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Sahab DA, Bamashmous MS, Ranauta A, Muirhead V. Socioeconomic inequalities in the utilization of dental services among adults in Saudi Arabia. BMC Oral Health 2022; 22:135. [PMID: 35448991 PMCID: PMC9027487 DOI: 10.1186/s12903-022-02162-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background This study used the Anderson Behavioral Model to assess the socioeconomic inequalities in dental services utilization among adults in Saudi Arabia, along with other predictors of utilization, to inform future planning of dental care services. Methods This cross-sectional study was a secondary analysis using national data from the 2019 Kingdom of Saudi Arabia World Health Survey (KSAWHS). The survey consisted of two interviewer-administered questionnaires: one household and one individual interview. The questions covered predisposing factors (age, gender, marital status, nationality, education, employment), enabling factors (income, household wealth, area-based socioeconomic class, health insurance, eligibility for free governmental health care, transportation and region of residence) and self-reported need for dental treatment. The main outcome was dental utilization in the past year; predisposing, enabling and need factors were independent variables. Hierarchical logistic regression analyses identified significant predictors of dental utilization, applying survey weights to adjust for the complex survey design. Adjusted odds ratios with 95% confidence intervals and p values were reported in the final model. Results The final dataset included 8535 adults (response rate = 95.4%). Twenty percent of adults had visited the dentist at least once in the past year (95% CI 18–21%). There were socioeconomic inequalities in dental utilization. High household income (OR 1.43, p = 0.043), second and middle household wealth status (OR 1.51, p = 0.003 and OR 1.57, p = 0.006) and access to free governmental health care (OR 2.05, p = 0.004) were significant predictors in the final regression model along with perceived need for dental treatment (OR 52.09, p < 0.001). Conclusion Socioeconomic inequalities in the utilization of dental services exist in Saudi Arabia. The need for treatment was the strongest predictor suggesting predominantly symptomatic attendance. Increasing awareness about the importance of preventive dental visits rather than symptomatic attendance could be an important policy implication to improve oral health and optimize dental care expenditure. Further research should explore the drivers for adults to seek preventive care in the absence of any recognized dental problems.
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Affiliation(s)
- Deema A Sahab
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. .,Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Mohamed S Bamashmous
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amitha Ranauta
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vanessa Muirhead
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Tiwari T, Maliq NN, Rai N, Holtzmann J, Yates L, Diep V, Tranby EP, Frantsve-Hawley J. Evaluating Trust in the Patient-Dentist Relationship: A Mixed-Method Study. JDR Clin Trans Res 2022:23800844221087592. [PMID: 35430916 DOI: 10.1177/23800844221087592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The objective of this article was to understand the trust of study participants in dental providers and trust-building practices used by dentists to establish and maintain trust with their patients. METHODS This study used a concurrent cross-sectional mixed-methods design to measure the participants' trust in their dental providers. An 11-item Dental Trust Scale (DTS) questionnaire was administered to 150 White, Black, and Hispanic study participants. In addition, the research team conducted semistructured interviews with 7 dentists in order to understand their perspectives related to patient trust. The internal consistency of the DTS was tested using Cronbach's α. Univariate and multivariable logistic regression models were run to test the association between the DTS mean score and individual participant factors. Qualitative information from interviews was analyzed using a thematic analysis approach. RESULTS The overall mean score of dental trust for the entire sample was 3.4. The DTS had good internal consistency (α = 0.93). Overall, dental trust was significantly higher in participants who had a regular dentist (F = 8.74, P = 0.003). The qualitative data were grouped under these key thematic categories: the importance of trust, building trust, and trust in treatment planning. Qualitative analysis also showed that the 2 main trust-building tools used by dentists were communication and understanding the patient's lifestyle or social determinants of health. KNOWLEDGE TRANSFER STATEMENT This study provides insight into the dentist-patient relationship. It increases our understanding of levels of dental trust among patients and examines methods used by the dentist to build trust. The outcomes of this study can be considered by dentists in their everyday practice as they seek to build trust with their patients.
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Affiliation(s)
- T Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - N N Maliq
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - N Rai
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J Holtzmann
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - L Yates
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - V Diep
- CareQuest Institute for Oral Health, Boston, MA, USA
| | - E P Tranby
- CareQuest Institute for Oral Health, Boston, MA, USA
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Winkelmann J, Gómez Rossi J, Schwendicke F, Dimova A, Atanasova E, Habicht T, Kasekamp K, Gandré C, Or Z, McAuliffe Ú, Murauskiene L, Kroneman M, de Jong J, Kowalska-Bobko I, Badora-Musiał K, Motyl S, Figueiredo Augusto G, Pažitný P, Kandilaki D, Löffler L, Lundgren C, Janlöv N, van Ginneken E, Panteli D. Exploring variation of coverage and access to dental care for adults in 11 European countries: a vignette approach. BMC Oral Health 2022; 22:65. [PMID: 35260137 PMCID: PMC8905841 DOI: 10.1186/s12903-022-02095-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach. METHODS We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists. RESULTS Completed vignettes were received from 11 countries: Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different physical barriers to accessing dental care. The limited availability of contracted dentists (especially in rural areas) and the unequal distribution and lack of specialised dentists are major access barriers to public dental care. CONCLUSIONS According to the results, statutory coverage of dental care varies across European countries, while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries, leading to high out-of-pocket spending. Socioeconomic status is thus a main determinant for access to dental care, but other factors such as geography, age and comorbidities can also inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care.
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Affiliation(s)
- Juliane Winkelmann
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.
| | - Jesús Gómez Rossi
- Charité Universitätsmedizin, Department of Oral Diagnostics, Digital Health and Health Services Research, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Falk Schwendicke
- Charité Universitätsmedizin, Department of Oral Diagnostics, Digital Health and Health Services Research, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Antoniya Dimova
- Medical University - Varna, 55 Marin Drinov str, Varna, 9002, Bulgaria
| | - Elka Atanasova
- Medical University - Varna, 55 Marin Drinov str, Varna, 9002, Bulgaria
| | - Triin Habicht
- WHO Barcelona Office for Health Systems Financing, Sant Pau Art Nouveau Site (La Mercè pavilion), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | | | - Coralie Gandré
- Institute for Research and Information in Health Economics (IRDES), 117, bis Rue Manin, 75019, Paris, France
| | - Zeynep Or
- Institute for Research and Information in Health Economics (IRDES), 117, bis Rue Manin, 75019, Paris, France
| | - Úna McAuliffe
- Oral Health Services Research Centre and School of Public Health, University College Cork, Cork, T12K8AF, Ireland
| | - Liubove Murauskiene
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21/ 27, 03101, Vilnius, Lithuania
| | - Madelon Kroneman
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118, 3513 CR, Utrecht, The Netherlands
| | - Judith de Jong
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118, 3513 CR, Utrecht, The Netherlands
| | - Iwona Kowalska-Bobko
- Faculty of Health Science, Institute of Public Health, Jagiellonian University Medical College, ul. Skawińska 8, 31-066, Kraków, Poland
| | - Katarzyna Badora-Musiał
- Faculty of Health Science, Institute of Public Health, Jagiellonian University Medical College, ul. Skawińska 8, 31-066, Kraków, Poland
| | - Sylwia Motyl
- Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Gonçalo Figueiredo Augusto
- Public Health Research Centre, National School of Public Health, Nova University Lisbon, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
| | - Peter Pažitný
- Prague University of Economics and Business, W. Churchill Sq. 1938/4, 130 67, Prague 3, Žižkov, Czech Republic
| | - Daniela Kandilaki
- Prague University of Economics and Business, W. Churchill Sq. 1938/4, 130 67, Prague 3, Žižkov, Czech Republic
| | | | - Carl Lundgren
- Vardanalys, Drottninggatan 89, 113 60, Stockholm, Sweden
| | - Nils Janlöv
- Vardanalys, Drottninggatan 89, 113 60, Stockholm, Sweden
| | - Ewout van Ginneken
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.,European Observatory on Health Systems and Policies, WHO European Centre for Health Policy, Eurostation (Office 07C020), Place Victor Horta/Victor Hortaplein, 40/10, 1060, Brussels, Belgium
| | - Dimitra Panteli
- European Observatory on Health Systems and Policies, WHO European Centre for Health Policy, Eurostation (Office 07C020), Place Victor Horta/Victor Hortaplein, 40/10, 1060, Brussels, Belgium
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Nmadu AG, Jafaru A, Dahiru T, Joshua IA, Nwankwo B, Mohammed-Durosinlorun A. Cross-sectional study on knowledge, attitude and prevalence of domestic violence among women in Kaduna, north-western Nigeria. BMJ Open 2022; 12:e051626. [PMID: 35260449 PMCID: PMC8905932 DOI: 10.1136/bmjopen-2021-051626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Domestic violence is a global issue of public health concern with detrimental effects on women's physical, mental and social well-being. There is a paucity of community-based studies assessing the knowledge and attitude of women towards domestic violence in Nigeria. OBJECTIVE To assess knowledge, attitudes, prevalence and associated factors of domestic violence among women in a community in Kaduna, Nigeria. DESIGN A descriptive cross-sectional study. SETTING A selected community in Kaduna South Local Government Area in Kaduna State. PARTICIPANTS In total, 170 women aged 15-49 years participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES The outcomes were knowledge, attitude and prevalence of domestic violence. RESULTS The mean age of the respondents was 28.7+7.9 years. A total of 113 (66.5%) respondents had high level of knowledge about domestic violence with 114 (67.1%) having non-tolerant attitudes towards domestic violence. The lifetime prevalence and 12-month prevalence of domestic violence were 47.1% and 35.3%, respectively. The results of logistic regression identified the educational status of women as a significant predictor of knowledge of domestic violence (adjusted OR (aOR)=0.32; 95% CI 0.15 to 0.68), while marital status (aOR=0.21; 95% CI 0.05 to 0.96), occupation of women (aOR=2.49; 95% CI 1.13 to 5.49), their tolerance of wife beating (aOR=0.33; 95% CI 0.15 to 0.72) and their partners' consumption habit of alcohol/substance use (aOR=7.91; 95% CI 3.09 to 20.27) were identified as significant predictors of the women's experience of domestic violence. CONCLUSION Domestic violence was relatively high among women. Though a majority had high level of knowledge about domestic violence, a significant third had tolerant attitudes towards it. Appropriate health interventions need to be implemented by governmental and relevant stakeholders to target negative attitudes and address associated factors of domestic violence against women.
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Affiliation(s)
- Awawu Grace Nmadu
- Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna, Kaduna State, Nigeria
| | - Abubakar Jafaru
- Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna, Kaduna State, Nigeria
| | - Tukur Dahiru
- Department of Community Medicine, College of Health Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Istifanus Anekoson Joshua
- Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna, Kaduna State, Nigeria
| | - Bilkisu Nwankwo
- Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna, Kaduna State, Nigeria
| | - Amina Mohammed-Durosinlorun
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna, Kaduna State, Nigeria
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Mannell J, Lowe H, Brown L, Mukerji R, Devakumar D, Gram L, Jansen HAFM, Minckas N, Osrin D, Prost A, Shannon G, Vyas S. Risk factors for violence against women in high-prevalence settings: a mixed-methods systematic review and meta-synthesis. BMJ Glob Health 2022; 7:bmjgh-2021-007704. [PMID: 35296455 PMCID: PMC8928330 DOI: 10.1136/bmjgh-2021-007704] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/08/2022] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Violence against women (VAW) affects one in three women globally. In some countries, women are at much higher risk. We examined risk factors for VAW in countries with the highest 12-month prevalence estimates of intimate partner violence (IPV) to develop understanding of this increased risk. METHODS For this systematic review, we searched PUBMED, CINAHL, PROQUEST (Middle East and North Africa; Latin America and Iberia; East and South Asia), Web of Science, EMBASE and PsycINFO (Ovid) for records published between 1 January 2000 and 1 January 2021 in English, French and Spanish. Included records used quantitative, qualitative, or mixed-methods, reported original data, had VAW as the main outcome, and focused on at least one of 23 countries in the highest quintile of prevalence figures for women's self-reported experiences of physical and/or sexual violence in the past 12 months. We used critical interpretive synthesis to develop a conceptual model for associations between identified risk factors and VAW. RESULTS Our search identified 12 044 records, of which 241 were included for analysis (2 80 360 women, 40 276 men, 274 key informants). Most studies were from Bangladesh (74), Uganda (72) and Tanzania (43). Several quantitative studies explored community-level/region-level socioeconomic status and education as risk factors, but associations with VAW were mixed. Although fewer in number and representing just one country, studies reported more consistent effects for community-level childhood exposure to violence and urban residence. Theoretical explanations for a country's high prevalence point to the importance of exposure to other forms of violence (armed conflict, witnessing parental violence, child abuse) and patriarchal social norms. CONCLUSION Available evidence suggests that heightened prevalence of VAW is not attributable to a single risk factor. Multilayered and area-level risk analyses are needed to ensure funding is appropriately targeted for countries where VAW is most pervasive. PROSPERO REGISTRATION NUMBER The review is registered with PROSPERO (CRD42020190147).
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Affiliation(s)
| | - Hattie Lowe
- Institute for Global Health, UCL, London, UK
| | - Laura Brown
- Institute for Global Health, UCL, London, UK
| | | | | | - Lu Gram
- Institute for Global Health, UCL, London, UK
| | | | | | - David Osrin
- Institute for Global Health, UCL, London, UK
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da Silva Araújo Júnior CA, Rebelo Vieira JM, Rebelo MAB, Herkrath FJ, Herkrath APCDQ, de Queiroz AC, Pereira JV, Vettore MV. The influence of change on sense of coherence on dental services use among adolescents: a two-year prospective follow-up study. BMC Oral Health 2021; 21:663. [PMID: 34953499 PMCID: PMC8709982 DOI: 10.1186/s12903-021-02026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the influence of change on sense of coherence (SOC) on dental services use in adolescents over a two-year period. METHODS A prospective follow-up study was conducted involving 334 12-year-old adolescents from public schools in the city of Manaus, Amazonas, Brazil. The predictors of use of dental services in the last 12 months were selected according to the Andersen's behavioural theoretical model. The predisposing factors included sex, self-reported skin colour and SOC. The enabling factors were dental insurance, monthly family income and parents/guardians schooling. Dental pain, perceived oral health status, dental caries and gingival status were used to assess need factors. Multivariable Poisson regression with robust variance was used to estimate incidence-rate ratios (IRR) and 95% confidence intervals between the independent variables and use of dental services. RESULTS Adolescent's SOC scores decreased significantly between baseline and one-year follow-up. SOC decline decreased the likelihood of using dental services in the last 12 months (IRR = 0.96 95%CI 0.92-0.99). Dental caries (IRR = 1.03 95%CI 1.01-1.04) and gingival bleeding (IRR = 1.01 95%CI 1.01-1.02) remained associated with use of dental services in the last 12 months. Adolescents with dental pain were more likely to have visited a dentist in the last year (IRR = 1.03, 95%CI 1.01-1.06). CONCLUSION SOC decrease over one-year period was a meaningful factor of dental services use among 12-year-old adolescents. Dental pain and clinical conditions were also relevant factors that can influence use of dental services in this group.
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Affiliation(s)
| | - Janete Maria Rebelo Vieira
- School of Dentistry, Federal University of Amazonas, Av. Ministro Waldemar Pedrosa, 1539, Praça 14 de Janeiro, Manaus, AM, CEP 69025-050, Brazil
| | - Maria Augusta Bessa Rebelo
- School of Dentistry, Federal University of Amazonas, Av. Ministro Waldemar Pedrosa, 1539, Praça 14 de Janeiro, Manaus, AM, CEP 69025-050, Brazil
| | - Fernando José Herkrath
- Instituto Leônidas e Maria Deane, Fundacão Oswaldo Cruz, Manaus, Rua Teresina, 476, Adrianópolis, Manaus, AM, CEP: 69027-070, Brazil
| | - Ana Paula Corrêa de Queiroz Herkrath
- School of Dentistry, Federal University of Amazonas, Av. Ministro Waldemar Pedrosa, 1539, Praça 14 de Janeiro, Manaus, AM, CEP 69025-050, Brazil
| | - Adriana Corrêa de Queiroz
- School of Dentistry, Federal University of Amazonas, Av. Ministro Waldemar Pedrosa, 1539, Praça 14 de Janeiro, Manaus, AM, CEP 69025-050, Brazil
| | - Juliana Vianna Pereira
- School of Dentistry, Federal University of Amazonas, Av. Ministro Waldemar Pedrosa, 1539, Praça 14 de Janeiro, Manaus, AM, CEP 69025-050, Brazil
| | - Mario Vianna Vettore
- Department of Health and Nursing Sciences, Faculty of Health and Sports Sciences, University of Agder, Campus Kristiansand, Universitetsveien 25, 4630, Kristiansand, Norway.
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de Abreu MHNG, Cruz AJS, Borges-Oliveira AC, Martins RDC, Mattos FDF. Perspectives on Social and Environmental Determinants of Oral Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413429. [PMID: 34949037 PMCID: PMC8708013 DOI: 10.3390/ijerph182413429] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022]
Abstract
Most oral conditions have a multifactorial etiology; that is, they are modulated by biological, social, economic, cultural, and environmental factors. A consistent body of evidence has demonstrated the great burden of dental caries and periodontal disease in individuals from low socioeconomic strata. Oral health habits and access to care are influenced by the social determinants of health. Hence, the delivery of health promotion strategies at the population level has shown a great impact on reducing the prevalence of oral diseases. More recently, a growing discussion about the relationship between the environment, climate change, and oral health has been set in place. Certainly, outlining plans to address oral health inequities is not an easy task. It will demand political will, comprehensive funding of health services, and initiatives to reduce inequalities. This paper sought to give a perspective about the role of social and physical environmental factors on oral health conditions while discussing how the manuscripts published in this Special Issue could increase our knowledge of the topic.
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Steiner RJ, Pampati S, Kortsmit KM, Liddon N, Swartzendruber A, Pazol K. Long-Acting Reversible Contraception, Condom Use, and Sexually Transmitted Infections: A Systematic Review and Meta-analysis. Am J Prev Med 2021; 61:750-760. [PMID: 34686301 PMCID: PMC9125421 DOI: 10.1016/j.amepre.2021.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/14/2021] [Accepted: 04/21/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Given mixed findings regarding the relationship between long-acting reversible contraception and condom use, this systematic review and meta-analysis synthesizes studies comparing sexually transmitted infection‒related outcomes between users of long-acting reversible contraception (intrauterine devices, implants) and users of moderately effective contraceptive methods (oral contraceptives, injectables, patches, rings). METHODS MEDLINE, Embase, PsycINFO, Global Health, CINAHL, Cochrane Library, and Scopus were searched for articles published between January 1990 and July 2018. Eligible studies included those that (1) were published in the English language, (2) were published in a peer-reviewed journal, (3) reported empirical, quantitative analyses, and (4) compared at least 1 outcome of interest (condom use, sexual behaviors other than condom use, sexually transmitted infection‒related service receipt, or sexually transmitted infections/HIV) between users of long-acting reversible contraception and users of moderately effective methods. In 2020, pooled ORs were calculated for condom use, chlamydia/gonorrhea infection, and trichomoniasis infection; findings for other outcomes were synthesized qualitatively. The protocol is registered on the International Prospective Register of Systematic Reviews (CRD42018109489). RESULTS A total of 33 studies were included. Long-acting reversible contraception users had decreased odds of using condoms compared with oral contraceptive users (OR=0.43, 95% CI=0.30, 0.63) and injectable, patch, or ring users (OR=0.58, 95% CI=0.48, 0.71); this association remained when limited to adolescents and young adults only. Findings related to multiple sex partners were mixed, and only 2 studies examined sexually transmitted infection testing, reporting mainly null findings. Pooled estimates for chlamydia and/or gonorrhea were null, but long-acting reversible contraception users had increased odds of trichomoniasis infection compared with oral contraceptive users (OR=2.01, 95% CI=1.11, 3.62). DISCUSSION Promoting condom use specifically for sexually transmitted infection prevention may be particularly important among long-acting reversible contraception users at risk for sexually transmitted infections, including adolescents and young adults.
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Affiliation(s)
- Riley J Steiner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sanjana Pampati
- Oak Ridge Institute for Science and Education, Atlanta, Georgia
| | - Katherine M Kortsmit
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Liddon
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Swartzendruber
- Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, Georgia
| | - Karen Pazol
- Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, Georgia
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Bunch PM, Loevner LA, Bhala R, Hepp MB, Hirsch JA, Johnson MH, Lyp KL, Quigley EP, Salamon N, Jordan JE, Schwartz ES. The American Society of Neuroradiology: Cultivating a Diverse and Inclusive Culture to Build a Stronger Organization. AJNR Am J Neuroradiol 2021; 42:2127-2129. [PMID: 34593384 DOI: 10.3174/ajnr.a7310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Nurelhuda NM, Keboa MT, Lawrence HP, Nicolau B, Macdonald ME. Advancing Our Understanding of Dental Care Pathways of Refugees and Asylum Seekers in Canada: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168874. [PMID: 34444623 PMCID: PMC8395044 DOI: 10.3390/ijerph18168874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 12/02/2022]
Abstract
The burden of oral diseases and need for dental care are high among refugees and asylum seekers (humanitarian migrants). Canada’s Interim Federal Health Program (IFHP) provides humanitarian migrants with limited dental services; however, this program has seen several fluctuations over the past decade. An earlier study on the experiences of humanitarian migrants in Quebec, Canada, developed the dental care pathways of humanitarian migrants model, which describes the care-seeking processes that humanitarian migrants follow; further, this study documented shortfalls in IFHP coverage. The current qualitative study tests the pathway model in another Canadian province. We purposefully recruited 27 humanitarian migrants from 13 countries in four global regions, between April and December 2019, in two Ontario cities (Toronto and Ottawa). Four focus group discussions were facilitated in English, Arabic, Spanish, and Dari. Analysis revealed barriers to care similar to the Quebec study: Waiting time, financial, and language barriers. Further, participants were unsatisfied with the IFHP’s benefits package. Our data produced two new pathways for the model: transnational dental care and self-medication. In conclusion, the dental care needs of humanitarian migrants are not currently being met in Canada, forcing participants to resort to alternative pathways outside the conventional dental care system.
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Affiliation(s)
- Nazik M. Nurelhuda
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, ON M5G 1G6, Canada; (N.M.N.); (H.P.L.)
| | - Mark T. Keboa
- Faculty of Dentistry, 500-2001 McGill College, McGill University, Montréal, QC H3A 1G1, Canada; (M.T.K.); (B.N.)
| | - Herenia P. Lawrence
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, ON M5G 1G6, Canada; (N.M.N.); (H.P.L.)
| | - Belinda Nicolau
- Faculty of Dentistry, 500-2001 McGill College, McGill University, Montréal, QC H3A 1G1, Canada; (M.T.K.); (B.N.)
| | - Mary Ellen Macdonald
- Faculty of Dentistry, 500-2001 McGill College, McGill University, Montréal, QC H3A 1G1, Canada; (M.T.K.); (B.N.)
- Correspondence:
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Steinert JI, Alacevich C, Steele B, Hennegan J, Yakubovich AR. Response strategies for promoting gender equality in public health emergencies: a rapid scoping review. BMJ Open 2021; 11:e048292. [PMID: 34385251 PMCID: PMC8361708 DOI: 10.1136/bmjopen-2020-048292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic threatens to widen existing gender inequities worldwide. A growing body of literature assesses the harmful consequences of public health emergencies (PHEs) for women and girls; however, evidence of what works to alleviate such impacts is limited. To inform viable mitigation strategies, we reviewed the evidence on gender-based interventions implemented in PHEs, including disease outbreaks and natural disasters. METHODS We conducted a rapid scoping review to identify eligible studies by systematically searching the databases MEDLINE, Global Health and Web of Science with the latest search update on 28 May 2021. We used the Sustainable Development Goals as a guiding framework to identify eligible outcomes of gender (in)equality. RESULTS Out of 13 920 records, 16 studies met our eligibility criteria. These included experimental (3), cohort (2), case-control (3) and cross-sectional (9) studies conducted in the context of natural disasters (earthquakes, droughts and storms) or epidemics (Zika, Ebola and COVID-19). Six studies were implemented in Asia, seven in North/Central America and three in Africa. Interventions included economic empowerment programmes (5); health promotion, largely focused on reproductive health (10); and a postearthquake resettlement programme (1). Included studies assessed gender-based outcomes in the domains of sexual and reproductive health, equal opportunities, access to economic resources, violence and health. There was a dearth of evidence for other outcome domains relevant to gender equity such as harmful practices, sanitation and hygiene practices, workplace discrimination and unpaid work. Economic empowerment interventions showed promise in promoting women's and girls' economic and educational opportunities as well as their sexual and reproductive health during PHEs. However, some programme beneficiaries may be at risk of experiencing unintended harms such as an increase in domestic violence. Focused reproductive health promotion may also be an effective strategy for supporting women's sexual and reproductive health, although additional experimental evidence is needed. CONCLUSIONS This study identified critical evidence gaps to guide future research on approaches to alleviating gender inequities during PHEs. We further highlight that interventions to promote gender equity in PHEs should take into account possible harmful side effects such as increased gender-based violence. REVIEW REGISTRATION DOI 10.17605/OSF.IO/8HKFD.
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Affiliation(s)
- Janina I Steinert
- TUM Schoool of Governance, Technical University of Munich, München, Germany
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Caterina Alacevich
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Bridget Steele
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexa R Yakubovich
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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Ghanbarzadegan A, Bastani P, Luzzi L, Brennan D. Inequalities in utilization and provision of dental services: a scoping review. Syst Rev 2021; 10:222. [PMID: 34376247 PMCID: PMC8356458 DOI: 10.1186/s13643-021-01779-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are many determinants that can affect inequality in oral and dental health. This study is aimed to explore the main determinants of inequality in both utilization and provision of dental services in Organization for Economic Co-operation and Development (OECD) countries. METHODS Four databases including PubMed, ISI WOS, Scopus, and ProQuest were searched up to 8 Aug 2020, applying the relevant keywords. Thematic analysis was used for synthesizing and extracting data. Trend analysis was applied to determine the trends of the inequality determinants. RESULTS Thematic analysis led to 6 main themes, 13 sub-themes, and 53 sub-sub-themes. The main themes represent the main inequality determinants for both utilization and provision of dental services. The streamgraph illustrated that fewer studies have been conducted on social and cultural determinants, and for almost all determinants the trend of published articles has been increasing since 2007, with the exception of health policies. CONCLUSIONS Inequality in the utilization and provision of dental services is addressed by various factors including individual, social, cultural and economic determinants, health policies, and availability of services. The first four determinants are related to utilization and the last two are related to the provision of services. All these aspects must be considered to reduce inequality in dental services.
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Affiliation(s)
- Arash Ghanbarzadegan
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Peivand Bastani
- Health Human Resources Research Centre, School of Health Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Liana Luzzi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - David Brennan
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5000, Australia
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Which determinants should be considered to reduce social inequalities in paediatric dental care access? A cross-sectional study in France. PLoS One 2021; 16:e0255360. [PMID: 34347827 PMCID: PMC8336796 DOI: 10.1371/journal.pone.0255360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/14/2021] [Indexed: 12/03/2022] Open
Abstract
Better access to dental care through systemic and educational strategies is needed to lessen the burden of disease due to severe early caries. Our study aims to describe family characteristics associated with severe early caries: parental knowledge, attitudes, practices in oral health and socio-demographic factors. For this cross-sectional study, 102 parents of children aged under 6 years with severe early caries and attending paediatric dentistry service in France completed a questionnaire during face-to-face interviews. Caries were diagnosed clinically by calibrated investigators, using the American Academy of Paediatric Dentistry criteria, and dental status was recorded using the decayed, missing, and filled teeth index. The majority of children were from underprivileged backgrounds and had poor oral health status, with a median dmft index of 10. Parents highlighted the difficulty of finding suitable dental care in private practices. Parents appeared to have good oral health knowledge and engaged in adapted behaviours but showed a low sense of self-efficacy. They perceived the severity of early caries as important but the susceptibility of their child as moderate. The study affirmed the importance of improving the accessibility of paediatric dental care and developing educational strategies to enhance the knowledge, skills, and oral health practices of families.
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Ju X, Do LG, Brennan DS, Luzzi L, Jamieson LM. Inequality and Inequity in the Use of Oral Health Services in Australian Adults. JDR Clin Trans Res 2021; 7:389-397. [PMID: 34315314 DOI: 10.1177/23800844211027489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Social determinants drive disparities in dental visiting. This study aimed to measure inequality and inequity in dental visiting among Australian adults. METHODS Data were obtained from the National Study of Adult Oral Health (2017 to 2018). Participants were Australian adults aged ≥30 y. The outcome of interest was dental visiting in the last 12 mo. Disparity indicators included education and income. Other sociodemographic characteristics included age, gender, Indigenous status, main language, place of birth, residential location, health card and dental insurance status, and individual's self-rated and impaired oral health. To characterize inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration indexes and the slope and relative indexes of inequality. Inequalities were depicted through concentration curves. Indirect standardization with a nonlinear model was used to measure inequity. RESULTS A total of 9,919 Australian adults were included. Bivariate analysis showed a gradient by education and income on dental visiting, with 48% of those with lowest educational attainment/income having not visited a dentist in the last 12 mo. The concentration curves showed pro-low education and pro-poor income inequalities. All measures of absolute and relative indices were negative, indicating that from the bottom to the top of the socioeconomic ladder (education and income), the prevalence of no dental visiting decreased: absolute and relative concentration index estimates were approximately 2.5% and 5.0%, while the slope and relative indexes of inequality estimates were 14% to 18% and 0.4%, respectively. After need standardization, the group with the highest education or income had almost 1.5-times less probability of not having a dental visit in the previous year than those with the lowest education or income. CONCLUSION The use of oral health services exhibited socioeconomic inequalities and inequities, disproportionately burdening disadvantaged Australian adults. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by policy makers when planning a dental labor force in relation to the capacity of supply dental services to 1) reduce the inequality and inequity in the use of oral health services and 2) meet identified oral health needs across the Australian population, which is important for preventive dental care.
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Affiliation(s)
- X Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - L G Do
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - D S Brennan
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - L Luzzi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - L M Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
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Ju X, Mejia GC, Wu Q, Luo H, Jamieson LM. Use of oral health care services in the United States: unequal, inequitable-a cross-sectional study. BMC Oral Health 2021; 21:370. [PMID: 34301209 PMCID: PMC8299583 DOI: 10.1186/s12903-021-01708-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 07/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Social determinants drive disparities in dental visiting. Disparities can be measured simply by comparing outcomes between groups (inequality) but can also consider concepts of social justice or fairness (inequity). This study aimed to assess differences in dental visiting in the United States in terms of both social inequality and inequity. Methods Data were obtained from a cross-sectional study—the National Health and Nutrition Examination Survey (NHANES) 2015–2016, and participants were US adults aged 30+ years. The outcome of interest, use of oral health care services, was measured in terms of dental visiting in the past 12 months. Disparity was operationalized through education and income. Other characteristics included age, gender, race/ethnicity, main language, country of birth, citizenship and oral health status. To characterize existing inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration index (ACI and RCI), the slope index of inequality (SII) and relative index of inequality (RII) and through concentration curves (CC). Indirect standardization with a non-linear model was used to measure inequity. Results A total of 4745 US adults were included. Bivariate analysis showed a gradient by both education and income in dental visiting, with a higher proportion (> 60%) of those with lower educational attainment /lower income having not visited a dentist. The concentration curves showed pro-higher education and income inequality. All measures of absolute and relative indices were negative, indicating that from lower to higher socioeconomic position (education and income), the prevalence of no dental visiting decreased: ACI and RCI estimates were approximately 8% and 20%, while SII and RII estimates were 50% and 30%. After need-standardization, the group with the highest educational level had nearly 2.5 times- and the highest income had near three times less probability of not having a dental visit in the past 12 months than those with the lowest education and income, respectively. Conclusion The findings indicate that use of oral health care is threatened by existing social inequalities and inequities, disproportionately burdening disadvantaged populations. Efforts to reduce both oral health inequalities and inequities must start with action in the social, economic and policy spheres.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, 5005, Australia.
| | - Gloria C Mejia
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, 5005, Australia.,SA Aboriginal Chronic Disease Consortium, Wardliparingga, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, USA
| | - Huabin Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, USA
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, 5005, Australia
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Chang Q, Gao X, Xu M, Zhang C, Du S, Wang X, Feng X, Tai B, Hu D, Lin H, Wang B, Wang C, Zheng S, Liu X, Rong W, Wang W, Xu T, Si Y. Socioeconomic-related inequality in dental care utilization among preschool children in China. Community Dent Oral Epidemiol 2021; 49:505-512. [PMID: 34288037 DOI: 10.1111/cdoe.12681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to investigate socioeconomic-related inequality in dental care service utilization in the past 12 months among Chinese preschool children and to explore the contribution of various factors to this inequality. METHOD A total of 40 305 children aged 3-5 years from 372 kindergartens who participated in the Fourth National Oral Health Survey in China were included in the final analysis. The method of data weighting in complex sampling was adopted to make the samples more representative. Erreygers-corrected concentration index (EI) was used to measure socioeconomic-related inequality in dental care service utilization. The horizontal inequality index (HI) was employed to analyse horizontal inequality. Decomposition analyses were conducted to explore the contributions of income level, need variables (dmft, caregiver-evaluated oral health status and toothache experience) and nonneed variables (caregiver education level, residential location, age, and sex) to the inequality of health service utilization. RESULT The utilization of oral health services within the past 12 months among the high-, middle- and low-income groups was 17.4% (95% CI: 15.6-19.3), 13.6% (95% CI: 12.2-15.1) and 9.4% (95% CI: 8.1-11.0) respectively. The concentration curve was below the line of equality, and the EI and HI were 0.072 and 0.078, respectively, indicating that dental care utilization in children aged 3-5 years was concentrated in those who were better off. The contribution of the need variables to socioeconomic-related inequality in dental services was minimal, and most dental care utilization inequality could be explained by household income, caregiver education attainment and urban-rural disparities, accounting for 32.0%, 49.4% and 20.4% respectively. CONCLUSION This study reveals the existence of pro-rich inequality in dental care utilization among preschool children in China. The decomposition analysis suggests that income, caregiver education background and urban-rural disparities are the main factors contributing to this outcome. Equity-oriented policies and programmes are needed to achieve equitable dental care utilization.
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Affiliation(s)
- Qing Chang
- Department of Second Clinical Division, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoli Gao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mengru Xu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chunzi Zhang
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shuo Du
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xing Wang
- Chinese Stomatological Association, Beijing, China
| | - Xiping Feng
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baojun Tai
- School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Deyu Hu
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - Huancai Lin
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yetsen University, Guangzhou, China
| | - Bo Wang
- Chinese Stomatological Association, Beijing, China
| | - Chunxiao Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuguo Zheng
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xuenan Liu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wensheng Rong
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Weijian Wang
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tao Xu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Si
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
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Galvão MHR, Medeiros ADA, Roncalli AG. Contextual and individual factors associated with public dental services utilisation in Brazil: A multilevel analysis. PLoS One 2021; 16:e0254310. [PMID: 34242338 PMCID: PMC8270158 DOI: 10.1371/journal.pone.0254310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study verified the association between contextual and individual factors and public dental services utilisation in Brazil. METHODS The study was conducted based on a cross-sectional population-based household survey performed in Brazil (National Health Survey- 2019)). Data was collected between August 2019 and March 2020. Total sample included 43,167 individuals aged ≥15 years who had at least one dental appointment in the last 12 months before interview. Study outcome was 'public dental service utilisation', and Andersen's behavioral model was adopted for selecting independent variables. A multilevel analysis was performed using individual factors as first level and federation units as second level. RESULTS The highest prevalence of public dental service utilisation on an individual level was observed among unable to read or write people (PR: 3.31; p<0.001), indigenous (PR: 1.40; p<0.001), black or brown (PR: 1.16; p<0.001), with per capita household income of up to U$124 (PR: 2.40; p<0.001), living in the rural area (PR: 1.28; p<0.001), and who self-rated oral health as regular (PR: 1.15; p<0.001) or very bad/bad (PR: 1.26; p<0.001). On the contextual level, highest PR of public dental service utilisation was observed among those living in federal units with increased oral health coverage in primary health care. CONCLUSIONS Public dental service utilisation is associated with individual and contextual factors. These results can guide decision-making based on evidence from policymakers, demonstrating the potential for mitigating oral health inequalities and increasing service coverage in a public and universal health system.
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Affiliation(s)
- Maria Helena Rodrigues Galvão
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Arthur de Almeida Medeiros
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Angelo Giuseppe Roncalli
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Taira K, Mori T, Ishimaru M, Iwagami M, Sakata N, Watanabe T, Takahashi H, Tamiya N. Regional Inequality in Dental Care Utilization in Japan: An Ecological Study Using the National Database of Health Insurance Claims. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 12:100170. [PMID: 34527966 PMCID: PMC8356097 DOI: 10.1016/j.lanwpc.2021.100170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/15/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study examined regional inequalities in dental care utilization in Japan and the association of dental care utilization with socioeconomic factors. METHODS Using the Fourth National Database of Health Insurance Claims and Specific Health Checkups of Japan Open data, this ecological study analyzed 216 million pieces of aggregated data from April 2017 to March 2018. Nine indicators of dental care utilization were used: outpatient visits, outreach services, cavity fillings, pulpectomies, dental calculus removals, periodontal surgeries, tooth extractions, dental bridges, and dentures. Standardized claim ratios (SCRs) for these indicators were calculated for Japan's 47 prefectures, which were divided into three groups based on the number of dental clinics per population, average income per capita, and the proportion of university enrollments. Associations of the dental care utilization with dental supply and regional socioeconomic factors were examined. FINDINGS The ratios of maximum to minimum of SCRs were 1·4 for outpatient visits, 19·3 for outreach services, and 17·6 for periodontal surgeries. Dental supply was positively associated with outpatient visits, outreach services, dental calculus removal, and periodontal surgeries. Regional average income and educational level were positively associated with dental calculus removals, and negatively associated with pulpectomies, tooth extractions, dental bridges, and dentures. INTERPRETATION In Japan, regional inequalities in dental care utilization exist for periodontal care and outreach services but are smaller for urgent and substantial dental care. Regional income and educational levels appear to have influence on dental care utilization. FUNDING Ministry of Health, Labour and Welfare of Japan (H31-19FA1001).
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Affiliation(s)
- Kento Taira
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Mori
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
- Department of General Internal Medicine, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Miho Ishimaru
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Taeko Watanabe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideto Takahashi
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- National Institute of Public Health, Wako, Saitama, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Naito R, Leong DP, Bangdiwala SI, McKee M, Subramanian SV, Rangarajan S, Islam S, Avezum A, Yeates KE, Lear SA, Gupta R, Yusufali A, Dans AL, Szuba A, Alhabib KF, Kaur M, Rahman O, Seron P, Diaz R, Puoane T, Liu W, Zhu Y, Sheng Y, Lopez-Jaramillo P, Chifamba J, Rosnah I, Karsidag K, Kelishadi R, Rosengren A, Khatib R, K R LIA, Azam SI, Teo K, Yusuf S. Impact of social isolation on mortality and morbidity in 20 high-income, middle-income and low-income countries in five continents. BMJ Glob Health 2021; 6:bmjgh-2020-004124. [PMID: 33753400 PMCID: PMC7986654 DOI: 10.1136/bmjgh-2020-004124] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/26/2020] [Accepted: 01/20/2021] [Indexed: 12/26/2022] Open
Abstract
Objective To examine the association between social isolation and mortality and incident diseases in middle-aged adults in urban and rural communities from high-income, middle-income and low-income countries. Design Population-based prospective observational study. Setting Urban and rural communities in 20 high income, middle income and low income. Participants 119 894 community-dwelling middle-aged adults. Main outcome measures Associations of social isolation with mortality, cardiovascular death, non-cardiovascular death and incident diseases. Results Social isolation was more common in middle-income and high-income countries compared with low-income countries, in urban areas than rural areas, in older individuals and among women, those with less education and the unemployed. It was more frequent among smokers and those with a poorer diet. Social isolation was associated with greater risk of mortality (HR of 1.26, 95% CI: 1.17 to 1.36), incident stroke (HR: 1.23, 95% CI: 1.07 to 1.40), cardiovascular disease (HR: 1.15, 95% CI: 1.05 to 1.25) and pneumonia (HR: 1.22, 95% CI: 1.09 to 1.37), but not cancer. The associations between social isolation and mortality were observed in populations in high-income, middle-income and low-income countries (HR (95% CI): 1.69 (1.32 to 2.17), 1.27 (1.15 to 1.40) and 1.47 (1.25 to 1.73), respectively, interaction p=0.02). The HR associated with social isolation was greater in men than women and in younger than older individuals. Mediation analyses for the association between social isolation and mortality showed that unhealthy behaviours and comorbidities may account for about one-fifth of the association. Conclusion Social isolation is associated with increased risk of mortality in countries at different economic levels. The increasing share of older people in populations in many countries argues for targeted strategies to mitigate its adverse effects.
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Affiliation(s)
- Ryo Naito
- Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Darryl P Leong
- Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Shrikant Ishver Bangdiwala
- Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - S V Subramanian
- Harvard Center for Population and Development Studies and Department of Society and Human Development, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Karen E Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | | | - Antonio L Dans
- Adult Medicine Research Unit, Philippine General Hospital, Manila, Philippines
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Manmeet Kaur
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Omar Rahman
- University of Liberal Arts Bangladesh, Dhaka, Dhaka District, Bangladesh
| | | | - Rafael Diaz
- ECLA - Academic Research Organization, Rosario, Argentina
| | - Thandi Puoane
- School of Public Health, University of Western Cape, Cape Town, Western Cape, South Africa
| | - Weida Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Xicheng District, Beijing, China
| | - Yibing Zhu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
| | - Yundong Sheng
- Jiangxinzhou Community Health Service Center, Nanjing, China
| | | | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Ismail Rosnah
- Community Health Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia, Malaysia
| | - Kubilay Karsidag
- Division of Endocrinology, Medical Faculty of Istanbul University, Fatih, Turkey
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Rasha Khatib
- Advocate Aurora Research Institute, Downers Grove, Illinois, USA.,Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Leela Itty Amma K R
- Health Action by People, Thiruvananthapuram, Kerala, India.,Department of Community Medicine, Sree Mookambika Institute of Medical Sciences, Kulasekharam, India
| | - Syed Iqbal Azam
- Community Health Sciences (CHS) department, The Aga Khan University, Karachi, Pakistan
| | - Koon Teo
- Population Health Research Institute, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton, Ontario, Canada .,Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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Chen Y, Zhang P, Luman ET, Griffin SO, Rolka DB. Incremental Dental Expenditures Associated With Diabetes Among Noninstitutionalized U.S. Adults Aged ≥18 Years Old in 2016-2017. Diabetes Care 2021; 44:1317-1323. [PMID: 33905345 PMCID: PMC8247485 DOI: 10.2337/dc20-2744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is associated with poor oral health, but incremental expenditures for dental care associated with diabetes in the U.S. are unknown. We aimed to quantify these incremental expenditures per person and for the nation. RESEARCH DESIGN AND METHODS We analyzed data from 46,633 noninstitutionalized adults aged ≥18 years old who participated in the 2016-2017 Medical Expenditure Panel Survey. We used two-part models to estimate dental expenditures per person in total, by payment source, and by dental service type, controlling for sociodemographic characteristics, health status, and geographic variables. Incremental expenditure was the difference in predicted expenditure for dental care between adults with and without diabetes. The total expenditure for the U.S. was the expenditure per person multiplied by the estimated number of people with diabetes. Expenditures were adjusted to 2017 USD. RESULTS The mean adjusted annual diabetes-associated incremental dental expenditure was $77 per person and $1.9 billion for the nation. Of this incremental expenditure, 51% ($40) and 39% ($30) were paid out of pocket and by private insurance, 69% ($53) of the incremental expenditure was for restorative/prosthetic/surgical services, and adults with diabetes had lower expenditure for preventive services than those without (incremental, -$7). Incremental expenditures were higher in older adults, non-Hispanic Whites, and people with higher levels of income and education. CONCLUSIONS Diabetes is associated with higher dental expenditures. These results fill a gap in the estimates of total medical expenditures associated with diabetes in the U.S. and highlight the importance of preventive dental care among people with diabetes.
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Affiliation(s)
- Yu Chen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth T Luman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Susan O Griffin
- Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deborah B Rolka
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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71
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Floríndez LI, Como DH, Floríndez DC, Vigen C, Floríndez FM, Cermak SA. Identifying Gaps in Oral Care Knowledge, Attitudes, and Practices of Latinx Parents/Caregivers of Children With and Without Autism Spectrum Disorders. Health Equity 2021; 5:185-193. [PMID: 33937604 PMCID: PMC8080905 DOI: 10.1089/heq.2020.0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose: This pilot study used data from a survey to examine the knowledge, attitudes, and practices about oral care of Latinx parents/caregivers of children with or without autism spectrum disorder (ASD) to identify gaps to focus future intervention. Methods: Sixty English-speaking Latinx parents/caregivers who had a child between 4 and 14 years with or without ASD (n=31 ASD, n=29 typically developing [TD]) completed a questionnaire on oral health knowledge, practices, access to care, and demographics. Caregiver responses were compared, and gaps in knowledge and practices were identified. Results: There were no significant differences in parent age, child age, income, insured status, or overall knowledge scores, only a significant difference in education (p=0.02), with the ASD group reporting less. Scores for knowledge, attitudes, access and practice were all nonsignificantly positively correlated, as was attitudes with access and practice. However, knowledge and attitudes were significantly negatively correlated. Additional significant findings were parents who had lower income and education, had lower oral knowledge scores, decreased frequency of dental visits, increased feelings of being discriminated against, children with increased fear of the dentist, and decreased ease of finding a dentist. Conclusion: Factors such as income, education, ethnicity, and having a child with ASD can influence what Latinx parents and caregivers know about oral health and how their children experience receiving dental care. Latinx parents/caregivers of children with and without ASD report barriers to dental care, including difficulty attending visits or feeling stigmatized by their dental provider due to their ethnicity. Fear of the dentist is significantly correlated with ASD diagnosis and lower social demographics of the parent, and may contribute to a reduction in preventative oral care visits as well. Health care providers should consider these perspectives when providing care to this population to mitigate further oral health inequities.
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Affiliation(s)
- Lucía I Floríndez
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Dominique H Como
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Daniella C Floríndez
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Cheryl Vigen
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | | | - Sharon A Cermak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
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72
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An Investigation of the Association between Health Screening and Dental Scaling in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084294. [PMID: 33919535 PMCID: PMC8073085 DOI: 10.3390/ijerph18084294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022]
Abstract
Dental disease is one of the most prevalent chronic diseases worldwide, and its expenditure is continuously increasing. Periodontal disease is increasing as a chronic non-communicable disease in adults and older people. Health screening has been shown to be cost-effective and improves the quality of life through the early detection of diseases. This study aimed to analyze the relationship between national health screening and dental scaling as a preventive service for periodontal disease. The study used sample cohort data from 2002 to 2015 provided by the National Health Insurance Sharing Service in South Korea. A logistic regression analysis of the utilization of dental scaling was performed to identify the independent effects of national health screening. People who underwent health screening showed a higher tendency to undergo dental scaling. Additionally, disparities in utilization according to socioeconomic status were reduced among those who underwent screening. The intervention to extend dental coverage could be more beneficial when combined with health screening, encouraging more people to participate and reducing inequalities in utilization.
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73
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Pengpid S, Peltzer K. Prevalence and Correlates of Dental Service Utilization among Adults in Solomon Islands. J Int Soc Prev Community Dent 2021; 11:166-172. [PMID: 34036078 PMCID: PMC8118046 DOI: 10.4103/jispcd.jispcd_400_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 12/01/2022] Open
Abstract
Aims and Objectives: The aim of this study was to assess dental service utilization (DSU) among adults in a Pacific Island country. Materials and Methods: In a cross-sectional nationally representative survey in Solomon Islands, 2,533 individuals (18–69 years) responded to questions on DSU, sociodemographic and health information in 2015. Results: More than half of the participants (55.3%) never had DSU, 36.4% had more than 12 months DSU, and 8.3% had past 12 months DSU. In adjusted multinomial logistic regression analysis, older age, ever screened for blood pressure, using toothpaste, and having had pain in teeth, gum, or mouth in the past year were associated with both >12 months and past 12 months DSU. Higher education, ever screened for cholesterol, being divorced, separated, or widowed, poor self-rated oral health (SROH), and experienced difficulty in chewing foods in the past 12 months were associated with >12 months or past 12 months DSU. High physical activity was negatively associated with >12 months DSU. Conclusion: Less than one in ten participants had past 12 months DSU and several factors were found, which can be targeted in interventions.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand.,Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
| | - Karl Peltzer
- Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
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74
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Murillo-Pedrozo AM, Martínez-Herrera E, Ronda-Pérez E, Agudelo-Suárez AA. A Qualitative Study of the Health Perceptions in the Venezuelan Immigrant Population in Medellín (Colombia) and Its Conditioning Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3897. [PMID: 33917688 PMCID: PMC8068052 DOI: 10.3390/ijerph18083897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
This study explored the general and oral health perceptions in the Venezuelan immigrant population in Medellín (Colombia) and its conditioning factors. A qualitative study involving Venezuelan immigrants ≥18 years with a minimum stay of six months in Colombia was conducted. Dentists, dental students, and other health professionals also participated. Semi-structured interviews (n = 17), focus groups (n = 2), and key informants' interviews (n = 4) were utilized. The interviews and focus groups were recorded and transcribed for later narrative content analysis. A high degree of vulnerability of participants was found due to the precarious living conditions from the premigratory moment and the lack of job placement possibilities at the time of settling in Colombia, where the migratory status played a fundamental role. Among the perceived needs, the mitigation of noncommunicable diseases stood out. Poor mental health symptoms (depression and anxiety) were perceived, and oral health was not a priority. Barriers to accessing health and dental care were found. The migrant condition was found to be a determinant that affected physical, mental, and oral health and the provision of health care. This situation is of interest to the construction of public health policies that guarantee access to fundamental rights.
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Affiliation(s)
| | - Eliana Martínez-Herrera
- Research Group of Epidemiology, National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellín 050010, Colombia;
- Research Group on Health Inequalities, Environment, Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005 Barcelona, Spain
| | - Elena Ronda-Pérez
- Public Health Research Group, University of Alicante, 03690 Alicante, Spain;
- CIBERESP, 28029 Madrid, Spain
| | - Andrés A. Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Medellín 050010, Colombia;
- Public Health Research Group, University of Alicante, 03690 Alicante, Spain;
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75
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Buffarini R, Coll CVN, Moffitt T, Freias da Silveira M, Barros F, Murray J. Intimate partner violence against women and child maltreatment in a Brazilian birth cohort study: co-occurrence and shared risk factors. BMJ Glob Health 2021; 6:e004306. [PMID: 33931414 PMCID: PMC8098765 DOI: 10.1136/bmjgh-2020-004306] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) against women and child maltreatment (CM) are major public health problems and human rights issues and may have shared causes. However, their overlap is understudied. We investigated the prevalence of IPV and CM, their co-occurrence in households and possible shared risk factors, in the general population of a Brazilian urban setting. METHODS Prospective population-based birth cohort, including over 3500 mother-child dyads with maternal reports on both IPV and CM when children were 4 years old. Eleven neighbourhood, family and parental risk factors were measured between birth and age 4 years. Bivariate and multivariate Poisson regression models with robust variance were used to test which potential risk factors were associated with IPV, CM and their co-occurrence. RESULTS The prevalence of any IPV and CM were 22.8% and 10.9%, respectively; the co-occurrence of both types of violence was 5%. Multivariate analyses showed that the overlap of IPV and CM was strongly associated with neighbourhood violence, absence of the child's biological father, paternal antisocial behaviour in general and a mother-partner relationship characterised by high levels of criticism, maternal depression and younger maternal age. A concentration of many risk factors among 10% of the population was associated with a sixfold increase in risk for overlapping IPV and CM compared with households with no risk factors. CONCLUSION IPV and CM share important risk factors in the family and neighbourhood environments and are particularly common in households with multiple social disadvantages and family difficulties. Integrated preventive interventions are needed.
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Affiliation(s)
- Romina Buffarini
- Postgraduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
- Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
| | - Carolina V N Coll
- Postgraduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
- Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Terrie Moffitt
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College, London, United Kinkdom
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Mariangela Freias da Silveira
- Postgraduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Fernando Barros
- Postgraduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, RS, Brazil
- Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
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76
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Galvão MHR, Roncalli AG. Does the implementation of a national oral health policy reduce inequalities in oral health services utilization? The Brazilian experience. BMC Public Health 2021; 21:541. [PMID: 33740941 PMCID: PMC7980604 DOI: 10.1186/s12889-021-10586-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to assess the trend in income-related inequalities in oral health services utilization by the Brazilian population from 1998 to 2013. This period represents a timeline that includes different stages of implementation of the National Oral Health Policy. Methods The design was based on repeated cross-sectional surveys using secondary data from household-based studies carried out in Brazil in 1998, 2003, 2008, and 2013. The dependent variable was “having access to a dentist appointment at least once in a lifetime (yes/no).” Monthly household per capita income, based on Brazil’s minimum wage, was included as the main independent variable. To measure the inequalities in oral health access related to economic position, the following complex indexes based on regression were used: (a) the slope index of inequality (SII) and (b) the relative index of inequality (RII). Results There was a reduction in the percentage of individuals who never had a dentist appointment for all age groups and income classifications. In general, there was a reduction trend in absolute inequality for all age groups (p < 0.001). The relative inequality and reduction trend were different between the age groups studied. Conclusions The National Oral Health Policy was very important for expanding free of charge, public access to dental appointment. However, despite policy implementation, there continues to be high levels of inequality in access to dental consultation. Assessing which strategies are necessary to overcome this challenge is discussed.
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Affiliation(s)
| | - Angelo Giuseppe Roncalli
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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77
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Time-to-Treatment in Oral Cancer: Causes and Implications for Survival. Cancers (Basel) 2021; 13:cancers13061321. [PMID: 33809427 PMCID: PMC8000007 DOI: 10.3390/cancers13061321] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022] Open
Abstract
The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.
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78
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Pilotto LM, Celeste RK. Contextual determinants for use of dental services according to different healthcare financing systems: Andersen's model. Community Dent Oral Epidemiol 2021; 50:99-105. [PMID: 33719085 DOI: 10.1111/cdoe.12636] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/06/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore contextual factors associated with overall dental service use, and investigate whether these factors influenced choice of the type of service according to the healthcare financing alternatives (public services; out-of-pocket services; and private health insurance), by adults and older individuals, based on the most recent Andersen's behavioural model. METHODS Cross-sectional study with individual data on 17,305 adults from 177 Brazilian municipalities in the National Oral Health Survey (SBBrasil 2010). Municipal-level information was obtained from health information systems and census data. Multilevel multinomial logistic regression was carried out for multivariable analysis. RESULTS In the previous year, 38.2% of the individuals visited the dentist; of which 21.4% used out-of-pocket spending, 11.6% used public services and 5.2% private dental insurance. Municipalities with population coverage of public primary dental care >80% had higher chances of using public services (OR = 1.28, 95%CI:1.00-1.64) than those with ≤60%, but lower chances of using private insurance (OR = 0.56, 95%CI:0.38-0.83). Municipalities with population coverage of private dental insurance > 5% had lower chances of using public services (OR = 0.62, 95%CI:0.47-0.81) than those with <1% coverage, and greater chances of using private insurance (OR = 4.33, CI:95% 2.02-9.29). These factors were not associated with out-of-pocket dental services. CONCLUSIONS Municipal coverage of dental services is associated with dental care use, and this is different according to the type of financing system (public or private), as they may change the individual's choice of service. A large public healthcare system may increase public service use for those with reduced access and decrease private service use.
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Affiliation(s)
- Luciane Maria Pilotto
- Department of Social and Preventive Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Roger Keller Celeste
- Department of Social and Preventive Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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79
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Singh KA, Brennan DS. Use of dental services among middle-aged adults: predisposing, enabling and need variables. Aust Dent J 2021; 66:270-277. [PMID: 33521979 DOI: 10.1111/adj.12828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine if making a visit, number of visits and services varied by predisposing (gender, perceived health competence, education, previous relief of pain visit), enabling (dental anxiety, income, social support) and need (perceived need, number of teeth and oral pain) characteristics. METHODS Dental visiting and services data from a sample of middle-aged South Australian adults were collected from 61% of participants at 12-months (n = 603) and 59% after 24-months (n = 583). Visiting over 2-years, mean visits and mean services were analysed by log binomial and Poison regression using the Andersen and Newman model. RESULTS The percentage having a dental visit over 2-years was lower for males than females, prevalence ratio (PR, 95% CI) 0.91 (0.84, 0.99), and for higher than lower dental anxiety, PR = 0.78 (0.62, 0.98). Number of visits was associated with higher than lower income, rate ratio (RR, 95%CI) 1.20 (1.02, 1.41) but lower for those with higher social support, RR = 0.86 (0.74, 0.99). Services were lower for those with higher perceived health competence, RR = 0.72 (0.56, 0.92) but higher for those with perceived needs, RR = 1.22 (1.01, 1.46). CONCLUSIONS While need and cost factors predict dental service use, psychosocial variables such as health competence and social support also need to be considered.
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Affiliation(s)
- K A Singh
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - D S Brennan
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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80
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Pengpid S, Peltzer K. Prevalence and correlates of dental service utilisation among a national general adult population sample in Sudan. BMC Oral Health 2021; 21:61. [PMID: 33573643 PMCID: PMC7879665 DOI: 10.1186/s12903-021-01422-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Prompt dental service utilisation (DSU) is needed for the prevention and treatment of oral diseases, and it is therefore important to determine the facilitators and barriers of DSU. There is, however, scarce information available on DSU in Sudan. Therefore, this study aimed to investigate the prevalence and associated factors of DSU in a general population-based survey among 18-69 year-old persons in Sudan. METHODS Cross-sectional nationally representative data of 7,722 18-69 year-old persons (36 years median age) from the 2016 Sudan Stepwise approach to surveillance (STEPS) survey were analysed. Using questionnaire, anthropometric and biochemical measures, predisposing, enabling and health and lifestyle factors of DSU were assessed. Multinomial logistic regression was conducted to estimate the predictors of DSU (> 12 months and past 12 months, with never DSU as the reference category). RESULTS About two-thirds of the participants (64.6%) had never DSU, 22.0% had more than 12-month DSU, and 13.4% had past 12- month DSU. Among those who had ever DSU, the main reason for the last DSU was pain or trouble with teeth, gums, or mouth (66.9%), treatment or follow-up treatment 22.3%, and routine check-up treatment 5.0%. In adjusted multinomial logistic regression analysis, higher education (p < 0.001), urban residence (p < 0.001), screened for blood pressure (p < 0.001), raised total cholesterol (p < 0.05), poor SROH (p < 0.001), pain in teeth or mouth (p < 0.001), and not working because of teeth or mouth (p < 0.01) were positively and not knowing their household income (p < 0.01), high physical activity (p < 0.05), and having 20 or more teeth (p < 0.001), were negatively associated with both > 12 months and past 12 months DSU. Higher household income (p < 0.001), overweight/obesity (p < 0.05), using tooth paste (p < 0.001), and difficulty chewing (p < 0.001), were positively, and male sex (p < 0.01), and teeth cleaning twice or more times a day (p < 0.05), were negatively associated with > 12 months or past 12 months DSU. CONCLUSION More than one in ten participants had past 12 months DSU and several factors were detected which could be targeted in intervention activities. Study findings suggest to improve oral health awareness, in particular stressing the relevance of regular dental check-ups, by using different modalities of oral health promotion.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand.,Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa.
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81
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Tan YR, Tan EH, Jawahir S, Mohd Hanafiah AN, Mohd Yunos MH. Demographic and socioeconomic inequalities in oral healthcare utilisation in Malaysia: evidence from a national survey. BMC Oral Health 2021; 21:34. [PMID: 33468125 PMCID: PMC7816410 DOI: 10.1186/s12903-020-01388-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022] Open
Abstract
Background Throughout the years, oral healthcare utilisation in Malaysia has been low despite various efforts by the Ministry of Health Malaysia for improvement. This study aimed to determine the prevalence of oral healthcare utilisation and identify factors associated with oral healthcare utilisation among adults in Malaysia. Methods Secondary data analysis of adults aged 18 years and over from the National Health and Morbidity Survey 2019 was conducted in this study. Characteristics of respondents and those who utilised oral healthcare were described using complex sample descriptive statistics. Logistic regression analysis was performed to examine the association between the dependent and independent variables. Dependent variable was oral healthcare utilisation in the last 12 months. Independent variables were demographic and socioeconomic factors (predisposing, enabling and need characteristics) based on Andersen’s Behavioural Model. Results A total of 11,308 respondents, estimated to represent 21.7 million adults aged 18 years and over in Malaysia were included in the analysis. Prevalence of oral healthcare utilisation in the last 12 months was 13.2%. Demographic factors of sex, age, marital status, and socioeconomic factors of education level and occupation as well as health belief such as medical check-up were significantly related to oral healthcare utilisation. Enabling factor of household income quintile had significant association with oral healthcare utilisation. Inequalities were observed; females (OR = 1.57, 95% CI = 1.25, 1.96), younger adults (OR = 1.64, 95% CI = 1.15, 2.33), those who were married (OR = 1.65, 95% CI = 1.23, 2.22), those with higher education (OR = 2.21, 95% CI = 1.23, 3.99), those who had medical check-up in the last 12 months (OR = 1.86, 95% CI = 1.53, 2.25) and those with higher income (OR = 1.43, 95% CI = 1.04, 1.96) were more likely to utilise oral healthcare. Conclusion Understanding factors associated with utilisation of oral healthcare could help in formulating effective interventions to improve oral healthcare utilisation. Demographic and socioeconomic factors are strong determinants of oral healthcare utilisation in Malaysia. Appropriate interventions to strengthen the existing programmes aimed to promote regular and timely oral health check-ups are needed to improve oral healthcare utilisation.
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Affiliation(s)
- Yeung R'ong Tan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Ee Hong Tan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Ainul Nadziha Mohd Hanafiah
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Muhammad Hafiz Mohd Yunos
- Tengkawang Dental Clinic, Terengganu Health Department, Ministry of Health Malaysia, 21700 Hulu Terengganu, Terengganu, Malaysia
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Improving Oral Health care Using Academic Detailing-Reproducibility and Scalability of the Added Value for Oral Care Field Studies Approach. J Evid Based Dent Pract 2020; 20:101474. [PMID: 33303101 DOI: 10.1016/j.jebdp.2020.101474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/30/2020] [Accepted: 08/06/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES A proof-of-concept study has shown that the Added Value for Oral Care (ADVOCATE) Field Studies approach (academic detailing with feedback data) is considered a feasible, useful, and acceptable way to motivate general dental practitioners (GDPs) to reflect on and, if required, change their oral health-care delivery. The aims of this proof-of-principle study were to test whether such results were reproducible and to reach consensus among stakeholders on recommendations for wider implementation. METHODS Eleven groups of GDPs were recruited in 6 countries (Denmark, England Germany, Hungary, Ireland, and The Netherlands). Each group had 3 academic detailing meetings, being stimulated by feedback data. Focus group interviews were held to evaluate the reproducibility of the Field Studies approach. A World Café session explored suggestions for the wider implementation of the approach. RESULTS Replicable results on feasibility, acceptability, and usefulness of the Field Studies approach were seen; 7 out of 9 themes identified in the proof-of-concept study were validated. Directed content analyses identified that adjustments to procedures to collect and present feedback data were desirable. Overall, the approach can stimulate GDPs to reflect on and change aspects of their oral health-care delivery. CONCLUSIONS The Field Studies approach, after some adjustments to data collection procedures, is ready for further testing in larger studies.
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Schwendicke F, Nitschke I, Stark H, Micheelis W, Jordan RA. Epidemiological trends, predictive factors, and projection of tooth loss in Germany 1997-2030: part II. Edentulism in seniors. Clin Oral Investig 2020; 24:3997-4003. [PMID: 32246279 PMCID: PMC7544707 DOI: 10.1007/s00784-020-03265-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/19/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This is the second part of a report on tooth loss in Germany 1997-2030. Here, we describe trends in the prevalence of edentulism in seniors 1997-2014, assess predictive factors for edentulism, and projected it into 2030. MATERIAL AND METHODS We used data from three waves of the cross-sectional, multi-center, nationwide representative German Oral Health Studies. Overall, 3449 seniors (65-74 years) were included (1997: 1367; 2005: 1040; 2016: 1042). Age, sex, educational level, smoking status, and the cohort were entered into age-cohort binary-logistic regression models to assess the association of predictors with edentulism and to project edentulism in 2030 via Monte Carlo simulations. RESULTS Between 1997 and 2014, the prevalence of edentulism decreased from 24.8 to 12.4%. With each year of age, the risk of being edentate increased (by 11%, p < 0.001); it was also significantly increased in female versus male (by 40%, p = 0.001), low versus medium and high educational level (up to 257%, p < 0.001), and in former and current smokers (up to 258%, p < 0.001). We predict the prevalence of edentulism to be reduced to 4.2% in 2030. The reduction will be higher in males, never and former smokers, and those with low socio-educational level. On an absolute level and despite a growing elderly population (aged 60-80 years), the number of edentate individuals will have decreased by 3.6 million in 2030 compared with 1997. CONCLUSIONS Edentulism in seniors has declined equitably in Germany. The decline is expected to continue until 2030. Further efforts are needed to tackle the underlying risk factors. CLINICAL RELEVANCE This study presents trends of edentulism in Germany for a period of three decades. It provides clinically relevant data for health care planning by 2030.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
| | - Ina Nitschke
- Clinic for General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Helmut Stark
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Rheinische Friedrich Wilhelms University of Bonn, Bonn, Germany
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Torppa-Saarinen E, Tolvanen M, Lahti S, Suominen AL. Changes and determinants of unmet oral health treatment need. Community Dent Oral Epidemiol 2020; 49:158-165. [PMID: 33104256 DOI: 10.1111/cdoe.12587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 09/19/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our aim was to describe the nature and determinants of the changes in unmet treatment need between the years 2000 and 2011 after a major oral healthcare reform and a wider supply of subsidized care. METHODS The study used a longitudinal sample (n = 3838) of adults who had participated in both the Health 2000 and 2011 surveys (BRIF 8901). Those reporting self-assessed treatment need without having visited a dentist in the previous 12 months were categorized as having unmet treatment need. Two logistic regression models were applied to determine the effects of predisposing and enabling factors on change in unmet treatment need. Model 1 was conducted among those who reported unmet treatment need in 2000 and evaluated the determinants for improvement. Model 2 was conducted among those who did not have unmet treatment need in 2000 to evaluate the risk factors for having unmet treatment need by 2011. RESULTS Unmet treatment need was reported by 25% of the participants in 2000 and by 20% in 2011. Those with unmet treatment need in 2000 were less likely to report improvement by 2011 if they had poor subjective oral health, basic or intermediate education level, or poor perceived economic situation in 2000. Those who did not have unmet treatment need in 2000 were more likely to have it in 2011 if they were males or from northern Finland and less likely to if they came from central Finland or were older. CONCLUSIONS The wider supply of subsidized oral health care during the study years did not lead to complete elimination of treatment need. The determinants of unmet treatment need, such as low or intermediate education level and perceived economic difficulties, should be used in targeting the services at those with treatment need to achieve better oral health outcomes.
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Affiliation(s)
| | - Mimmi Tolvanen
- Institute of Dentistry, University of Turku, Turku, Finland.,Institute of Medicine, Center for Life Course Health Research, University of Oulu, Turku, Finland
| | - Satu Lahti
- Department of Community Dentistry, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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85
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Flythe JE, Hilliard TS, Ikeler K, Keller S, Gipson DS, Grandinetti AC, Nordyke RJ, Perrone RD, Roy-Chaudhury P, Unruh M, West M, Bocell F, Hurst FP. Toward Patient-Centered Innovation: A Conceptual Framework for Patient-Reported Outcome Measures for Transformative Kidney Replacement Devices. Clin J Am Soc Nephrol 2020; 15:1522-1530. [PMID: 32276947 PMCID: PMC7536748 DOI: 10.2215/cjn.00110120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Individuals with dialysis-dependent kidney failure experience considerable disease- and treatment-related decline in functional status and overall well-being. Despite these experiences, there have been few substantive technological advances in KRT in decades. As such, new federal initiatives seek to accelerate innovation. Historically, integration of patient perspectives into KRT product development has been limited. However, the US Food and Drug Administration recognizes the importance of incorporating patient perspectives into the total product life cycle (i.e., from product conception to postmarket surveillance) and encourages the consideration of patient-reported outcomes in regulatory-focused clinical trials when appropriate. Recognizing the significance of identifying patient-reported outcome measures (PROMs) that capture contemporary patient priorities, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and US Food and Drug Administration, convened a workgroup to (1) develop a conceptual framework for a health-related quality of life PROM; (2) identify and map existing PROMs to the conceptual framework, prioritizing them on the basis of their supporting evidence for use in the regulatory environment; and (3) describe next steps for identifying PROMs for use in regulatory clinical trials of transformative KRT devices. This paper summarizes the proposed health-related quality-of-life PROM conceptual framework, maps and prioritizes PROMs, and identifies gaps and future needs to advance the development of rigorous, meaningful PROMS for use in clinical trials of transformative KRT devices.
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Affiliation(s)
- Jennifer E. Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Kourtney Ikeler
- American Institutes for Research, Chapel Hill, North Carolina
| | - San Keller
- American Institutes for Research, Chapel Hill, North Carolina
| | - Debbie S. Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Prabir Roy-Chaudhury
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, North Carolina
| | - Mark Unruh
- School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Melissa West
- Kidney Health Initiative and American Society of Nephrology, Washington, DC
| | - Fraser Bocell
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Frank P. Hurst
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
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86
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Aravena-Rivas Y, Carbajal-Rodríguez G. Geographical and socioeconomic inequalities in dental attendance among children in Peru: Findings from the Demographic and Family Health Survey 2017. Community Dent Oral Epidemiol 2020; 49:78-86. [PMID: 33016467 DOI: 10.1111/cdoe.12580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/28/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the study was to explore the presence of inequalities in the use of dental services among <12-year-old children residing in Peru, according to their wealth quintile and natural region of residence. METHODS This was a cross-sectional secondary data analysis of the 2017 Demographic and Family Health Survey of Peru (n = 39 881 children). Generalized Poisson regression models, adjusted for gender, age, maternal ethnicity, place of residence and health coverage, were used to study the association between wealth quintile and use of dental services followed by stratified models by the natural region (Metropolitan Lima, coast, Andes mountains and jungle) and predicted probability graphs to study the effect of the natural region on inequalities in the use of dental services. RESULTS Inequalities in the use of dental services among children were observed according to the wealth quintile and natural region. A social gradient was present in the Andes mountains, coast and jungle regions. The greatest inequalities were observed in the coast (richest vs poorest quintile PR = 1.81 95% CI = 1.56-2.11) and jungle regions (richest vs poorest quintile PR = 1.81 95% CI = 1.53-2.14). The jungle presented the lowest proportion of children using dental services, while Metropolitan Lima had the highest proportion. No significant differences were observed between wealth quintiles among children from Metropolitan Lima. CONCLUSIONS Differences in socioeconomic inequalities in the use of dental services among natural regions were observed. The distribution of dental centres and personnel, and the geographical and demographic characteristics of each region, may play an important role in the presence of the inequalities observed.
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Affiliation(s)
- Yanela Aravena-Rivas
- Faculty of Dentistry, Centre for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Universidad de La Frontera, Temuco, Chile
| | - Gisselle Carbajal-Rodríguez
- Academic Department of Social Dentistry, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Peru
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Gurney JK, McLeod M, Stanley J, Campbell D, Boyle L, Dennett E, Jackson S, Koea J, Ongley D, Sarfati D. Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends. BMJ Open 2020; 10:e036451. [PMID: 32973053 PMCID: PMC7517556 DOI: 10.1136/bmjopen-2019-036451] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES In this manuscript, we describe broad trends in postoperative mortality in New Zealand (a country with universal healthcare) for acute and elective/waiting list procedures conducted between 2005 and 2017. DESIGN, PARTICIPANTS AND SETTING We use high-quality national-level hospitalisation data to compare the risk of postoperative mortality between demographic subgroups after adjusting for key patient-level confounders and mediators. We also present temporal trends and consider how rates in postoperative death following acute and elective/waiting list procedures have changed over this time period. RESULTS AND CONCLUSION A total of 1 836 683 unique patients accounted for 3 117 374 admissions in which a procedure was performed under general anaesthetic over the study period. We observed an overall 30-day mortality rate of 0.5 per 100 procedures and a 90-day mortality rate of 0.9 per 100. For acute procedures, we observed a 30-day mortality rate of 1.6 per 100, compared with 0.2 per 100 for elective/waiting list procedures. In terms of procedure specialty, respiratory and cardiovascular procedures had the highest rate of 30-day mortality (age-standardised rate, acute procedures: 3-6 per 100; elective/waiting list: 0.7-1 per 100). As in other contexts, we observed that the likelihood of postoperative death was not proportionally distributed within our population: older patients, Māori patients, those living in areas with higher deprivation and those with comorbidity were at increased risk of postoperative death, even after adjusting for all available factors that might explain differences between these groups. Increasing procedure risk (measured using the Johns Hopkins Surgical Risk Classification System) was also associated with an increased risk of postoperative death. Encouragingly, it appears that risk of postoperative mortality has declined over the past decade, possibly reflecting improvements in perioperative quality of care; however, this decline did not occur equally across procedure specialties.
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Affiliation(s)
- Jason K Gurney
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Melissa McLeod
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Doug Campbell
- Department of Anaesthesia and Perioperative Medicine, Auckland DHB Anaesthesia, Auckland District Health Board, Auckland, New Zealand
| | - Luke Boyle
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Elizabeth Dennett
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
- Department of General Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Sarah Jackson
- Department of Anaesthesia, Capital and Coast District Health Board, Wellington, New Zealand
| | - Jonathan Koea
- Department of General Surgery, Waitemata District Health Board, Takapuna, New Zealand
| | - Dick Ongley
- Department of Anaesthesia, Canterbury District Health Board, Christchurch, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Xu M, Gao X, Wu H, Ding M, Zhang C, Du S, Wang X, Feng X, Tai B, Hu D, Lin H, Wang B, Wang C, Zheng S, Liu X, Rong W, Wang W, Xu T, Si Y. Measuring and decomposing socioeconomic-related inequality in the use of oral health services among Chinese adults. Community Dent Oral Epidemiol 2020; 49:47-54. [PMID: 32959367 DOI: 10.1111/cdoe.12575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aimed to measure socioeconomic-related inequality and horizontal inequity in the use of oral health services and decompose this inequality among adults of different age groups in China. METHODS In total, 10 973 adults (3669 aged 35-44 years, 3767 aged 55-64 years and 3537 aged 65-74 years) who participated in the 4th National Oral Health Survey (2015-2016) in China were included. Concentration curves and the Erreygers-corrected concentration index (EI) were employed to measure socioeconomic-related inequality in the use of oral health services. Then, inequity in this utilization was measured by the horizontal inequity index (HI). Furthermore, decomposition analyses were conducted for the three groups to explain the contributions of income level, need factors (ie self-assessed oral health and evaluated oral health status), other factors (ie sex, residential location, educational attainment level and type of basic insurance) and a residual term to overall inequality in oral health service utilization. RESULTS The significant positive EI and HI values indicated that pro-rich inequality and inequity in oral health service utilization exist among Chinese adults. Income and type of basic medical insurance contributed the most to socioeconomic-related inequality in the use of oral health services among adults aged 55-64 and 65-74 years. However, the main driving factors of socioeconomic inequality among adults aged 35-44 years in dental care use included income, educational achievement, type of basic medical insurance and residential location. The need variables accounted for a very small proportion of overall socioeconomic-related inequality in oral health service use in all three groups. CONCLUSIONS Oral healthcare service utilization was disproportionately concentrated among better-off Chinese adults. The primary determinants of inequality in dental care use in different age groups provide information for policymakers to create more targeted policies to achieve equity in the oral healthcare system in China.
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Affiliation(s)
- Mengru Xu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoli Gao
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Huijing Wu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Min Ding
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chunzi Zhang
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shuo Du
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xing Wang
- Chinese Stomatological Association, Beijing, China
| | - Xiping Feng
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baojun Tai
- School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Deyu Hu
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - Huancai Lin
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yetsen University, Guangzhou, China
| | - Bo Wang
- Chinese Stomatological Association, Beijing, China
| | - Chunxiao Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuguo Zheng
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xuenan Liu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wensheng Rong
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Weijian Wang
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tao Xu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Si
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
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Lexomboon D, Gavriilidou NN, Höijer J, Skott P, Religa D, Eriksdotter M, Sandborgh-Englund G. Discontinued dental care attendance among people with dementia: A register-based longitudinal study. Gerodontology 2020; 38:57-65. [PMID: 32954536 DOI: 10.1111/ger.12498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the factors that increase the risk of discontinuing dental care utilisation after dementia is diagnosed in a population in Stockholm County, Sweden. BACKGROUND As the progression of dementia results in a deteriorating ability to maintain good oral health, it is important to identify people at risk of discontinued dental care after being diagnosed with dementia. MATERIALS AND METHODS This study is a register-based longitudinal study. Data were extracted from the Swedish Dementia Registry (SveDem), the Swedish National Patient Register, the Dental Health Register and the Municipal Dental Care Register (Stockholm County Council). The data included people using both general public dental services and care-dependent individuals. Dental visits three years before and after dementia had been diagnosed were analysed. RESULTS In total, 10 444 people were included in the analysis, of which 19% did not have dental visits recorded after they were diagnosed with dementia. A logistic regression model, adjusted for relevant factors, showed that the factors associated with a greater risk for discontinued dental attendance were fewer remaining teeth (OR = 0.96, 95% CI = 0.95, 0.97) and living alone compared to living with another adult (OR = 1.23, 95% CI = 1.05, 1.43). People with Parkinson's disease dementia had a lower risk (OR = 0.40, 95% CI = 0.19, 0.84) than people with Alzheimer's disease. CONCLUSION Patients, dental and healthcare personnel, and family members should all be aware of these risk factors so that appropriate support and oral care for people with dementia can be delivered.
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Affiliation(s)
| | | | - Jonas Höijer
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pia Skott
- Academic Center for Geriatric Dentistry, Stockholm, Sweden.,Department of Orofacial Medicine, Folktandvården Stockholms Län AB, Stockholm, Sweden
| | - Dorota Religa
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Sandborgh-Englund
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Academic Center for Geriatric Dentistry, Stockholm, Sweden
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Qu X, Qi X, Wu B. Disparities in Dental Service Utilization among Adults in Chinese Megacities: Do Health Insurance and City of Residence Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186851. [PMID: 32961720 PMCID: PMC7559892 DOI: 10.3390/ijerph17186851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/22/2022]
Abstract
The aims of the study were to present the prevalence of dental service utilization among adults (age between 18 and 65) in Chinese megacities and to examine the associations of health insurance and city of residence with dental visits. This study was a cross-sectional analysis of the 2019 New Era and Living Conditions in Megacities Survey data with a sample of 4835 participants aged 18–65 from 10 different megacities in China. The data including gross domestic product (GDP) per capita of each megacity obtained from the National Bureau of Statistics of China as a city-level characteristic. After adjusting sampling weights, approximately 24.28% of the participants had at least one dental visit per year. Findings from multilevel mixed-effects linear models showed that participants residing in megacities with higher GDP per capita (β = 0.07, p < 0.001) who had Urban Employee Basic Medical Insurance (β = 0.25, p < 0.001) or Urban Resident Basic Medical Insurance (β = 0.19, p < 0.01) had more frequent dental visits after adjusting demographic characteristics, socioeconomic status, health status, health behavior and attitude, and oral health indicators. Margins post-estimation model results demonstrated disparities in the predicted probability of having never visited a dentist by types of health insurance and city of residence. In conclusion, the prevalence of dental visits in China was found to be low. This study highlights socioeconomic inequalities in dental service utilization. There is a great need to develop more dental care programs and services and expand health insurance to cover dental care in China.
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Affiliation(s)
- Xiaomin Qu
- School of Social Development, East China University of Political Science and Law, 555 Longyuan Road Songjiang District, Shanghai 201620, China;
| | - Xiang Qi
- Rory Meyer College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA;
| | - Bei Wu
- Rory Meyer College of Nursing, NYU Aging Incubator, New York University, 433 First Avenue, New York, NY 10010, USA
- Correspondence: ; Tel.: +1-212-992-5951
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91
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Hajek A, Kretzler B, König HH. Determinants of Dental Service Use Based on the Andersen Model: A Study Protocol for a Systematic Review. Healthcare (Basel) 2020; 8:healthcare8030333. [PMID: 32927878 PMCID: PMC7551796 DOI: 10.3390/healthcare8030333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Drawing on the Andersen model, there is a large body of evidence examining the determinants of health care use, such as doctor visits or hospitalization. However, far less is known about the determinants of dental service use, explicitly using the Andersen model. Consequently, the aim of this systematic review is to summarize and critically analyze evidence from observational studies that examine the determinants of dental service use based on the Andersen model. Methods and analysis: The following electronic databases will be searched: PubMed, PsycInfo, and CINAHL. Our main inclusion criterion is: observational studies (cross-sectional and longitudinal) investigating the determinants of dental service use based on the Andersen model. Disease-specific samples will be excluded. Data extraction will concentrate on methods (such as measurement of dental service use), sample characteristics (such as age and gender) and key results. The study quality will be assessed using an appropriate tool. Three steps (selecting the studies, extracting the data and assessment of study conducted) will be performed by two reviewers. The findings will be displayed using figures, summary tables, narrative summaries and meta-analysis (if studies are deemed similar enough and of appropriate quality).
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92
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Gonçalves AJG, Pereira PHS, Monteiro V, Silva Junior MF, Baldani MH. Estrutura dos serviços de saúde bucal ofertados na Atenção Básica no Brasil: diferenças regionais. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Teve-se por objetivo analisar as condições de acessibilidade, estrutura e oferta de serviços odontológicos de Unidades Básicas de Saúde com Equipe de Saúde Bucal e compará-los entre as regiões geográficas brasileiras. O estudo quantitativo, analítico e transversal utilizou dados secundários referentes aos Módulo I, V e VI da Avaliação Externa do 2º Ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) (2013-2014). A análise descritiva foi realizada por frequências absolutas (n) e relativas (%), e houve comparação entre regiões brasileiras pelo teste qui-quadrado com uso do Teste Z ajustado pelo método Bonferroni (p<0,05). A amostra foi constituída por 24.056 Unidades Básicas de Saúde, nas quais atuavam 29.778 Equipes de Atenção Básica; destas, 16.203 (67,3%) possuíam serviços odontológicos e abrigavam 18.119 Equipes de Saúde Bucal. De maneira geral, as Unidades Básicas de Saúde apresentavam boa estrutura física, porém, baixa acessibilidade para pessoas com deficiência. Os consultórios odontológicos apresentavam estrutura física adequada e equipamentos, instrumentos e insumos odontológicos suficientes. No entanto, exibiam alta proporção na oferta de serviço mutiladores em comparação a procedimentos que evitariam as extrações dentárias, e baixa oferta de referência especializada. Além disso, houve evidenciadas desigualdades regionais, favoráveis às regiões Sul e Sudeste.
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93
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Echeverria MS, Silva AER, Agostini BA, Schuch HS, Demarco FF. Regular use of dental services among university students in southern Brazil. Rev Saude Publica 2020; 54:85. [PMID: 32844983 PMCID: PMC7438030 DOI: 10.11606/s1518-8787.2020054001935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/10/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To verify the prevalence and factors associated with regular use of dental services in university students of the Universidade Federal de Pelotas (UFPel). METHODS This cross-sectional study interviewed 1,865 students aged 18 years or older, starting bachelor’s degrees in 2017, enrolled in the second academic semester of 2017 and in the first of 2018 in classroom courses at UFPel. We considered regular users those who reported regularly going to the dentist with or without perceived dental problems. To test factors associated with regular use of dental services, demographic, socioeconomic and oral health variables were collected. Statistical analyses were based on Poisson regression models. RESULTS The prevalence of regular use of dental services was 45.0% (95%CI 42.7–47.3). University students of high economic class (PR = 1.47; 95%CI 0.91–2.36), with last private dental appointment (PR = 1.29; 95%CI 1.03–1.61), positive self-perception of oral health (PR = 2.33; 95%CI 1.79–3.03) and no report of toothache in the last six months (PR = 1.22; 95%CI 1.03–1.45) showed higher prevalence of regular use of dental services. CONCLUSION The results point to inequalities in the regular use of dental services related to socioeconomic factors and a lower use among university students with worse oral health conditions. These results suggest that public health prevention and promotion policies in higher education institutions must be carried out to ensure quality of life among these young adults.
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Affiliation(s)
- Mariana Silveira Echeverria
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Alexandre Emidio Ribeiro Silva
- Programa de Pós-Graduação em Odontologia, Faculdade de Odontologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | | | - Helena Silveira Schuch
- Programa de Pós-Graduação em Odontologia, Faculdade de Odontologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Flávio Fernando Demarco
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil
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94
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Rashidian A, Mehdizadeh P, Dopeykar N, Hosseini M, Olyaeemanesh A. Inequality in dental expenditures among Iranian households: A cross-sectional survey using the National Health Accounts. Dent Res J (Isfahan) 2020; 17:306-313. [PMID: 33282158 PMCID: PMC7688036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Recently, inequality in dental care has become increasingly popular in both developed and developing countries as a matter of health policy. Thus, the aims of this study were examining inequality in dental care expenditures and assessing the effects of insurance coverage and other variables on these services. MATERIALS AND METHODS In this cross-sectional and descriptive-analytical study, we used secondary data of the National Health Accounts that has been conducted in 2008 in Iran. The sample size was 17,239 households in all over the country. All analyses were performed by Stata software using Mann-Whitney test and logistic regression. P < 0.05 was considered statistically significant. To determine inequality in dental services, the concentration index (CI) was used. RESULTS CI for total dental expenditures was 0.315 and for orthodontics was 0.6. Findings showed that out-of-pocket expenditure for dental care was progressive and there was a significant relationship between total dental expenditure with residence areas (odds ratio [OR] =1.3; P > 0.001), complementary insurance coverage (OR = 1.3; P > 0.001), family size (OR = 1.46; P > 0.001), and income (OR = 1.3; P > 0.001). CONCLUSION Dental expenditures were progressive in Iran, and the rich have paid more share for these services. It seems that implementing insurance programs, changes in the financing of dental care, development of insurance basic benefits package, supporting programs for the poor, adopting educational policies, and promoting oral health for vulnerable people can have an effective role in decreasing inequality in using dental services.
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Affiliation(s)
- Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Mehdizadeh
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Health Economics Department, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Parisa Mehdizadeh, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. E-mail:
| | - Nooredin Dopeykar
- Health Economics Department, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Hosseini
- Department of Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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95
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Raittio E, Huumonen S, Suominen AL. Is the technical quality of root fillings associated with socioeconomic status? A cross-sectional study among Finnish adults. Eur J Oral Sci 2020; 128:415-422. [PMID: 32776471 DOI: 10.1111/eos.12730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Abstract
We investigated differences in the technical quality of root fillings according to socioeconomic status. In the Finnish Health 2000 Survey, which comprised a sample of 8,028 adults aged over 29 yr, 6,115 underwent panoramic radiography. A total of 7,986 endodontically treated teeth were detected among 3,095 participants. The criterion for a technically inadequate root filling was a distance from the root filling to the root apex of over 3 mm or a filling extruding beyond the apex. Educational level, employment status, and income were the measures of socioeconomic status. Differences in the frequency of inadequate root fillings according to socioeconomic status were investigated using a multilevel logistic mixed-effects model taking into account age, gender, number of teeth, and type of root filled tooth. Almost half (46%) of the root fillings were inadequate. Among the over 64-yr-olds, higher education and higher income were associated with a higher probability of having an inadequate root filling. Among the under 65-yr-olds, socioeconomic status was not associated with root filling quality. Contrary to expectation, lower socioeconomic status was not associated with poorer endodontic treatment quality; however, higher income and higher education was associated with higher odds for inadequate root fillings among the over 64-yr-olds.
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Affiliation(s)
- Eero Raittio
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Sisko Huumonen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Anna L Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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96
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Innes NPT, Chu CH, Fontana M, Lo ECM, Thomson WM, Uribe S, Heiland M, Jepsen S, Schwendicke F. A Century of Change towards Prevention and Minimal Intervention in Cariology. J Dent Res 2020; 98:611-617. [PMID: 31107140 DOI: 10.1177/0022034519837252] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Better understanding of dental caries and other oral conditions has guided new strategies to prevent disease and manage its consequences at individual and public health levels. This article discusses advances in prevention and minimal intervention dentistry over the last century by focusing on some milestones within scientific, clinical, and public health arenas, mainly in cariology but also beyond, highlighting current understanding and evidence with future prospects. Dentistry was initially established as a surgical specialty. Dental caries (similar to periodontitis) was considered to be an infectious disease 100 years ago. Its ubiquitous presence and rampant nature-coupled with limited diagnostic tools and therapeutic treatment options-meant that these dental diseases were managed mainly by excising affected tissue. The understanding of the diseases and a change in their prevalence, extent, and severity, with evolutions in operative techniques, technologies, and materials, have enabled a shift from surgical to preventive and minimal intervention dentistry approaches. Future challenges to embrace include continuing the dental profession's move toward a more patient-centered, evidence-based, less invasive management of these diseases, focused on promoting and maintaining oral health in partnership with patients. In parallel, public health needs to continue to, for example, tackle social inequalities in dental health, develop better preventive and management options for existing disease risk groups (e.g., the growing aging population), and the development of reimbursement and health outcome models that facilitate implementation of these evolving strategies. A century ago, almost every treatment involved injections, a drill or scalpel, or a pair of forceps. Today, dentists have more options than ever before available to them. These are supported by evidence, have a minimal intervention focus, and result in better outcomes for patients. The profession's greatest challenge is moving this evidence into practice.
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Affiliation(s)
- N P T Innes
- 1 School of Dentistry, University of Dundee, Dundee, UK
| | - C H Chu
- 2 Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - M Fontana
- 3 Cariology and Restorative Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - E C M Lo
- 2 Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - W M Thomson
- 4 Department of Oral Sciences, School of Dentistry, University of Otago, Dunedin, New Zealand
| | - S Uribe
- 5 School of Dentistry, Universidad Austral de Chile, Valdivia, Chile
| | - M Heiland
- 6 Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Jepsen
- 7 Periodontology, Operative, and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - F Schwendicke
- 8 Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
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97
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Azevedo MBD, Pinto RDS, Abreu MHNGD, Lucas SD. Factors associated with the needs of specialised dental treatment among adults aged 35-44 years old in the state of Minas Gerais, Brazil: a multilevel cross-sectional study. CIENCIA & SAUDE COLETIVA 2020; 25:2783-2792. [PMID: 32667559 DOI: 10.1590/1413-81232020257.29852018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 12/03/2018] [Indexed: 11/22/2022] Open
Abstract
This study evaluated the individual and contextual factors associated with the specialised dental treatment needs of a population of adults aged 35 to 44 years old in the state of Minas Gerais. The individual variables were obtained from the database of the SB Minas Gerais project - a survey of oral health status of the population of Minas Gerais, Brazil. The variables at the municipal level were derived from any available public databases related to oral health services. A multilevel analysis was performed to evaluate the association of independent individuals and contextual variables with or without dental treatment needs in the secondary care of the oral health network. Individuals with a higher income (OR 0.53; CI95% 0.31-0.93) and with greater access to oral health care (OR 0.94; CI95% 0.90-0.99) had less secondary care treatment needs. Income and access to oral health care are related to the needs of specialised dental treatment in Minas Gerais.
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Affiliation(s)
- Mônica Baltazar de Azevedo
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
| | - Rafaela da Silveira Pinto
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
| | - Mauro Henrique Nogueira Guimarães de Abreu
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
| | - Simone Dutra Lucas
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
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Abstract
Currently, a few of studies revealed that there is an association between mastication and cognitive impairment. There is no study of Korean adult representative samples in relation to mastication and cognitive decline. This study was to investigate the relationship between mastication and mild cognitive impairment in Korean adults.A population-based cross-sectional study was conducted in which a total of 7029 subjects (2987 men and 4042 women) over 45 years old were surveyed from the Korea Longitudinal Study on Aging (KLoSA), Round 5th survey. Logistic regression analysis was performed for the study data controlling for confounding factors such as age, gender, education, income, smoking, drinking, exercise, wearing denture, and the number of chronic diseases.Decreased chewing function is associated with mild cognitive impairment (odds ratio [OR] = 3.24, 95% confidence interval [CI] = 2.67-3.93) after controlling for confounding variables. In the participants who did not wear dentures, the reduction of chewing function was strongly correlated with mild cognitive impairment (OR = 3.97, 95% CI = 3.11-5.08).Mastication was associated with mild cognitive impairment. To prevent cognitive decline, health specialists should pay more attention to the decline of the mastication in people without dentures.
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Affiliation(s)
- Mi-Sun Kim
- Department of Dental Hygiene, Kyungdong University, Wonju, South Korea
| | - Bumjo Oh
- Department of Family Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Ji Won Yoo
- Department of Internal Medicine, School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Dong-Hun Han
- Department of Preventive and Social Dentistry, Seoul National University, Seoul, South Korea
- Dental Research Institute, Seoul National University, Seoul, South Korea
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99
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Al Agili DE, Farsi NJ. Need for dental care drives utilisation of dental services among children in Saudi Arabia. Int Dent J 2020; 70:183-192. [DOI: 10.1111/idj.12539] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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100
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Rentsch CT, Kidwai-Khan F, Tate JP, Park LS, King JT, Skanderson M, Hauser RG, Schultze A, Jarvis CI, Holodniy M, Re VL, Akgün KM, Crothers K, Taddei TH, Freiberg MS, Justice AC. Covid-19 Testing, Hospital Admission, and Intensive Care Among 2,026,227 United States Veterans Aged 54-75 Years. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.04.09.20059964. [PMID: 32511595 PMCID: PMC7276022 DOI: 10.1101/2020.04.09.20059964] [Citation(s) in RCA: 303] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
IMPORTANCE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes coronavirus disease 2019 (Covid-19), an evolving pandemic. Limited data are available characterizing SARS-Cov-2 infection in the United States. OBJECTIVE To determine associations between demographic and clinical factors and testing positive for coronavirus 2019 (Covid-19+), and among Covid-19+ subsequent hospitalization and intensive care. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study including all patients tested for Covid-19 between February 8 and March 30, 2020, inclusive. We extracted electronic health record data from the national Veterans Affairs Healthcare System, the largest integrated healthcare system in the United States, on 2,026,227 patients born between 1945 and 1965 and active in care. Exposures: Demographic data, comorbidities, medication history, substance use, vital signs, and laboratory measures. Laboratory tests were analyzed first individually and then grouped into a validated summary measure of physiologic injury (VACS Index). Main Outcomes and Measures: We evaluated which factors were associated with Covid-19+ among all who tested. Among Covid-19+ we identified factors associated with hospitalization or intensive care. We identified independent associations using multivariable and conditional multivariable logistic regression with multiple imputation of missing values. RESULTS Among Veterans aged 54-75 years, 585/3,789 (15.4%) tested Covid-19+. In adjusted analysis (C-statistic=0.806) black race was associated with Covid-19+ (OR 4.68, 95% CI 3.79-5.78) and the association remained in analyses conditional on site (OR 2.56, 95% CI 1.89-3.46). In adjusted models, laboratory abnormalities (especially fibrosis-4 score [FIB-4] >3.25 OR 8.73, 95% CI 4.11-18.56), and VACS Index (per 5-point increase OR 1.62, 95% CI 1.43-1.84) were strongly associated with hospitalization. Associations were similar for intensive care. Although significant in unadjusted analyses, associations with comorbid conditions and medications were substantially reduced and, in most cases, no longer significant after adjustment. CONCLUSIONS AND RELEVANCE Black race was strongly associated with Covid-19+, but not with hospitalization or intensive care. Among Covid-19+, risk of hospitalization and intensive care may be better characterized by laboratory measures and vital signs than by comorbid conditions or prior medication exposure.
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Affiliation(s)
- Christopher T Rentsch
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, US, 06516
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, WC1E 7HT
| | - Farah Kidwai-Khan
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, US, 06516
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US, 06520
| | - Janet P Tate
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, US, 06516
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US, 06520
| | - Lesley S Park
- Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, CA, US, 94305
| | - Joseph T King
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, US, 06516
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, US, 06520
| | - Melissa Skanderson
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, US, 06516
| | - Ronald G Hauser
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, US, 06516
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, US, 06520
| | - Anna Schultze
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, WC1E 7HT
| | - Christopher I Jarvis
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, WC1E 7HT
| | - Mark Holodniy
- VA Palo Alto Healthcare System, US Department of Veterans Affairs, Palo Alto, CA, US, 94304
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, US, 94305
| | - Vincent Lo Re
- Division of Infectious Diseases, Department of Medicine and Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US, 19104
| | - Kathleen M Akgün
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, US, 06516
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US, 06520
| | - Kristina Crothers
- VA Puget Sound Health Care System and Department of Medicine, University of Washington School of Medicine, Seattle, WA, US, 98104
| | - Tamar H Taddei
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, US, 06516
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US, 06520
| | - Matthew S Freiberg
- Geriatric Research Education and Clinical Center (GRECC), US Department of Veterans Affairs, Tennessee Valley Health Care System, Nashville, TN, US 37212
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, US, 37232
| | - Amy C Justice
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, US, 06516
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US, 06520
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, US, 06511
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