Association between Medicaid adult nonemergency dental benefits and dental services use and expenditures

Background

Only some states provide coverage of nonemergency dental services for adult Medicaid enrollees. This study examined the association between coverage of Medicaid adult nonemergency dental services and dental services use and expenditures.

To reduce routine computed tomographic angiography for thoracic aortic injury assessment in level II blunt trauma patients using three mediastinal signs on the initial chest radiograph: a preliminary report

Purpose

CTA is routinely ordered on level II blunt thoraco-abdominally injured patients for assessment of injury to the thoracic aorta. The vast majority of such assessments are negative. The question being asked is, Does the accurate interpretation of the three mediastinal signs permit reliable determination of which patients need CTA for aortic assessment? The purpose of this investigation was to evaluate the role of three specifically selected mediastinal anatomic signs on the initial supine chest radiograph (CXR) of adult level II blunt thoraco-abdominally injured patients for the presence or absence of a mediastinal hematoma. The presence of a mediastinal hematoma is typically used as an indicator for computed tomographic angiography (CTA). The three mediastinal signs are the right para-tracheal stripe (RPTS), left para-spinal line (LPSL), and the left apical extra-pleural area (LAPA).

Materials and methods

The patient triage designation (level II trauma) was made by the attending physician at the time of admission. The initial CXR image and the CTA report of the 197 adult blunt level II thoraco-abdominally injured patients obtained on the day of admission were compared. The CXR of each of the 197 patients was independently assessed by each of four observers specifically for the status of the three mediastinal signs. Each observer was blinded to the CTA report until after the status of the three mediastinal sign evaluation had been determined. Two or three of the mediastinal signs being positive were required to determine that the CXR was positive for a mediastinal hematoma.

Results

Two or three of the selected mediastinal signs were normal in 192 (97.5%) patients. None of these patients had either a mediastinal hematoma or a major aortic injury on CTA. In each of the remaining five (2.5%) patients, two or three of the mediastinal signs were abnormal. Each of these patients had a mediastinal hematoma and a major thoracic aortic injury on CTA.

Conclusions

This preliminary study suggests that the accurate interpretation of the three specifically selected mediastinal signs on the initial supine CXR of adult level II blunt thoraco-abdominally injured patients could reduce the need for routine CTA for thoracic aortic injury assessment, and requires verification by an additional study.

     

Causes of community suicides among indigenous South Australians

A retrospective review of suicides occurring among Aboriginal people in the community in South Australia over a 5-year period was undertaken from January 2005 to December 2009. Twenty-eight cases were identified, consisting of 21 males (age range 16–44 years, mean 29.9 years) and 7 females (age range 23–45 years, mean 32.0 years). Deaths in all cases were caused by hanging (100%). Toxicological evaluation of blood revealed alcohol (39.3% of cases), cannabinoids (39.3%), benzodiazepines (10.7%), opiates (7.1%), antidepressants (7.1%), amphetamines (3.6%) and volatiles (3.6%). This study has demonstrated that the method of suicide overwhelmingly preferred by indigenous victims in South Australia is hanging. The precise reasons for this preference are uncertain, however, an indigenous person in South Australia presenting as a suicide where a method other than hanging has been used would be exceedingly uncommon, raising the possibility of alternative manners of death.     

Differences in local and national database recordings of deaths from suicide

A search was undertaken at Forensic Science South Australia (FSSA) for all cases of suicide registered in South Australia, Australia, over a 10-year period from January 2003 to December 2012. More recent data was not accessioned as not all contemporary cases may have been completed or formally registered. The data were compared to corresponding numbers on two national registers: the National Coronial Information System (FSSA, with a death rate of 13.3/100,000 population. NCIS data were available from 2003 to 2010, with 1542 suicides recorded (12.3/100,000 population). ABS data were available from 2003 to 2011, with 1366 deaths coded as suicides (12.4/100,000 population). Significant differences were found between local data on suicides and related data accrued nationally from the same population, with only 67.8% of local drug overdoses recorded on the NCIS. Although this represents an Australian-based study the conclusions have global applications. Thus, given the likely accuracy of local data, reliance on smaller, community-specific datasets in any country/jurisdiction may be of far greater use in analyzing and monitoring such complex cases.     

Etiology and body area of injuries in young female dancers presenting to sports medicine clinic: A comparison by age group

Introduction. Improving knowledge regarding injuries sustained by pediatric dancers is important in order to better understand injury risk. The aim of this study is to analyze dance injury etiology and body area by age in a cohort of young female dancers presenting to a pediatric sports/dance medicine clinic. Methods. The cross-sectional epidemiological study of a 5% probability sample of dancers evaluated between 1/1/2000 and 12/31/2009 with a musculoskeletal injury requiring physician evaluation. A total of 2,133 charts were reviewed from which 171 female dancers 8–17 years old (mean age 14.7 years) were identified. Data were stratified by age, <12 years and ≥12 years, and analyzed based on injury body area, type, and etiology. Fisher’s exact test was used to determine statistical significance. Results. Injuries sustained by dancers in the younger age category (<12 years) were largely to the foot-ankle/lower leg/knee (93.3%) versus thigh-hip/spine/upper extremity (6.7%). In comparison, dancers in the older age group (≥12 years) had a large proportion of injuries to the foot-ankle/lower leg/knee (67.3%) as well, but had a notably larger fraction of injuries to the thigh-hip/spine/upper extremity (32.7%; p = 0.04). Approximately two-thirds of the injuries sustained in the younger age group (<12 years) were classified as bony. In comparison, injuries in the older age group (≥12 years) were roughly half bony and half soft tissue (51.3% and 48.7%, respectively; p = 0.29). Most injuries were overuse in etiology for both younger and older age groups (86.7% and 82.1%, respectively; p = 1.00). Through puberty, there was a decline in the injuries to the foot-ankle/lower leg/knee. Conversely, there was an increase in the thigh/hip-pelvis/spine/upper extremity injuries through growth. Conclusions. Injuries to young female dancers in this study cohort were mostly categorized as overuse in etiology, and differed by the age group and the body area. Increased information regarding dance injuries can help guide future injury prevention efforts.