A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

Objective:Pit and fissure sealants have been used for many decades to prevent the initiation of caries on susceptible tooth surfaces. The purpose of this study was to analyze the peer-reviewed published scientific literature on pit and fissure sealants over the last 50 years.
Materials and methods:
On the PubMed database, all publications on pit and fissure sealants from 1962-2011 were extracted using the search phrase [(pit OR fissure) AND (sealant OR sealants OR adhesive)]. Details of all retrievals were individually entered into SPSS for analysis.
Results:
A total of 2829 publications were found. The mean number of authors was 2.73 ± 1.90 (range = 1-23). Although single-authorship was the modal group with 32.1%, it had a sustained decrease from 75.0% for 1962-1971 to 17.6% for 2002-2011. On the contrary, publications with three or more authors increased from 8.3% to 47.3% during the same period. Human studies accounted for 88.6% and clinical trial was 11.9%, followed by reviews at 10.2% and randomized controlled trials at 6.9%. English was the language of reporting for 82.0% of the studies.
Conclusion:
It is anticipated that future research on pit and fissure sealants will focus on newer and more effective materials.

The purpose of this study was to investigate knowledge about HIV/AIDS among classroom secondary school teachers and document any efforts at educating their pupils about HIV prevention. A self-administered questionnaire addressed issues on demography, knowledge and awareness on HIV/AIDS and their roles in HIV/AIDS prevention. All consenting school teachers in the Irewole local government area of Osun State, Nigeria, participated in this study. The response rate was 91.7% (n = 180). There were more males (76.4%) than females (23.0%) The mean (± SD) age of the respondents was 41.5 (±15.5) years. More than 90% had adequate knowledge of HIV/AIDS and indicated that it could be prevented. Furthermore, 86.1% wanted HIV/AIDS preventive education to be made compulsory in the secondary school curriculum. There were 131 (n = 165, 79.4%) teachers who did not teach HIV/AIDS prevention, while 32 (19.4%) teachers believed that the pupils were too young and that the non-availability of guidelines and resources are reasons for not teaching it. One hundred and fifty-three (92.7%) of the respondents would like to attend a course/programme/workshop to update their knowledge and 139 (84.2%) of teachers would like to be part of an HIV/ AIDS prevention group for their community. There is a need for school teachers to be trained adequately and provided with a structured educational programme to follow in order to enhance effectiveness in HIV/ AIDS preventive education to pupils.

Oral manifestations of diabetes mellitus have been documented, but the effect of glycemic control on the oral tissues has been scantily reported. The oral health status of 65 metabolically controlled adult diabetic patients attending the Diabetes Clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was prospectively assessed over six months and compared with that of 54 non-diabetic acting as controls. The mean duration of diabetes was 100.5+/-85.1 months. The difference in periodontal status of the patients and control, assessed using the Community Periodontal Index of Treatment Needs (CPITN), was not statistically significant (p=0.07). The degree of hyposalivation between the two groups was, however, statiscally significant (p<0.05). No significant difference was observed in the altered taste, burning mouth sensation, angular cheilitis, glossitis, and stomatitis status of the two groups. We conclude, with adequate metabolic control, the oral health status of a diabetic may not be significantly different from that of a non-diabetic except for xerostomia. A good understanding of the interactions between systemic diseases and oral health is imperative for physicians and dental practitioners. The need for early detection and closer linkages between the dental and medical professions in managing diabetic patients is emphasized.

In this study, 1,325 school children from 7 farm schools were examined. Their mean age (+/- SD) was 10.5 +/- 3.0 (range 6-11) years. At baseline, the mean DMFT score was 1.1 +/- 1.7 and 36.4% of the children had caries. The prevalence of fluorosis among the children was 12.6%. Curative treatment was offered to all the children. A total of 113 children (8.5%) with one-surface cavities on permanent teeth and without fluorosis were treated using the atraumatic restorative treatment (ART) approach. A total number of 163 cavities were included in the study, of which 82 were treated with Fuji IX glass-ionomer cement and 81 with Ketac-MOLAR (hand mix). One year after treatment, restoration and sealant parts of ART fillings were examined. Caries status was also determined. The placing of the ART fillings and their evaluation were performed by different practitioners. A total number of 108 restorations (58 with Fuji IX, 50 with Ketac-MOLAR) were evaluated. Results of ART fillings showed a survival rate of 93.1% with Fuji and 94.0% with Ketac-MOLAR. Retention of the sealant parts of ART fillings was observed in 81% of restorations with Fuji IX and 76% with Ketac-MOLAR, not connected to the filled cavity. Caries was absent on all teeth restored with Fuji IX and noted in only one tooth restored with Ketac-MOLAR, not connected to the filled cavity. The retention rate after a 12-month period was acceptable and ART approach proved to be an appropriate technique for restoring teeth in this population group. There were no statistically significant differences between the survival rates of the two glass-ionomer restorative materials (P > 0.05).

A project for improving primary health care in an underserved rural area of Osun State, Nigeria, involved the creation of a partnership between the local government, the community and a medical college. Joint administrative and technical committees were established, and community mobilization was fostered. The evidence so far indicates that partnership designs can accelerate the development of primary health care in an affordable manner.

Background: The influence of drug metabolizing enzyme, transporter and nuclear receptor single nucleotide polymorphisms (SNPs) on efavirenz (EFV) concentrations in human breast milk and infants exposed through breast milk is understudied. SNPs in maternal CYP2B6, NR1I3, ABCG2 and ABCB5 were investigated here.

Methods: HIV positive nursing mothers (n = 51) receiving once daily regimens containing 600 mg EFV and their exclusively breastfed infants were recruited from 3 Nigerian hospitals. Paired dried blood spots (DBS; maternal and infant) and dried breast milk spots (DMS) were collected 12 - 14 hours post maternal dose. EFV was quantified by validated LC-MS/MS. Plasma EFV concentration was estimated using [DBS[EFV]/(1-HCT)]*fbpp, where HCT is average haematocrit and fbpp is fraction bound to plasma protein. Genotyping for CYP2B6 rs3745274, NR1I3 rs2307424, NR1I3 rs3003596, ABCB5 rs6461515, ABCB5 rs2301641, ABCG2 rs2231164 and ABCG2 rs2622604 was conducted. Associations of EFV concentrations with SNPs and demographic factors were investigated by univariate (Mann-Whitney U test) and multivariate analyses (multiple linear regression). P < 0.05 was considered statistically significant.

Results: Median (IQR) EFV breast milk concentration was 2280 (1180, 3270) ng/ml. Using 150ml/kg/day as average milk intake, this equates to ~340 (177, 491) ug/kg/day infant dose and resulted in 178 (87.7, 340) ng/ml in infant plasma. Maternal plasma EFV was 2310 (1580, 4460) ng/ml and median (IQR) milk-to-maternal plasma ratio was 0.82 (0.51, 1.1). There were significant correlations between maternal plasma and breast milk EFV concentrations (p = 1.3 x 10-12; rho = 0.80) and between breast milk and infant plasma (p = 7.9 x 10-5; rho = 0.52). Significant differences in maternal, infant and breast milk EFV concentrations were observed based on CYP2B6 rs3745274 genotypes (Figure 1). Only CYP2B6 rs3745274 was independently associated with breast milk [B = 0.22 (0.10, 0.35), p = 0.001], maternal [B = 0.23 (95% CI: 0.13, 0.32), p=1.5 x 10-5] and infant [B = 0.23 (0.09, 0.37), p = 0.002] EFV concentrations in multivariate analyses. Other statistically significant SNP associations were observed in univariate but not multivariate analysis.

Conclusion: CYP2B6 rs3745274 was independently associated with EFV concentrations in human breast milk and infants exposed through breast milk. Further study is warranted to define clinical significance and implications for stratified medicine in these patients.

Background: Despite the risk of HIV transmission, breastfeeding is the preferred and recommended feeding option for infants born to HIV+ mothers in low- and middle-income countries. This is because reduction in HIV transmission associated with the avoidance of breastfeeding is counter-balanced by increases in morbidity and mortality from other causes. Efavirenz (EFV), used in these settings, is contraindicated in children <3 years old or 10 kg. However, it is used by nursing mothers and very limited data are available on its excretion into human breast milk. The aim of this study was to investigate the level of exposure of breastfed infants to maternal EFV through breast milk.

Methods: 34 HIV+ nursing mothers taking 600 mg EFV once daily as part of HAART and their exclusively breastfed infants were recruited from 2 Nigerian hospitals. Mid-dose dried blood spots were collected from mothers (untimed for babies) and EFV concentrations were determined using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Univariate (dependent-sample t-test) and multivariate analyses (multiple linear regression) were used to assess relationships between patient demographics and EFV concentrations in mother and infants. p <0.05 was considered to be statistically significant.

Results: Median maternal and infant EFV concentrations were 1300 (95% confidence interval [CI] 950, 2200; range 72, 6200) and 96 (95%CI 50, 160; range <25, 2600) ng/mL, respectively (ratio 0.06 [95%CI 0.04, 0.09]). Maternal EFV concentration was within therapeutic range for 59%, >4000 ng/mL in 12% and <1000 ng/mL in 29%. Only about 5% of the infants had EFV concentrations >1000 ng/mL. There was a significant correlation between maternal and infant EFV concentrations (p = 2.2E-6; r = 0.65). In multivariate analysis, maternal EFV concentration (p = 2.9E-7) and infant body weight (p = 0.03) were significantly correlated with infant EFV concentrations, accounting for >50% of observed variance.

Conclusions: Breastfed infants are exposed to maternal EFV through breast milk. However, the target concentration for prevention of infection in breastfed, uninfected infants is unknown. Therefore, breastfed infants need to be closely monitored for toxicity and emergence of NNRTI resistance, which may limit therapeutic options in those who eventually become infected with HIV.

Background: Etravirine (ETV) is metabolized by CYP3A4 and CYP2C19. A known inhibitor of CYP2C19, omeprazole increases ETV exposure by 41%. Since CYP2C19*2 (rs4244285) can affect CYP2C19 expression there is the potential to alter ETV exposure. We previously showed utility of physiologically based PK (PBPK) models for predicting genetic associations and drug-drug interactions from in vitro data in the absence of clinical data. The aim of this study was to develop a PBPK model for ETV PK and predict effects of CYP2C19*2 in virtual human subjects.

Methods: A new open-source PBPK model was developed with algorithms describing covariance between demographics and organ size, hepatic metabolism, induction of metabolic enzymes, expression, and mechanisms regulating absorption and distribution. In vitro data describing chemical properties as well as absorption, distribution, metabolism, and elimination of ETV were used to simulate ETV PK at 200 mg twice daily in 200 virtual subjects. Simulated PK parameters, such as Ctrough, Cmax, and AUC were compared with observed values from the literature. The impact of CYP2C19*2 on ETV clearance was then determined by altering CYP2C19 expression in the model. All simulations were conducted using the differential equation solver Berkeley Madonna.

Results: Simulated PK variables at steady state (mean ± SD) were Ctrough (293 ± 185 ng/mL), Cmax (363 ± 207 ng/mL), and AUC (4005 ± 2364 ng/mL.h), in agreement with previous clinical PK data: Ctrough (297 ± 391 ng/mL) and AUC (4522 ± 4710 ng/mL.h). Simulated mean ETV clearance (CL/F), volume of distribution, and ka were 59 ± 31 (L/h), 14.9 ± 3.6 L/kg, and 0.17 ± 0.011 hr–1, respectively. ETV (CL/F) was predicted to be 62 ± 35, 53 ± 31, and 41 ± 28 L/h for CYP2C19 *1/*1, *1/*2 and *2/*2, respectively.

Conclusions: The IVIVE model predicted in vivo PK of ETV in individuals with different CYP2C19 genotypes. The frequency of CYP2C19*2 has a higher frequency in Asian populations which may underpin heterogeneity in ETV exposure. Mechanistic evaluation of disposition can inform PBPK models and prediction of pharmacogenetic associations. IVIVE may be particularly helpful for the rational design of novel regimens for use in stratified populations. This includes prediction of optimal dose and dosing regimen, selection of partner drugs and validation of the likely overall pharmacological effect of discrete molecular processes, all of which can and should be tested in clinical studies.