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Apical periodontitis and associated factors in a rural population of southern Brazil: a multilevel analysis. Clin Oral Investig 2023:10.1007/s00784-023-04886-7. [PMID: 36746818 DOI: 10.1007/s00784-023-04886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aims to evaluate the association between apical periodontitis (AP) and sociodemographic/clinical factors in a probability sample of individuals living in a rural area of southern Brazilian. MATERIALS AND METHODS A cross-sectional study was conducted involving 584 non-edentulous adult individuals who had undergone a full-mouth radiographic survey. Periapical status was analysed using the periapical index (PAI). Endodontic status was evaluated considering the occurrence of voids in the filling material and the root filling length. Crown status was classified based on the presence of caries, restorations, and prosthetic crowns. Sociodemographic variables, frequency of dental care, and periodontal disease were also registered. The data were analysed using hierarchical multilevel Poisson regression analysis. The multilevel structure was composed of three models: sociodemographic variables, clinical variables, and clinical variables adjusted by sociodemographic variables (α = 5%). RESULTS The prevalence of AP in the sample was 60.45%. AP was significantly associated with age, skin colour, schooling, periodontal disease, and frequency of dental care (P < 0.005). Among the 10,396 teeth evaluated, 868 (8.35%) had AP, which was significantly associated with tooth group, dental arch, crown status, and endodontic treatment (P < 0.005). CONCLUSIONS The prevalence of AP was high in the population studied. An older age, black/brown skin colour, low level of schooling, infrequent dental care, severe periodontal disease, mandibular teeth, posterior teeth, inadequate crown status, and having undergone endodontic treatment were significantly associated with the outcome. Clinical relevance This study about a rural probability sample reinforces that AP is still a recurrent oral health problem.
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de Souza VGL, Herkrath FJ, Garnelo L, Gomes AC, Lemos UM, Parente RCP, Herkrath APCDQ. Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: A cross-sectional household-based survey. PLoS One 2022; 17:e0277845. [PMID: 36413557 PMCID: PMC9681076 DOI: 10.1371/journal.pone.0277845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tooth loss is an oral health condition with high prevalence and negative impact on quality of life. It is the result of the history of oral diseases and their treatment as well as provision of dental care and access to dental services. Socioeconomic characteristics are determinants of tooth loss and living in rural areas is also a risk factor for its incidence. OBJECTIVE To identify contextual and individual factors associated with self-reported tooth loss among adults and elderly people living in rural riverside areas. METHODS A cross-sectional household-based survey was conducted in 2019 with rural riverside communities on the left bank of the Rio Negro River, Manaus, Amazonas. These communities are covered by a fluvial health team and two riverside health teams. Interviews were conducted in a representative random sample of dwellers aged ≥ 18 years, using electronic forms to obtain information on oral health conditions, demographic and socioeconomic characteristics, and use of and access to health services. The outcome was self-reported tooth loss. After the descriptive analysis of the data, a multilevel Poisson regression analysis was performed to estimate the prevalence ratio for the outcome. Variables with p-value ≤0.20 in the bivariate analyses were included in the multiple analysis considering the hierarchy between individual and contextual variables in the multilevel model. Variables with p-value ≤0.10 were kept in the final model and the significance level adopted was 0.05. RESULTS 603 individuals from 357 households were assessed (mean age 44.1 years). The average number of missing teeth was 11.2 (±11.6); 27.4% of individuals had lost more than 20 teeth (non-functional dentition) and 12.1% were completely edentulous. Contextual characteristic of primary healthcare offered was associated with the outcome. The tooth loss was lower in territories covered by riverside health teams. At individual level, tooth loss was greater in older individuals who had experienced dental pain over the past six months and whose sugar consumption was high. Black or brown individuals, individuals whose household income was higher, those who were on the Bolsa Família cash transfer program, those who consulted a dentist over the past year, and those who reported satisfaction with their teeth/oral health reported less tooth loss. CONCLUSION Tooth loss was associated with contextual territorial factors related to the healthcare service and individual demographic, behavioral, socioeconomic, and service-related characteristics as well as self-perceived oral health conditions. The findings suggest that actions focused on the oral health of these populations involve not only changes in the healthcare service organization, but also intersectoral policies that contribute to reducing social inequalities.
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Affiliation(s)
| | - Fernando José Herkrath
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
- Superior School of Health Siences, State University of Amazonas, Manaus, Amazonas, Brazil
| | - Luiza Garnelo
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
| | - Andréia Coelho Gomes
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
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Comparison of the Oral Microbiota Structure among People from the Same Ethnic Group Living in Different Environments. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6544497. [PMID: 35800217 PMCID: PMC9256442 DOI: 10.1155/2022/6544497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 11/20/2022]
Abstract
The characteristics of the oral microbiota may depend on oral health, age, diet, and geography, but the influence of the geographic setting on the oral microbiota has received limited attention. The characteristics of oral microbiota have been reported to differ between urban and rural environments. In order to minimize the influence of genetic background, we recruited 54 volunteers from the same ethnic group, living in urban and rural areas of Gansu Province, China. We collected dental plaque samples and divided them into four groups according to the participant's area of residence and dental caries status. We sequenced the 16S rRNA of these samples using the Pacific Biosciences sequencing platform and analyzed the correlation between the geographic area and the characteristics of the oral microbiota. Analysis of the alpha and beta diversity revealed that there were significant differences in diversity and composition of dental plaque microflora among the four groups. Cluster analysis revealed that geographic area played an important role in determining the oral microbiota. Network analysis of oral microorganisms showed that geographic differences had major influence on the composition characteristics and internal structure of oral microorganisms. We found that some dominant strains which may play a key role in maintaining oral health, such as Streptococcus oralis, Capnocytophaga sputigena, Porphyromonas catoniae, Corynebacterium matruchotii, Haemophilus parainfluenzae, and Prevotella loescheii, were less affected by the geographic setting. These results provide a deeper understanding of factors influencing the composition of the oral microbiota and could contribute to early diagnosis and effective prevention of dental caries in different settings.
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Cericato GO, Agostini BA, Costa FDS, Thomson WM, Demarco FF. Rural-urban differences in oral health among older people in Southern Brazil. Braz Oral Res 2021; 35:e135. [PMID: 34932664 DOI: 10.1590/1807-3107bor-2021.vol35.0135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 06/20/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess the association between oral health and rurality in an older Brazilian population. Population-based samples of 1,451 urban and 411 rural elders were obtained from two databases. Several oral health and related measures, including the number of teeth lost, use of dental prostheses, dental visits, self-reported oral health, and perceived need for a dental prosthesis, were compared. Oral health-related information was obtained by a trained research team with interviews conducted in the individuals' homes. Regression models were used to verify the association between living in rural areas and oral health outcomes after adjusting for possible confounding factors. The elderly population mostly comprised of women in rural or urban areas, and the mean age was 70 years in both locations. Less-educated individuals (without or with complete elementary schooling) were more common in rural regions than in urban areas. After adjustment for socioeconomic characteristics, living in rural areas was associated with a lower perceived need for dental prostheses (PR 0.68, 95% CI 0.56-0.84), poor self-reported oral health (OR 1.24; 95% CI 1.05-1.46), and having fewer teeth (β -1.31; 95% CI -2.18 to -0.45). The place of residence had a significant impact on oral health indicators, with rurality negatively influencing oral health. These findings suggest that preventive and curative strategies for dental services may be needed for the Brazilian rural population.
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Affiliation(s)
| | | | - Francine Dos Santos Costa
- Universiade do Vale do Taquari - Univates, Dental School, Department of Biological and Health Sciences, Lajeado, RS, Brazil
| | - William Murray Thomson
- The University of Otago, Faculty of Dentistry, Department of Oral Sciences, Dunedin, New Zealand
| | - Flávio Fernando Demarco
- Universidade Federal de Pelotas - UFPel, Graduate Program in Dentistry, Department of Restorative Dentistry, Pelotas, RS, Brazil
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Alhozgi A, Feine JS, Tanwir F, Shrivastava R, Galarneau C, Emami E. Rural-urban disparities in patient satisfaction with oral health care: a provincial survey. BMC Oral Health 2021; 21:261. [PMID: 33992110 PMCID: PMC8122552 DOI: 10.1186/s12903-021-01613-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Identifying spatial variation in patient satisfaction is essential to improve the quality of care. Thus, the objective of this study was to investigate rural–urban disparities in patient satisfaction and to determine the factors that could influence satisfaction with oral health care. Methods Data from 1788 parents/caregivers of children who participated in the Quebec Ministry of Health clinical study were subject to secondary analysis. The Perneger model of patient satisfaction was used as the conceptual framework for the study. Satisfaction with oral health care was measured using the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II). Explanatory variables included predisposing factors and enabling resources. Statistical analyses included descriptive statistics, as well as bivariate and linear regression models. Results Individuals with higher income, dental insurance coverage, having a family dentist, reporting ease in finding a dentist, and having access to a private dental clinic were more satisfied with oral health care (p < 0.001). There were statistically significant differences between rural and urban Quebec residents in their ratings of patient satisfaction on four items, including dental office location (p = 0.013), dental equipment (p = 0.016), cost of dental treatment (p < 0.001), and cleanliness of dental office (p = 0.004), with greater satisfaction for urban dwellers. The multiple linear regression model showed that major determinants of patient satisfaction were being born in Canada, income ≥ 40,000$ CAD, having a family dentist, and having visited the dentist in the last year for regular checkups. However, ethnicity, having difficulty finding a dentist, and being in need of dental treatment negatively influenced patient satisfaction with oral health care. Conclusions These findings suggest that Quebec rural–urban disparity exists in patient satisfaction with care and that determinants of health influence this outcome. Intensive and powerful knowledge dissemination activities are needed to mobilize policymakers in implementing public health strategies to reduce this disparity.
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Affiliation(s)
- Abdalgader Alhozgi
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500, Montreal, QC, H3A 1G1, Canada
| | - Jocelyne S Feine
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500, Montreal, QC, H3A 1G1, Canada
| | - Farzeen Tanwir
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500, Montreal, QC, H3A 1G1, Canada
| | - Richa Shrivastava
- Sri Aurobindo College of Dentistry, Sanwer Road, Indore, India.,Faculty of Dentistry, Université de Montréal, C.P. 6128, succursale centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Chantal Galarneau
- Institut National de Santé Publique du Québec, 190 Boul Crémazie E, Montreal, QC, H2P 1E2, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500, Montreal, QC, H3A 1G1, Canada.
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Oliveira LM, de David SC, Ardenghi TM, Moreira CHC, Zanatta FB. Gingival inflammation influences oral health-related quality of life in individuals living in a rural area of southern Brazil. J Clin Periodontol 2020; 47:1028-1039. [PMID: 32558954 DOI: 10.1111/jcpe.13333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 12/25/2022]
Abstract
AIM The aim of the present cross-sectional study was to evaluate whether the extent levels of gingival inflammation (GI) in whole mouth or restricted to the anterior region are independently associated with oral health-related quality of life (OHRQoL) in individuals living in a rural area of southern Brazil. MATERIALS AND METHODS A probability sample of 688 individuals was submitted to a full-mouth periodontal examination at six sites on each tooth. Extent levels of GI in whole mouth and restricted to anterior region were dichotomously considered when bleeding on probing (BoP) occurred at 20% or more of whole-mouth sites and at 10% or more of anterior region sites, respectively, in individuals with probing depths ≤3 mm, totalling 121 individuals analysed, aged 15-82 years. OHRQoL was assessed using the simplified version of the Oral Health Impact Profile (OHIP14 ) questionnaire. Adjusted multilevel Poisson regression analysis was used with a conceptual hierarchical approach to calculate the rate ratio (RR) of OHIP14 scores. RESULTS In the adjusted model, higher extent levels of full-mouth GI (RR = 1.23; 95% confidence interval [CI]: 1.06-1.44; p = .004) and GI restricted to the anterior region (RR = 1.29; 95% CI: 1.11-1.51; p ≤ .001) were significantly associated with poorer OHRQoL. CONCLUSIONS The extent of GI in whole mouth (≥20% of sites with BoP) and in the anterior region (≥10% of sites with BoP) was independently associated with OHRQoL in individuals living in a rural area.
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Affiliation(s)
- Leandro M Oliveira
- Department of Stomatology, Postgraduate Program in Dentistry, Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Silvia C de David
- Department of Conservative Dentistry - Periodontology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Thiago M Ardenghi
- Department of Stomatology, Postgraduate Program in Dentistry, Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Carlos H Cunha Moreira
- Department of Stomatology, Postgraduate Program in Dentistry, Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Fabrício B Zanatta
- Department of Stomatology, Postgraduate Program in Dentistry, Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
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Ferreira TDGM, Rocha JMD, David SCD, Boligon J, Casarin M, Grellmann AP, Marin J, Ardenghi TM, Zanatta FB, Moreira CHC. Sampling strategy of an epidemiological survey using a satellite image program. Rev Saude Publica 2019; 53:47. [PMID: 31066825 PMCID: PMC6536105 DOI: 10.11606/s1518-8787.2019053000834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/25/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process. METHODS A probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O'Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed. RESULTS Among 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy. CONCLUSIONS The careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.
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Affiliation(s)
- Ticiane de Góes Mário Ferreira
- Universidade Federal de Santa Maria . Curso de Odontologia. Programa de Pós-Graduação em Ciências Odontológicas . Santa Maria , RS , Brasil
| | - José Mariano da Rocha
- Universidade Federal de Santa Maria . Curso de Odontologia. Programa de Pós-Graduação em Ciências Odontológicas . Santa Maria , RS , Brasil
| | - Silvia Cardoso de David
- Universidade Federal do Rio Grande do Sul . Faculdade de Odontologia . Departamento de Periodontia . Porto Alegre , RS , Brasil
| | - Jociana Boligon
- Universidade Federal de Santa Maria . Curso de Odontologia. Programa de Pós-Graduação em Ciências Odontológicas . Santa Maria , RS , Brasil
| | - Maísa Casarin
- Universidade Federal de Pelotas . Faculdade de Odontologia . Departamento de Semiologia e Clínica . Pelotas , RS , Brasil
| | - Alessandra Pascotini Grellmann
- Universidade Federal de Santa Maria . Curso de Odontologia. Programa de Pós-Graduação em Ciências Odontológicas . Santa Maria , RS , Brasil
| | - Janice Marin
- Universidade Federal de Santa Maria . Curso de Odontologia. Programa de Pós-Graduação em Ciências Odontológicas . Santa Maria , RS , Brasil
| | - Thiago Machado Ardenghi
- Universidade Federal de Santa Maria . Curso de Odontologia. Departamento de Estomatologia . Santa Maria , RS , Brasil
| | - Fabricio Batistin Zanatta
- Universidade Federal de Santa Maria . Curso de Odontologia. Departamento de Estomatologia . Santa Maria , RS , Brasil
| | - Carlos Heitor Cunha Moreira
- Universidade Federal de Santa Maria . Curso de Odontologia. Departamento de Estomatologia . Santa Maria , RS , Brasil
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Addi RA, Benksim A, Cherkaoui M. Sociodemographic Inequalities and Health Behaviors in the Dental and Periodontal Health. WORLD JOURNAL OF DENTISTRY 2019; 10:29-34. [DOI: 10.5005/jp-journals-10015-1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
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Gaber A, Galarneau C, Feine JS, Emami E. Rural-urban disparity in oral health-related quality of life. Community Dent Oral Epidemiol 2017; 46:132-142. [PMID: 28940682 DOI: 10.1111/cdoe.12344] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 08/22/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The objective of this population-based cross-sectional study was to estimate rural-urban disparity in the oral health-related quality of life (OHRQoL) of the Quebec adult population. METHODS A 2-stage sampling design was used to collect data from the 1788 parents/caregivers of schoolchildren living in the 8 regions of the province of Quebec in Canada. Andersen's behavioural model for health services utilization was used as a conceptual framework. Place of residency was defined according to the Statistics Canada Census Metropolitan Area and Census Agglomeration Influenced Zone classification. The outcome of interest was OHRQoL measured using the Oral Health Impact Profile (OHIP)-14 validated questionnaire. Data weighting was applied, and the prevalence, extent and severity of negative oral health impacts were calculated. Statistical analyses included descriptive statistics, bivariate analyses and binary logistic regression. RESULTS The prevalence of poor oral health-related quality life (OHRQoL) was statistically higher in rural areas than in urban zones (P = .02). Rural residents reported a significantly higher prevalence of negative daily-life impacts in pain, psychological discomfort and social disability OHIP domains (P < .05). Additionally, the rural population showed a greater number of negative oral health impacts (P = .03). There was no significant rural-urban difference in the severity of poor oral health. Logistic regression indicated that the prevalence of poor OHRQoL was significantly related to place of residency (OR = 1.6; 95% CI = 1.1-2.5; P = .022), perceived oral health (OR = 9.4; 95% CI = 5.7-15.5; P < .001), dental treatment needs factors (perceived need for dental treatment, pain, dental care seeking) (OR = 8.7; 95% CI = 4.8-15.6; P < .001) and education (OR = 2.7; 95% CI = 1.8-3.9; P < .001). CONCLUSION The results of this study suggest a potential difference in OHRQoL of Quebec rural and urban populations, and a need to develop strategies to promote oral health outcomes, specifically for rural residents. Further studies are needed to confirm these results.
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Affiliation(s)
- Amal Gaber
- Faculty of Dentistry, McGill University, Montréal, QC, Canada.,Faculty of Dentistry, Université de Montréal, Montréal, QC, Canada
| | | | | | - Elham Emami
- Faculty of Dentistry, McGill University, Montréal, QC, Canada.,Faculty of Dentistry, Université de Montréal, Montréal, QC, Canada.,School of Public Health, Public Health Research Institute, CRCHUM, Université de Montréal, Montréal, QC, Canada
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Caldwell JT, Lee H, Cagney KA. The Role of Primary Care for the Oral Health of Rural and Urban Older Adults. J Rural Health 2017; 33:409-418. [DOI: 10.1111/jrh.12269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/18/2017] [Accepted: 07/27/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Julia T. Caldwell
- Department of Hospital Medicine; University of Chicago; Chicago Illinois
| | - Haena Lee
- Department of Sociology; University of Chicago; Chicago Illinois
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Schroeder K, Gurenlian J, Portillo K. The Oral Health Needs of Wisconsin Farmers and the Need for Patient Activation: A Pilot Study. J Agromedicine 2017; 22:235-243. [PMID: 28402195 DOI: 10.1080/1059924x.2017.1318102] [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: 10/19/2022]
Abstract
OBJECTIVES This study aimed to determine the level of oral health need of Wisconsin farmers based on sociodemographic variables, perceived oral health, and actual oral health, and to evaluate the effectiveness of a dental hygiene patient activation intervention. METHODS Oral health screenings were administered by calibrated dental hygienists to 60 Wisconsin farmers attending the 2016 Wisconsin Farm Technology Days. Study participants self-administered the Oral Health Inventory Profile-14 survey and participated in an Adult Basic Screening Survey. Validity and reliability of both instruments have been established in previous studies. A follow-up phone call for Wisconsin farmers with a moderate- to high-risk oral health condition determined study participants followed the dental hygiene recommendations signified if study participants followed the dental hygiene recommendations and if patient activation had been achieved. RESULTS Study participants represented Wisconsin farmers (N = 60; n = 32 men, n = 28 women) with an average age range between 50 and 60 years old. The Oral Health Impact Profile-14 survey results indicated that this group of Wisconsin farmers did not perceive themselves to have an oral health problem. The Adult Basic Screening Survey results also indicated that the majority of study participants did not currently have active oral disease. There were 32% (n = 19) who qualified for follow-up phone call, with 15% (n = 3) seeking oral health care based on the dental hygiene recommendation. Significant associations between sociodemographic variables and actual oral health were not found, and the null hypotheses were not rejected. CONCLUSIONS Findings suggest that this group of Wisconsin farmers is receiving regular oral health care and patient activation despite literature suggesting that farmers and rural individuals might face unique barriers to health and oral health care.
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Affiliation(s)
| | - JoAnn Gurenlian
- b Department of Dental Hygiene, Division of Graduate Studies , Idaho State University , Pocatello , Idaho , USA
| | - Karen Portillo
- b Department of Dental Hygiene, Division of Graduate Studies , Idaho State University , Pocatello , Idaho , USA
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Lee J, Divaris K. The ethical imperative of addressing oral health disparities: a unifying framework. J Dent Res 2014; 93:224-30. [PMID: 24189268 PMCID: PMC3929974 DOI: 10.1177/0022034513511821] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/18/2013] [Accepted: 10/12/2013] [Indexed: 12/11/2022] Open
Abstract
Health disparities are preventable differences in the burden of disease or opportunities to achieve optimal health that are experienced by socially disadvantaged population groups. Reducing health disparities has been identified as an ethical imperative by the World Health Organization's Commission on Social Determinants of Health and numerous other national and international bodies. Significant progress has been made over the past years in identifying vulnerable groups, and 'distal' factors including political, economic, social, and community characteristics are now considered pivotal. It is thus unsurprising that the remarkable advances in the science and practice of dentistry have not led to notable reductions in oral health disparities. In this review, we summarize recent work and emphasize the need for a solid theoretical framing to guide oral health disparities research. We provide a theoretical framework outlining pathways that operate across the continuum of oral health determinants during the lifecourse and highlight potential areas for intervention. Because oral health disparities emanate from the unequal distribution of social, political, economic, and environmental resources, tangible progress is likely to be realized only by a global movement and concerted efforts by all stakeholders, including policymakers, the civil society, and academic, professional, and scientific bodies.
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Affiliation(s)
- J.Y. Lee
- The University of North Carolina at Chapel Hill - Department of Pediatric Dentistry, 228 Brauer Hall, Chapel Hill, North Carolina 27599, USA
| | - K. Divaris
- The University of North Carolina at Chapel Hill - Department of Pediatric Dentistry, 228 Brauer Hall, Chapel Hill, North Carolina 27599, USA
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Talbot JA, Coburn A, Croll Z, Ziller E. Rural considerations in establishing network adequacy standards for qualified health plans in state and regional health insurance exchanges. J Rural Health 2013; 29:327-35. [PMID: 23802935 DOI: 10.1111/jrh.12012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The Affordable Care Act (ACA) requires Health Insurance Exchanges (HIEs) to specify network adequacy standards for the Qualified Health Plans (QHPs) they offer to consumers. This article examines rural issues surrounding network adequacy standards, and offers recommendations for crafting standards that optimize rural access. METHOD This policy analysis reviews ACA requirements for QHP network adequacy standards, considering Medicaid managed care and Medicare Advantage (MA) standards as models. We analyze the implications of stringent vs flexible access standards in terms of how choices might affect health plans' participation in rural markets and rural enrollees' access to care. Finally, we propose strategies for designing standards with the degree of flexibility most likely to benefit rural consumers. FINDINGS A traditional approach to safeguarding rural access is to impose strict network adequacy standards on plans in rural areas. However, if strict standards prove difficult to meet due to rural provider scarcity, they might diminish QHPs' willingness to serve rural areas. Thus, they could exacerbate rather than alleviate rural access problems. CONCLUSIONS To benefit rural communities, network adequacy standards must be strong enough to provide real protections for beneficiaries, yet flexible enough to accommodate rural delivery system constraints and remain attainable for QHPs. Useful strategies to achieve this balance might include: adjusting standards according to degrees of rurality and rural utilization norms; counting midlevel clinicians toward fulfillment of patient-provider ratios; and allowing plans to ensure rural access through delivery system innovations such as telehealth.
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Affiliation(s)
- Jean A Talbot
- Muskie School of Public Service, University of Southern Maine, Portland, Maine 04103, USA. jean.talbot@.maine.edu
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Hart AM, Morgan KM, Casper GM. Rural parent behaviors and expectations when caring for children with acute respiratory infections. J Am Assoc Nurse Pract 2012; 25:431-439. [PMID: 24170640 DOI: 10.1111/j.1745-7599.2012.00802.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To explore rural parents' behaviors and expectations regarding acute respiratory infections (ARIs) in children. DATA SOURCES A random digit dial telephone survey administered to 655 rural adults; 176 answered questions regarding care of their children. CONCLUSIONS Increasing fluid intake was the action most parents reported "always" taking when caring for a child with an ARI. Parents take their child to see a provider when they "just know" their child will not get better or when the child has discolored phlegm or discharge. Most reported reasons for not taking child to a provider were because the child got better on their own and they knew how to treat their child on their own. When seeing a provider for an ARI, parents considered it very important that the provider listen to the child's symptoms, examine their child for the cause of their symptoms, and provide symptom management advice. Parents expect providers to treat the ARI in one visit and allow for follow-up by phone or e-mail. IMPLICATIONS FOR PRACTICE Nurse practitioners (NPs) in rural communities should be aware of the behaviors and expectations of parents in their practice. Awareness of these potentially unique issues will allow NPs to work with rural patients more effectively.
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Affiliation(s)
- Ann Marie Hart
- (Associate Professor), Fay W. Whitney School of Nursing, University of Wyoming, Laramie, Wyoming (Associate Professor), (Graduate Student), Family and Consumer Sciences, University of Wyoming, Laramie, Wyoming
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Abstract
PURPOSE To examine the differences in oral health status among residents of high-poverty counties, as compared to residents of other rural or urban counties, specifically on the prevalence of edentulism. METHODS We used the 2005 Behavioral Risk Factor Surveillance System (BRFSS) and the 2006 Area Resource File (ARF). All analyses were conducted with SAS and SAS-callable SUDAAN, in order to account for weighting and the complex sample design. FINDINGS Characteristics significantly related to edentulism include: geographic location, gender, race, age, health status, employment, insurance, not having a usual source of care, education, marital status, presence of chronic disease, having an English interview, not deferring care due to cost, income, and dentist saturation within the county. CONCLUSIONS Significant associations between high-poverty rural and other rural counties and edentulism were found, and other socioeconomic and health status indicators remain strong predictors of edentulism.
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Affiliation(s)
- Jordan Mitchell
- Healthcare Administration, School of Business, University of Houston, Clear Lake, Houston, TX, USA.
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Brumback BA, Zheng HW, Dailey AB. Adjusting for confounding by neighborhood using generalized linear mixed models and complex survey data. Stat Med 2012; 32:1313-24. [DOI: 10.1002/sim.5624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 08/27/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Babette A. Brumback
- Department of Biostatistics; University of Florida; Gainesville FL 32611 U.S.A
| | - Hao W. Zheng
- Department of Biostatistics; University of Florida; Gainesville FL 32611 U.S.A
| | - Amy B. Dailey
- Department of Health Sciences; Gettysburg College; Gettysburg PA 17325 U.S.A
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Brumback BA, Dailey AB, Zheng HW. Adjusting for confounding by neighborhood using a proportional odds model and complex survey data. Am J Epidemiol 2012; 175:1133-41. [PMID: 22510274 DOI: 10.1093/aje/kwr452] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In social epidemiology, an individual's neighborhood is considered to be an important determinant of health behaviors, mediators, and outcomes. Consequently, when investigating health disparities, researchers may wish to adjust for confounding by unmeasured neighborhood factors, such as local availability of health facilities or cultural predispositions. With a simple random sample and a binary outcome, a conditional logistic regression analysis that treats individuals within a neighborhood as a matched set is a natural method to use. The authors present a generalization of this method for ordinal outcomes and complex sampling designs. The method is based on a proportional odds model and is very simple to program using standard software such as SAS PROC SURVEYLOGISTIC (SAS Institute Inc., Cary, North Carolina). The authors applied the method to analyze racial/ethnic differences in dental preventative care, using 2008 Florida Behavioral Risk Factor Surveillance System survey data. The ordinal outcome represented time since last dental cleaning, and the authors adjusted for individual-level confounding by gender, age, education, and health insurance coverage. The authors compared results with and without additional adjustment for confounding by neighborhood, operationalized as zip code. The authors found that adjustment for confounding by neighborhood greatly affected the results in this example.
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Affiliation(s)
- Babette A Brumback
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, 32610, USA.
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Arcury TA, Savoca MR, Anderson AM, Chen H, Gilbert GH, Bell RA, Leng X, Reynolds T, Quandt SA. Dental care utilization among North Carolina rural older adults. J Public Health Dent 2012; 72:190-7. [PMID: 22536828 DOI: 10.1111/j.1752-7325.2012.00329.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This analysis delineates the predisposing, need, and enabling factors that are associated with regular and recent dental care in a multiethnic sample of rural older adults. METHODS A cross-sectional, comprehensive, oral-health survey conducted with a random, multiethnic (African American, American Indian, white) sample of 635 community-dwelling adults aged 60 years and older was completed in two rural southern counties. Logistic regression models assessed the simultaneous associations of dental care with predisposing, enabling, and need factors. RESULTS Almost no edentulous rural older adults received dental care; 27.1 percent of dentate rural older adults had received regular dental care, and 36.7 percent had received recent dental care. Predisposing (less than high-school education, dental anxiety), enabling (no regular place for dental care), and need factors (no filled teeth) reduced the odds of regular dental, while predisposing (dental anxiety), enabling (no regular place for dental care), and need factors (no filled teeth) reduced the odds of recent dental care. Having excellent, very good, or good self-rated oral health increased the odds of receiving regular and recent dental care. CONCLUSIONS Regular and recent dental care are infrequent among rural older adults. Contrary to expectations, those not receiving dental care are those who most need care; this has been referred to as the Paradox of Dental Need. Community access to dental care and the ability of older adults to pay for dental care must be addressed by public-health policy to improve the health and quality of life of older adults in rural communities.
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Affiliation(s)
- Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157-1084, USA.
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Arcury TA, Chen H, Savoca MR, Anderson AM, Leng X, Bell RA, Quandt SA. Ethnic variation in oral health and social integration among older rural adults. J Appl Gerontol 2011; 32:302-23. [PMID: 23788829 DOI: 10.1177/0733464811420428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This analysis examines the associations of oral health with social integration among ethnically diverse (African American, American Indian, White) rural older adults. Data are from a cross-sectional survey of 635 randomly selected community-dwelling adults aged 60+. Measures include self-rated oral health, number of teeth, number of oral health problems, social engagement, and social network size. Minority elders have poorer oral health than do White older adults. Most rural elders have substantial social engagement and social networks. Better oral health (greater number of teeth) is directly associated with social engagement, whereas the relationship of oral health to social network size is complex. The association of oral health with social engagement does not differ by ethnicity. Poorer oral health is associated with less social integration among African American, American Indian, and White elders. More research on the ways oral health affects the lives of older adults is warranted.
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Affiliation(s)
- Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, NC, USA
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Harris EF. Sex differences in esthetic treatment needs in American black and white adolescent orthodontic patients. Angle Orthod 2011; 81:743-9. [PMID: 21534724 DOI: 10.2319/101110-595.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To test whether the severity of malocclusions in adolescents who actually entered orthodontic treatment is different between the sexes, as this might explain the preponderance of girls in orthodontic practices. MATERIALS AND METHODS Severity was gauged with the 10-grade esthetic component of the Index of Orthodontic Treatment Need (IOTN) scored on the pretreatment intraoral photographs (n = 562) in a university-based specialty program. The samples of American White (n = 401) and American Black (n = 161) adolescents were free of craniofacial defects. Nonparametric statistics were used for analysis. RESULTS There is a significant sex difference in the IOTN in White teenagers due to milder, more esthetic cases among the girls. No sex difference occurs in the sample of Blacks, with both sexes having IOTN scores on a par with White males. The severity of malocclusion is independent of the age at start of treatment (within range of 12 to 19 years). CONCLUSIONS Greater subjective self-perceptions of occlusal issues seem to account for the preponderance of White girls in the patient pool, though why the sex difference is not evident in American Blacks is complex. We speculate that sex differences are larger in private practices, since there are fewer selection criteria for entering treatment.
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Affiliation(s)
- Edward F Harris
- Department of Orthodontics, College of Dentistry, University of Tennessee, Memphis, TN 38163, USA.
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