There is a need for continued debate and dialog to validate the proposed set of competencies, and a need for further research to identify best strategies for incorporating these competencies into global health educational programs. Future research should focus on implementation and evaluation of these competencies across a range of educational programs, and further delineating the competencies needed across all four proposed competency levels.

This cohort study describes the COVID-19 burden among incarcerated individuals and staff in Massachusetts jails and prisons and assesses the association of COVID-19 case rates with decarceration and testing rates.

No abstract

Unemployment rates in the United States are rapidly increasing as a result of the COVID-19 pandemic and attendant economic disruption. As employees lose their jobs, many will lose their employer-sponsored dental insurance (ESDI). Changes in insurance coverage are directly related to the oral health of the population, with many at risk of losing access to dental care. We assessed the impact of recent unemployment rates on insurance coverage and dental utilization. We estimated changes in dental insurance coverage at the state level, using previously applied econometric estimates. Expected changes in types of dental procedures performed at dental practices nationwide were assessed using a microsimulation model, using national practice survey data. Changes in emergency department (ED) visits for dental problems were estimated by fitting trendlines to ED visit patterns by payer type. Sensitivity analyses were conducted to assess how variations in unemployment rates and rates of ESDI in response to unemployment could alter the results. Since March 2020, the national unemployment rate has increased by 8.40 percentage points, an increase expected to result in more than 16 million individuals losing ESDI in the United States. Of these individuals, 45.0% are likely to enroll in their state’s Medicaid and Children’s Health Insurance Program, and 47.0% are expected to become uninsured. With these expected changes in dental insurance coverage, the average dental practice would experience decreases in routine checkup visits but increases in tooth extraction, a procedure that is highly used by publicly insured or uninsured patients. In addition, dental-related ED visits would be expected to grow by 4.0%. Losses of employment caused by the COVID-19 in the United States can have countervailing effects on people’s health by impeding access to dental care. Lack of dental insurance is expected to be more pronounced in states that have not expanded Medicaid or do not provide Medicaid dental benefits for adults.

Background Demand for dental services has been known to be closely linked to dental insurance and disposable income. Widespread economic uncertainty and health systems changes due to the coronavirus disease 2019 (COVID-19) thus may have a significant impact on dental utilization. Methods Using de-identified dental practice management data in 2019 and 2020, we observed variations in dental utilization among insured patients since the COVID-19 outbreak (during the period of practice closure and after reopening) by patient age, procedure types, insurance type, practice size, geographic area, and reopening status. We examined whether the rebound in procedure volumes at dental practices can be explained by county-level characteristics using hierarchical regression models. Results While dental utilization among privately insured individuals fully rebounded by August 2020, utilization still remained lower than the pre-pandemic level by 7.54% among the publicly insured population. Demand for teledentistry increased up to 60 times during practice closure. Geographic characteristics--such as median household income, percentages of rural or African American populations, and dental professional shortage designations --were significantly associated with the number of procedures performed at dental practices. Conclusion As a result of COVID-19, dental practices experienced substantial decreases in procedure volume, particular among patients covered by public insurance or residing in underserved areas. Practical Implications: During these economic downturns, state health officials would be encouraged to adopt policies to expand access to oral health care for vulnerable populations via oral health promotion strategies and increasing the supply of dentists or mid-level dental providers in underserved areas.