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PDF Editor FAQ

How would you change health care in the U.S.? I’m asking about actual care, so assume for purposes of the question that access to healthcare wasn’t an issue.

I would integrate oral and systemic health care in terms of care delivery, provider education, health care research design, health information technology, payer structures, and quality assurance. There is no logic in the arbitrary separation of medical and dental care, as confirmed by Weisz G, McGill University, who focuses on medical specialization (please see: Weisz G (2006), Divide and Conquer: A Comparative History of Medical Specialization (Oxford), “Stomatology vs. Dentistry,” pp. 218-225.)Research documents the significance of oral health for general (systemic) health, as well as the interrelationships between oral health conditions and chronic illness conditions such as CVD, inflammatory diseases, respiratory diseases, cancers, term stillbirth. Please see:Simon L, Obadan-Udoh E, Yansane AI, Gharpure A, Licht S, Calvo J, Deschner JJ, Damanaki A, Hackenberg B, Walji M, Spallek H, Kalenderian E (2019). Improving Oral-Systemic Healthcare through the Interoperability of Electronic Medical and Dental Records: An Exploratory Study. Appl Clin Inform 10(3): 367-376. doi: 10.1055/s-0039-1688832. Epub 2019 May 29. At: https://www.ncbi.nlm.nih.gov/pubmed/31141831Ishai A, Takx R, Abdelrahman A, El Kholy K, Van Dyke T, Tawakoi A (2018). Abstract 20033: Periodontal Disease Activity Independently Predicts Future Risk for Cardiovascular Events. Circulation 134, Supplement 1. https://www.ahajournals.org/doi/abs/10.1161/circ.134.suppl_1.20033Batty GD, Jun KJ, Mok Yejin, Lee SJ, Back JH, Lee S, Jee SH (2018). Oral health and later coronary heart disease: Cohort study of one million people. Eur J Prev Cardiol 25(6):598-605. Doi: 10-1177/2047487318759112 At: https://journals.sagepub.com/doi/pdf/10.1177/2047487318759112Allareddy V, Prakasam S, Rampa S, Stein K, Nalliah RP, Allareddy V, Venugopalan RS. (2017). Impact of Periapical Abscess on Infectious Complications in Patients Undergoing Extracorporeal Circulation Auxiliary to Open-Heart Surgical Procedures. J Evid Based Dent Pract. 2017 Mar;17(1):13-22.Potempa J, Mydel P, Koziel J (2017). The Case for Periodontitis in the Pathogenesis of Rheumatoid Arthritis. Nat Rev Rheumatol 13(10): 606-620. doi: 10.1038/nrrheum.2017.132. Epub 2017 Aug 24. At: https://pubmed.ncbi.nlm.nih.gov/28835673/Sampson V, Kamona N, Sampson A (2020). Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections? Br Dent J 228, 971–97 https://doi.org/10.1038/s41415-020-1747-8 At: https://www.nature.com/articles/s41415-020-1747-8Zimmerman S, Sloan PD, Ward K, Wretman CJ, Stearns SC, Poole P, Preisser JS (2020). Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence: A Cluster Randomized Trial. JAMA Network Open 3(6): e204321 doi:10.1001/jamanetworkopen.2020.4321 At: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767357https://www.dental.columbia.edu/news/how-common-oral-bacteria-makes-colon-cancer-more-deadly New York, NY (March 4, 2019) – Researchers at the Columbia University College of Dental Medicine have determined how F. nucleatum — a common oral bacteria often implicated in tooth decay — accelerates the growth of colon cancer. Please see: Rubinstein MR, Baik JE, Lagana SM, Han RP, Raab WJ, Sahoo D, Dalerba P, Wang TC, Han YW (2019). Fusobacterium nucleatum promotes colorectal cancer by inducing Wnt/β‐catenin modulator Annexin A1. EMBO Rep (2019)20:e47638 https://doi.org/10.15252/embr.201847638 At: https://www.embopress.org/doi/10.15252/embr.201847638Garcia J, Zhang X, Yang X, Rubinstein MR, Mao DY, Kitajewski J, Liu K, Han YW (2019). Omega-3 fatty acids suppress Fusobacterium nucleatum–induced placental inflammation originating from maternal endothelial cells [oral microbe] Term Stillbirth: https://insight.jci.org/articles/view/125436Research documents the potential for achieving health care cost reduction through integration. Please see:Nasseh K, Vujicic M, Glick M (2017). The relationship between periodontal interventions and healthcare costs and utilization: evidence from an integrated dental, medical, and pharmacy commercial claims database. Health Econ 26(4):519-527. At: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347922/pdf/HEC-26-519.pdfIt is vital to integrate EHR technology (medical-dental-behavioral, as in the HIT of the VA, US Military, Indian Health Service, and EHRs serving HRSA’s FQHCs in accordance with the recommendations of HRSA’, IOHPCP: HRSA (2014). IOHPCP (Integration of Oral Health and Primary Care Practice): https://www.hrsa.gov/sites/default/files/hrsa/oralhealth/integrationoforalhealth.pdf) or, at least, medical and dental records, so that providers (both medical and dental) have information about the entire patient, without arbitrary omission of comorbidity (as understood interdisciplinarily). Such integration helps avoid bias and improve quality in machine learning (ML) and artificial intelligence (AI) technologies. To avoid serious weakness in the design of health care artificial intelligence, and misplaced reliance on it in the case that AI is designed without grasping the impacts of omission of vital oral health data, it is important to assess this situation and to design an integrated approach to human health care data, both oral and systemic (and ideally also human behavioral care data).In Europe, the implementation of “Telematics” promises to advance interdisciplinary integration of patient data. (Correspondence (2018) from the Bundesministerium für Gesundheit (BMG or Federal Ministry of Health) of Germany.)

Is there anywhere online to view the cognitive test that President Trump took in July 2020 and of which he boasts doing so well?

Yes, here it is:Most of the test is oral and given to the patient by the doctor or other medical or mental health professional. The person giving the test scores it.This is not a test for intelligence. It is only an assessment for cognitive decline associated with various diseases or brain damage.Anyone who claims to have ‘aced’ it would be suspect for a personality disorder. Anyone who claims that the last 5 questions are difficult would certainly be considered to have cognitive issues and would need to have further neurological and cognition tests.I cringe every time I see that video of Trump describing his experience with this assessment. It is clear to any sane medical or mental health professional that he has no business being in the position of president of the United States. And that is beyond the facts that he lies about the test and the doctor’s reaction to his performance. That one interview itself is proof positive of his inability to function as POTUS.

What is scitzophrenia?

2020 APA Practice Guideline recommends ongoing monitoring of physical conditions“The 2020 American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia suggests patients with serious mental illness, and schizophrenia, in particular, may more frequently experience a variety of health conditions. These include, but are not limited to, cancer, cardiovascular disease, obesity, metabolic syndrome, diabetes mellitus, hepatitis C and HIV infections, sleep apnea, and poor oral health.14The guideline suggests physicians should discuss with their patients relevant physical and laboratory assessments that may be needed as part of initial evaluation and follow-up assessment.”This is quite technical but should answer your question… from the net…“Dysregulation across these systems has been observed in several additional studies of patients with schizophrenia:Reduced adiponectin levels have been observed in patients with schizophrenia.16Adiponectin, an adipokine hormone produced primarily by fat cells in adipose tissue, makes tissues more sensitive to insulin, while low levels of adiponectin are associated with insulin resistance, as reported in reviews from 2003, 2012, and 2017.16-18 Several studies have shown an association between low serum adiponectin levels and insulin resistance, type 2 diabetes, and cardiovascular disease in humans19The association between adiponectin and antipsychotic-naive schizophrenia is still unclear. Lower serum adiponectin levels have been detected in this subpopulation compared with healthy controls16,20Lower adiponectin levels have also been observed in antipsychotic-prescribed patients with schizophrenia16,20Elevated blood cytokine levels have been observed in antipsychotic-naive first-episode patients with schizophrenia, according to a 2018 systematic meta-review from 165 case-control studies, including 4 studies that examined immune profile in antipsychotic-naive patients.15Elevated pro-inflammatory cytokines have been differentially associated with regional brain volume alterations, although correlations are inconsistent and further studies are required to clarify these alterations in the context of systemic inflammation in the first-episode psychosis15Adipose tissue also releases pro-inflammatory cytokines (IL-6 and TNF-α), which may contribute to insulin resistance,21 and antipsychotic-naive patients with schizophrenia who have higher BMI have been observed to have increased levels of C-reactive protein, a biomarker of inflammation directly modulated by IL-622A 2016 meta-analysis of 208 antipsychotic-naive patients, including patients with schizophrenia, reported elevated prolactin levels in male and female patients compared with matched controls.23Prolactin is a polypeptide hormone secreted from the anterior pituitary gland. It is believed that prolonged elevations in prolactin may be associated with certain health effects, including amenorrhea, galactorrhea, osteoporosis, low libido, erectile dysfunction, and breast cancer, as reported in a 2016 study23Prolactin release may be increased in response to stress and be associated with HPA activity15,23″

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