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Disale PR, Zope SA, Suragimath G, Varma AS, Pisal A. Prevalence and severity of periodontitis in patients with established rheumatoid arthritis and osteoarthritis. J Family Med Prim Care 2020; 9:2919-2925. [PMID: 32984149 PMCID: PMC7491801 DOI: 10.4103/jfmpc.jfmpc_398_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Periodontitis is associated with many chronic health conditions including diabetes, cardiovascular disease, and rheumatoid arthritis (RA). RA and periodontitis have similarities in inflammatory mechanism, morphology, and histopathology. Osteoarthritis (OA) is a chronic, multifactorial degenerative disease characterized by the deterioration of cartilage in joints. Objective The aim of this study was to evaluate the prevalence and severity of periodontal disease in patients with established RA and OA. Materials and Methods A total of 200 patients reporting to the Department of Orthopaedics, KIMSDU, Karad were included in the study. Patients were divided into two groups: Group 1 that included 100 patients with established RA diagnosed according to American College of Rheumatology (ACR) classification 1987 criteria and Group 2 that comprised 100 patients diagnosed with OA. Demographic profile, medical and dental history, oral hygiene practices, and smoking status of study participants were recorded. Periodontal status of the patients were evaluated using the simplified oral hygiene index (OHI-S), Loe and Silness gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). On the basis of the CAL score periodontitis severity was defined as slight, moderate, and severe. Rheumatoid Factor (RF) and C-reactive protein (CRP) were considered as a serological marker in RA. Serological tests were performed to measure RF and CRP. Periodontal parameters and serological tests were correlated. Results This study reported 45% severe periodontitis prevalence in RA compared to OA group, which was 33%. Severity of periodontitis is significantly greater in RF positive RA group with mean CAL 5.38 mm compared to RF negative RA group with mean CAL 2.81 mm (P = 0.001). There was moderate positive correlation found between RF titer and severity of periodontitis (r = 0.311). Conclusion The severity of periodontitis was significantly higher among the patients with established RA as compared to patients with OA. RF positive patients had higher periodontal disease compared to RF negative patients. There was an increase in the mean clinical attachment loss with increase in RF titer.
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Affiliation(s)
- Pooja R Disale
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Satara, Maharashtra, India
| | - Sameer A Zope
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Satara, Maharashtra, India
| | - Girish Suragimath
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Satara, Maharashtra, India
| | - Alluri Siddhartha Varma
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Satara, Maharashtra, India
| | - Apurva Pisal
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, Satara, Maharashtra, India
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Gyllstrom E, Gearin K, Nease D, Bekemeier B, Pratt R. Measuring Local Public Health and Primary Care Collaboration: A Practice-Based Research Approach. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:382-389. [PMID: 31136512 DOI: 10.1097/phh.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the degree of public health and primary care collaboration at the local level and develop a model framework of collaboration, the Community Collaboration Health Model (CCHM). DESIGN Mixed-methods, cross-sectional surveys, and semistructured, key informant interviews. SETTING All local health jurisdictions in Colorado, Minnesota, Washington, and Wisconsin. PARTICIPANTS Leaders from each jurisdiction were identified to describe local collaboration. Eighty percent of local health directors completed our survey (n = 193), representing 80% of jurisdictions. The parallel primary care survey had a 31% response rate (n = 128), representing 50% of jurisdictions. Twenty pairs of local health directors and primary care leaders participated in key informant interviews. MAIN OUTCOME MEASURE(S) Thirty-seven percent of jurisdictions were classified as having strong foundational and energizing characteristics in the model. Ten percent displayed high energizing/low foundational characteristics, 11% had high foundational/low energizing characteristics, and 42% of jurisdictions were low on both. RESULTS Respondents reported wide variation in relationship factors. They generally agreed that foundational characteristics were present in current working relationships but were less likely to agree that relationships had factors promoting sustainability or innovation. CONCLUSIONS Both sectors valued working together in principle, yet few did. Identifying shared priorities and achieving tangible benefits may be critical to realizing sustained relationships resulting in population health improvement. Our study reveals broad variation in experiences among local jurisdictions in our sample. Tools, such as the CCHM, and technical assistance may be helpful to support advancing collaboration. Dedicated funding, reimbursement redesign, improved data systems, and data sharing capability are key components of promoting collaboration. Yet, even in the absence of new reimbursement models or funding mechanisms, there are steps leaders can take to build and sustain their relationships. The self-assessment tool and the CCHM can identify opportunities for improving collaboration and link practitioners to strategies.
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Affiliation(s)
- Elizabeth Gyllstrom
- Center for Public Health Practice, Minnesota Department of Health, St Paul, Minnesota (Drs Gyllstrom and Gearin); Department of Family Medicine, University of Colorado, Aurora, Colorado (Dr Nease); Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington (Dr Bekemeier); and Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota (Dr Pratt)
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Powell C, Nunery C, Hays S, Curry K. Moving Childhood Immunizations Out of the Public Health Setting: Effects on Immunization Rates. Policy Polit Nurs Pract 2019; 21:21-28. [PMID: 31791204 DOI: 10.1177/1527154419892961] [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]
Abstract
County health departments typically bear responsibility for implementing immunization programs. In 2011, the Florida state legislature made significant reductions in state health department funding, and responsibility for routine childhood immunizations in some counties was shifted to local federally qualified health centers. This study was conducted to assess the impact of these administrative changes on childhood immunization rates in one county. A secondary analysis of data in the state immunization registry was conducted to assess changes and patterns in childhood immunization rates within the local health department, federally qualified health centers, and private pediatric practices. These changes were compared in the 3-year period before, during, and after the change. Results revealed that there was no net negative change in the vaccination rates of 0- to 7-year-old children in the county. There was a shift in the proportion of vaccinations administered by each health care delivery setting. The majority of immunizations were administered in private pediatric practices. When state funding for the local public health department ceased, other delivery settings covered the immunizations previously provided in the public health sector.
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Affiliation(s)
| | | | - Stacia Hays
- The University of Florida College of Nursing, Gainesville, FL, USA
| | - Kim Curry
- The University of Florida College of Nursing, Gainesville, FL, USA
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Gambhir RS, Kumar R, Aggarwal A, Goel R, Anand S, Bhardwaj A. Primarycare teams and recent experiments towards population coverage in India. J Family Med Prim Care 2019; 7:845-851. [PMID: 30598922 PMCID: PMC6259535 DOI: 10.4103/jfmpc.jfmpc_49_18] [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: 11/08/2022] Open
Abstract
Many people in India, especially the poor, face the hurdle of seeking effective health care at an affordable cost, at a distance they can travel, and with the dignity they deserve. According to reports from across the world, it is evident that countries having a strong primary health care system, have better health outcomes, lower inequalities, and lower costs of care. Primary care requires a team of health professionals, workers, and volunteers having a judicious skill mix. Some initiatives have been taken by the government in states like Kerala, Assam, Chhattisgarh, etc., to strengthen the primary health care infrastructure and provide primary care as close to their homes as possible. Staff deficiencies were addressed and training was also provided to the untrained staff. The current review focuses on several other primary care organizations that are working in different parts of the country (rural and urban), for e.g. Healthspring, MeraDoctor, Swasth India, Rashtriya Swasthya Bima Yojna (RSBY) Outpatient Pilot Program, etc. The current review also throws spot light on the type of primary health care system existing in countries like China, South Africa and Brazil. Some lacunae in service delivery are also identified and addressed so that changes can be incorporated at the policy and program level.
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Affiliation(s)
- Ramandeep S Gambhir
- Department of Public Health Dentistry, BRS Dental College and Hospital, Panchkula, India
| | - Raman Kumar
- President Academy of Family Physicians of India, New Delhi, India
| | - Amit Aggarwal
- Department of Oral Medicine and Radiology, MM College of Dental Sciences and Research, Mullana, Ambala, Haryana, India
| | - Richa Goel
- Department of Public Health Dentistry, Karnavati School of Dentistry, Gandhinagar, Gujarat, India
| | - Samir Anand
- Department of Periodontics, Rayat and Bahra Dental College and Hospital, Mohali, Punjab, India
| | - Arvind Bhardwaj
- Department of Periodontics, Rayat and Bahra Dental College and Hospital, Mohali, Punjab, India
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Barriers and facilitators to intraorganizational collaboration in public health: Relational coordination across public health services targeting individuals and populations. Health Care Manage Rev 2018; 45:60-72. [PMID: 29742523 DOI: 10.1097/hmr.0000000000000203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Modern public health emphasizes population-focused services, which may require collaborative work both across and within organizations. Studies have explored interorganizational collaborations, but there are little data regarding collaborations within public health organizations. PURPOSE We measured intraorganizational collaboration and identified barriers and facilitators to collaboration within a large public health department through a mixed-methods study. METHODOLOGY/APPROACH Our study occurred at the Maricopa County (Arizona) Department of Public Health, the third largest local public health jurisdiction in the United States. To measure collaboration, we surveyed staff using the relational coordination tool. To identify barriers and facilitators to collaboration, we performed key informant interviews with department personnel. RESULTS Relational coordination scores varied according to the focus of the service; clinical services had significantly lower levels of relational coordination than population-focused services (p < .01). We found high levels of mutual respect and lower levels of shared knowledge across services. Facilitators to collaboration included purposive cross-program meetings around specific topics, the organization's structure and culture, and individuals' social identities. Barriers included raised expectations for collaboration, low slack resources, member's self-interest, and trust. CONCLUSION The relational coordination of services varied significantly according to the focus of the service. Population-focused public health services had higher levels of relational coordination than individually focused services. Collaboration was facilitated and impeded by both well-known and potentially emergent factors, such as purposive cross-service meetings and organizational culture. PRACTICE IMPLICATIONS Population-focused services possessed higher levels of collaboration than individually focused services. Intraorganizational collaboration for improved population health relies on deliberate support from senior management and structured activities to increase shared knowledge and mutual respect.
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Tabak RG, Parks RG, Allen P, Jacob RR, Mazzucca S, Stamatakis KA, Poehler AR, Chin MH, Dobbins M, Dekker D, Brownson RC. Patterns and correlates of use of evidence-based interventions to control diabetes by local health departments across the USA. BMJ Open Diabetes Res Care 2018; 6:e000558. [PMID: 30233805 PMCID: PMC6135437 DOI: 10.1136/bmjdrc-2018-000558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/11/2018] [Accepted: 07/24/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The nearly 3000 local health departments (LHDs) nationwide are the front line of public health and are positioned to implement evidence-based interventions (EBIs) for diabetes control. Yet little is currently known about use of diabetes-related EBIs among LHDs. This study used a national online survey to determine the patterns and correlates of the Centers for Disease Control and Prevention Community Guide-recommended EBIs for diabetes control in LHDs. RESEARCH DESIGN AND METHODS A cross-sectional study was conducted to survey a stratified random sample of LHDs regarding department characteristics, respondent characteristics, evidence-based decision making within the LHD, and delivery of EBIs (directly or in collaboration) within five categories (diabetes-related, nutrition, physical activity, obesity, and tobacco). Associations between delivering EBIs and respondent and LHD characteristics and evidence-based decision making were explored using logistic regression models. RESULTS Among 240 LHDs there was considerable variation among the EBIs delivered. Diabetes prevalence in the state was positively associated with offering the Diabetes Prevention Program (OR=1.28 (95% CI 1.02 to 1.62)), diabetes self-management education (OR=1.32 (95% CI 1.04 to 1.67)), and identifying patients and determining treatment (OR=1.27 (95% CI 1.05 to 1.54)). Although all organizational supports for evidence-based decision making factors were related in a positive direction, the only significant association was between evaluation capacity and identifying patients with diabetes and determining effective treatment (OR=1.54 (95% CI 1.08 to 2.19)). CONCLUSION Supporting evidence-based decision making and increasing the implementation of these EBIs by more LHDs can help control diabetes nationwide.
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Affiliation(s)
- Rachel G Tabak
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Renee G Parks
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Peg Allen
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Rebekah R Jacob
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Stephanie Mazzucca
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Katherine A Stamatakis
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
| | - Allison R Poehler
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Marshall H Chin
- Department of Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Hamilton, Ontario, Canada
| | - Debra Dekker
- National Association of County and City Health Officials (NACCHO), District of Columbia, Washington, USA
| | - Ross C Brownson
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J Siteman Cancer Center, Washington University School of Medicine, Washington University, St Louis, Missouri, USA
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Bell CN, Bowie JV, Thorpe RJ, Levine DM. A spatial analysis of race, local health-promoting resources and preventable hospitalizations. Prev Med 2017; 105:149-155. [PMID: 28917951 DOI: 10.1016/j.ypmed.2017.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Preventable hospitalizations (PHs) for chronic conditions could have been avoided if treated with primary healthcare. PH rates are higher among African Americans, and in areas with less healthcare. Little is known about the effects of non-healthcare local health-promoting resources (LHPRs). The objective of this study is to determine associations between LHPRs and chronic PH rates in Maryland, and to assess spatial clustering of areas with high PH rates. METHODS Hospitalizations in 2010 were obtained from the Maryland Health Services Cost Review Commission by zip code of residence. Negative binomial regressions were used to determine associations between PH rates and LHPRs by race. Clusters of zip codes with high PH rates were assessed using the spatial Scan Statistic. RESULTS PH rates were associated with family practitioners (IRR=0.98, 95% CI=0.97-0.99), physicians' assistants (IRR=0.98, 95% CI=0.96-0.99), internists (IRR=1.02, 95% CI=1.01-1.03), teaching hospitals (IRR=1.21, 95% CI=1.04-1.40), and local health departments (IRR=1.19, 95% CI=1.03-1.37). No LHPRs were associated with PHs among whites, but African American PH rates were associated with family practitioners (IRR=0.97, 95% CI=0.94-0.99), nurse practitioners (IRR=1.03, 95% CI=1.01-1.06), teaching hospitals (IRR=1.37, 95% CI=1.08-1.75) and gyms/recreational centers (IRR=0.85, 95% CI=0.73-0.99). Clusters of areas with high PH rates varied by race. African American PH clusters had fewer family practitioners and more federally qualified health centers and teaching hospitals. CONCLUSIONS Public health practitioners should look to LHPRs beyond physician supply or public clinics to address PHs, particularly among African Americans. Specific LHPRs could be used to target African American PH rates and clusters.
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Affiliation(s)
- Caryn N Bell
- Department of African American Studies, University of Maryland, College Park 20742, United States.
| | - Janice V Bowie
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 21205, United States; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, 21205, United States
| | - Roland J Thorpe
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 21205, United States; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, 21205, United States
| | - David M Levine
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 21205, United States
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Federally Qualified Health Center Substitution of Local Health Department Services. Am J Prev Med 2017; 53:405-411. [PMID: 28751056 DOI: 10.1016/j.amepre.2017.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 05/16/2017] [Accepted: 06/05/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Strategic and budgetary considerations have shifted local health departments (LHDs) away from safety net clinical services and toward population-focused services. Federally Qualified Health Centers (FQHCs) play an increasing role in the safety net, and may complement or substitute for LHD clinical services. The authors examined the association between FQHC service levels in communities and the presence of specific LHD clinical services in 2010 and 2013. METHODS Data from LHD surveys and FQHC service data were merged for 2010 and 2013. Multivariate regression and instrumental variable methods were used to examine FQHC service levels that might predict related LHD service presence or discontinuation from 2010 to 2013. RESULTS There were modest reductions in LHD service presence and increases in FQHC service volume over the time period. LHD primary care and dental service presence were inversely associated with higher related FQHC service volume. LHD prenatal care service presence, as well as a measure of change in general service approach, were not significantly associated with FQHC service volume. CONCLUSIONS LHDs were less likely to provide certain clinical services where FQHCs provide a greater volume of services, suggesting a substitution effect. However, certain clinical services, such as prenatal care, may complement the public health mission-and LHDs may be strategically placed to continue to deliver these services.
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Abstract
Dentistry is neither an allied health profession nor a paramedical profession. It is the only anatomically focused health care profession that is university-based and for which primary care responsibility is maintained by the profession. Dentists must have a reliable knowledge of basic clinical medicine for safely and effectively treating individuals with chronic and other diseases, which make them biologically and pharmacologically compromised. With changes in the life expectancy of people and lifestyles, as well as rapid advancement in biomedical sciences, dentists should have similar knowledge like a physician in any other fields of medicine. There are number of primary care activities that can be conducted in the dental office like screening of diabetics, managing hypertension etc., The present review was conducted after doing extensive literature search of peer-reviewed journals. The review throws a spotlight on these activities and also suggests some the measures that can be adopted to modify dental education to turn dentists to oral physicians.
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Affiliation(s)
- Ramandeep Singh Gambhir
- Department of Public Health Dentistry, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
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