly experienced inappropriate and/or unethical requests by biomedical researchers of their consulting biostatisticians. These additional survey findings from the Bioethical Issues in Biostatistical Consulting Questionnaire on 17 indirectly experienced inappropriate requests show the following: 1) the widespread nature of inappropriate, if not, frankly unethical requests made by biomedical researchers of their consulting biostatisticians and 2) the urgent need to develop and offer educational programs for biomedical researchers in training to correct these behaviors-be they intentional or accidental. This report speaks to the urgency for developing training programs for new and existing researchers to reduce the frequency of these inappropriate bioethical requests during biostatistical consultations. KNOWLEDGE TRANSFER STATEMENT/UNASSIGNED:The findings from this U.S. national survey of biostatisticians on inappropriate requests for data analyses by biomedical researchers strongly suggest a need for remedial actions, including 1) new educational modules for in-development and currently employed biomedical researchers, 2) improved institutional environments by research universities and companies regarding job and publication pressures, and 3) inclusion of a collaborating biostatistician as a working research team member from the early planning stages of all biomedical studies.

Background/UNASSIGNED:Inappropriate analysis and reporting of biomedical research remain a problem despite advances in statistical methods and efforts to educate researchers. Objective/UNASSIGNED:To determine the frequency and severity of requests biostatisticians receive from researchers for inappropriate analysis and reporting of data during statistical consultations. Design/UNASSIGNED:Online survey. Setting/UNASSIGNED:United States. Participants/UNASSIGNED:A randomly drawn sample of 522 American Statistical Association members self-identifying as consulting biostatisticians. Measurements/UNASSIGNED:The Bioethical Issues in Biostatistical Consulting Questionnaire soliciting reports about the frequency and perceived severity of specific requests for inappropriate analysis and reporting. Results/UNASSIGNED:Of 522 consulting biostatisticians contacted, 390 provided sufficient responses: a completion rate of 74.7%. The 4 most frequently reported inappropriate requests rated as "most severe" by at least 20% of the respondents were, in order of frequency, removing or altering some data records to better support the research hypothesis; interpreting the statistical findings on the basis of expectation, not actual results; not reporting the presence of key missing data that might bias the results; and ignoring violations of assumptions that would change results from positive to negative. These requests were reported most often by younger biostatisticians. Limitations/UNASSIGNED:The survey provides information on the reported frequency of inappropriate requests but not on how such requests were handled or whether the requests reflected researchers' maleficence or inadequate knowledge about statistical and research methods. In addition, other inappropriate requests may have been made that were not prespecified in the survey. Conclusion/UNASSIGNED:This survey suggests that researchers frequently make inappropriate requests of their biostatistical consultants regarding the analysis and reporting of their data. Understanding the reasons for these requests and how they are handled requires further study. Primary Funding Source/UNASSIGNED:U.S. Department of Health and Human Services.

This paper reports the changed findings over a 40-year period on oral health knowledge, attitudes, and practices (KAP) of a very remote and rural population living the Jeremie region of Haiti. The far-sighted investigators of that original 1970 survey stated in their published 1972 paper that our "…findings are descriptive, but have to be accepted tentatively rather than definitively because time was short, transportation was difficult, and the small sample that had to be used could not random." They further insightfully stated their hopes that their "…results may be regarded as an anthropological cultural baseline from which to review further findings concerning Haitian dental beliefs." The two follow-up surveys in 1997 and 2010 using the same exact KAP questionnaire on the same population of rural Haitians living in the Jeremie region fulfilled the extraordinary vision of those two initial investigators, Dr. Wesley Young (a nationally renowned U.S. public health dental academician) and Paul Rundberg (then a dental student at the University of Kentucky).