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Weatherspoon DJ, Hutfless S, Manski RJ. Claims analysis of Medicare fee-for-service oral health care encounters, from 2019 through 2021. J Am Dent Assoc 2023; 154:1000-1007.e1. [PMID: 37702636 DOI: 10.1016/j.adaj.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Many qualifying people rely on Medicare fee-for-service (FFS) for their health care insurance, although it rarely provides coverage for oral health care services. The objective of this study was to gain insights into oral health care that is being provided by all health care provider types for Medicare FFS beneficiaries. METHODS The authors used the Centers for Medicare & Medicaid Services Virtual Data Research Center to query 100% of Medicare FFS claims from 2019 through 2021 and identify all encounters for which there was either an oral health-related International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code or a CDT 2019-2021: Current Dental Terminology code recorded on the claim. The authors used a cross-sectional study design and calculated descriptive statistics to describe characteristics of identified oral health care encounters. The encounter level was the unit of analysis. RESULTS A total of 2,098,056 oral health care encounters were identified through Medicare FFS claims during the study observation period, with a lower volume observed after 2019. Nearly 98% of encounters were related to those in which oral health diagnoses were recorded (International Classification of Diseases, Tenth Revision, Clinical Modification code on claim), and non-oral health care providers primarily submitted these claims. Most encounters included beneficiaries with chronic conditions, and a roughly equal proportion included those qualifying for Medicare on the basis of age and disability. CONCLUSIONS Previously unreported characteristics of oral health care encounters were identified through administrative claims, providing insights into oral health care being provided to a subset of Medicare FFS beneficiaries. PRACTICAL IMPLICATIONS Future research and policies should focus on strengthening medical-dental integration models and expanding access to oral health care for the Medicare FFS population.
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Bowers JM, Seidenberg AB, Kemp JM. Skin Cancer Diagnosis Among People With Disabilities. Am J Prev Med 2023; 65:896-900. [PMID: 37062527 PMCID: PMC10576008 DOI: 10.1016/j.amepre.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION People with disabilities face unique challenges that may affect skin cancer prevention, diagnosis, and access to treatment. These challenges could be exacerbated by the COVID-19 pandemic. In 2022, the prevalence of self-reported skin cancer diagnoses, delayed medical care because of the coronavirus disease 2019 (COVID-19) pandemic, and skin cancer risk factors among people with disabilities were estimated. METHODS Data from the 2020 National Health Interview Survey (N=31,568 U.S. adults) were analyzed. Skin cancer diagnosis, age at the time of skin cancer diagnosis, skin cancer risk factors (e.g., sun protection), and delayed medical care because of the COVID-19 pandemic were included. Disability status was measured using the Washington Group Short Set on Functioning, which includes vision, hearing, mobility, communication, self-care, and cognitive disabilities. RESULTS Although 8.8% of U.S. adults reported having a disability, people with disabilities accounted for 14.7% of all self-reported skin cancer diagnoses, including 17.5% of melanoma diagnoses. Notably, people with disabilities were on average, older (mean age=59.8 years) than people without disabilities (mean age=46.8 years). Models that adjusted for age and other demographics revealed that people with disabilities had higher odds of delaying medical care because of the COVID-19 pandemic (OR=1.65, 95% CI=1.41, 1.94); people with disabilities reported being diagnosed with skin cancer later in life (age 61.5 vs 54.0 years; p<0.001) but had odds of reporting any skin cancer (OR=1.11, 95% CI=0.93, 1.32) or melanoma diagnosis (OR=1.33, 95% CI=0.95, 1.87) similar to those of people without disabilities. CONCLUSIONS Because of disability-related challenges, older age, and delaying medical care during the pandemic, people with disabilities may be at increased risk for inequitable skin cancer outcomes.
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Affiliation(s)
- Jennifer M Bowers
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Andrew B Seidenberg
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD; Truth Initiative Schroeder Institute, Washington, DC
| | - Jacqueline M Kemp
- Massachusetts Dermatology Associates, Beverly, MA; Department of Dermatology, Harvard Medical School, Boston, MA
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Macarevich Condessa A, Pilotto LM, Celeste RK, Hilgert JB. Use of dental services by disability status in Brazil in 2013. Community Dent Oral Epidemiol 2021; 49:471-477. [PMID: 33521999 DOI: 10.1111/cdoe.12623] [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: 10/25/2019] [Revised: 12/22/2020] [Accepted: 01/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the prevalence and factors associated with the use of oral health services in people with and without disabilities in Brazil. METHODS A cross-sectional study was used with the secondary data of 60,202 individuals from the Brazilian National Health Survey of 2013. The main exposure variable was 'Disability', and the main outcome was 'Dental service use'. Independent variables were selected using the modified Andersen and Davidson model, according to four groups: exogenous variables, primary determinants of oral health, health behaviours and oral health conditions. The analysis was based on a hierarchical approach stratified by 'disability (yes/no)', with multiple logistic regression incorporating sampling design. Interaction terms between the disability variable and covariates were tested in logistic regression models. RESULTS A total of 45.5% of the people without disabilities and 34.1% of those with disabilities visited the dentist in the last year. In the crude model, the nondisabled group used dental services more (OR = 1.61, 95%CI = 1.45-1.79), but the difference was no longer significant (OR = 1.18, 95%CI = 0.93-1.51) when adjusted by the health behaviour and oral health condition blocks. Determinants of dental use were similar among people with and without a disability. CONCLUSIONS No difference in dental service use according to disability status was found after adjusting for oral health conditions. Although edentulism is more prevalent among disabled people, they do not go to the dentist as regularly as nondisabled people. Health services should actively schedule maintenance visits to ensure that the needs of disabled individuals are fully addressed.
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Affiliation(s)
- Aline Macarevich Condessa
- Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciane Maria Pilotto
- Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Accessibility and accommodations for patients with mobility disabilities in a large healthcare system: How are we doing? Disabil Health J 2019; 12:679-684. [DOI: 10.1016/j.dhjo.2019.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/01/2019] [Accepted: 03/21/2019] [Indexed: 11/19/2022]
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Wong JL, Alschuler KN, Mroz TM, Hreha KP, Molton IR. Identification of targets for improving access to care in persons with long term physical disabilities. Disabil Health J 2019; 12:366-374. [PMID: 30880008 DOI: 10.1016/j.dhjo.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/23/2018] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND People with long-term physical disability (LTPD) continue to experience difficulties in accessing health care despite the focus of highlighting disparities in the last two decades. OBJECTIVES To describe health care utilization, accommodations and barriers experienced while accessing health care, and reasons why individuals delay or skip health care among people with LTPD. METHODS The current study was a part of a larger longitudinal survey administered to individuals with physical disability associated with one of four long-term conditions (MS; SCI; PPS; MD). Measures included demographics, health care utilization, barriers to health care, and reasons for delaying or skipping medical care from the sixth wave of data from 2015 to 2016. RESULTS Roughly 90% of all participants (N = 1159) saw at least one medical provider within 12 months. The most encountered barrier participants reported experiencing within that time was an office that did not have a safe transfer device to move them to an exam table (69%). Participants' physical function, quality of life, status of living with a spouse, diagnostic condition, and sex (male) were significantly associated with endorsing a barrier in accessing health care. The inability to afford out of pocket expenses was the highest reported reason for delaying health care. CONCLUSIONS People with LTPD access a variety of health care, including rehabilitation services, and continue to experience barriers when doing so. While understanding barriers individuals experience when accessing health care is important, it is equally important to document the type of care they delay or skip due to barriers.
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Affiliation(s)
- Jennifer L Wong
- University of Washington, Rehabilitation Medicine, United States.
| | | | - Tracy M Mroz
- University of Washington, Rehabilitation Medicine, United States
| | - Kimberly P Hreha
- University of Washington, Rehabilitation Medicine, United States
| | - Ivan R Molton
- University of Washington, Rehabilitation Medicine, United States.
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Couto P, Pereira PA, Nunes M, Mendes RA. Oral health-related quality of life of Portuguese adults with mild intellectual disabilities. PLoS One 2018; 13:e0193953. [PMID: 29561892 PMCID: PMC5862473 DOI: 10.1371/journal.pone.0193953] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 02/21/2018] [Indexed: 01/30/2023] Open
Abstract
Individuals with disabilities are regarded as a highly vulnerable population group, particularly as far as oral health is concern. However, few studies have assessed the impact of the oral condition on the quality of life of these individuals. Therefore, the aim of this study is to expand knowledge on the oral health status of the Portuguese adults with mild intellectual disability, and to assess how the patient's oral health is related to their quality of life. A sample of 240 adults with mild intellectual disabilities linked to the Portuguese Federation for Intellectual Disability, were interviewed using a previously validated version of the Oral Health Impact Profile. An oral health examination was also conducted using three oral health indexes: Clinical Oral Health Index (COHI); Clinical Oral Care Needs Index (COCNI) and the Clinical Oral Prevention Index (COPI). Sociodemographic characteristics and dental health factors were also collected, following statistical analysis. More than half of the individuals (54,9%) presented one or more problems of major to severe impact on health (COHI level 2); only 4,6% of the individuals do not need treatment or examination (COCNI level 0) and 85% of the study sample needs measures of educational or preventive action (COPI level 1). In 76,9% of the participants, oral health had impact on the quality of life. The most affected dimensions of life were physical pain with 61,9%, followed by psychological discomfort and psychological disability with 45,1% and 45%, respectively. With relation to oral health factors and sociodemographic variables it was verified that fewer teeth and higher self-perception of need for dental treatment had a negative impact on the quality of life. On the other hand, institutionalization and an increase in at least one category in the self-perception of the oral health status had a positive impact on the quality of life. Given the high burden of oral disease and the considerable impact on quality of life found in this study, the establishment of guidelines to improve the oral health and quality of life of these individuals should be regarded as imperative.
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Affiliation(s)
- Patrícia Couto
- Faculty of Health Sciences, Beira Interior University, Covilhã, Portugal
- * E-mail: (PC); (RAM)
| | - Paulo Almeida Pereira
- Department of Economics, Management and Social Sciences, Portuguese Catholic University, Viseu, Portugal
| | - Manuel Nunes
- Faculty of Health Sciences, Beira Interior University, Covilhã, Portugal
| | - Rui Amaral Mendes
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail: (PC); (RAM)
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Han J, Nian H, Zheng ZY, Zhao MM, Xu D, Wang C. Effects of health education intervention on negative emotion and quality of life of patients with laryngeal cancer after postoperative radiotherapy. Cancer Radiother 2018; 22:1-8. [DOI: 10.1016/j.canrad.2017.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/16/2017] [Accepted: 04/19/2017] [Indexed: 12/30/2022]
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Pan MY, Hsieh TC, Tai HC, Lin MS, Lin YC, Chen MY. Prevalence of and factors associated with fewer than 20 remaining teeth in Taiwanese adults with disabilities: a community-based cross-sectional study. BMJ Open 2017; 7:e016270. [PMID: 28993381 PMCID: PMC5639993 DOI: 10.1136/bmjopen-2017-016270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To examine the prevalence of and the factors associated with a number of remaining teeth (NRT) <20 among adults with disabilities. DESIGN A community-based, cross-sectional descriptive study. SETTING This study was part of a health promotion programme designed for community-dwelling adults with disabilities. PARTICIPANTS A total of 549 adults with disabilities, aged 20-80 years, living in the community in Chiayi County in Taiwan. OUTCOME MEASURES Various parameters, including NRT, oral health behaviours (ie, oral hygiene, dietary habits and substance use), comorbidities, disability classification and capability for performing activities of daily living, were measured. Data were statistically analysed using descriptive statistics and multivariate logistic regression analysis. RESULTS The mean NRT was 18.1 (SD=10.9); 44.8% of participants had NRT <20 (including 13.7% edentulous participants). Most participants had poor oral hygiene: 83.4% reported seldom using dental floss, 78% did not undergo regular 6-monthly dental check-ups and 77.4% seldom brushed their teeth after meal. After adjusting for potentially confounding variables, the intellectual disability group had a significantly higher risk of an NRT <20 than the physical disability group (OR 2.30, 95% CI 1.30 to 4.08). Additionally, the rare use of dental floss and hypertension significantly increased the possibility of an NRT <20 (OR 1.73-2.12, 95% CI 1.15 to 3.71). CONCLUSIONS An NRT <20 and edentulism were highly prevalent among adults with disabilities, who displayed poor oral hygiene behaviours. Adults with intellectual disabilities had a greater likelihood of having an NRT <20 than did those with physical disability. In addition to unmodifiable factors, the poor use of dental floss was significantly associated with an NRT <20.
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Affiliation(s)
- Mei-Yu Pan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | | | - Hung-Cheng Tai
- Department of General Education, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Ming-Shyan Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Chen Lin
- Department of Health Promotion, Chiayi Bureau of Health, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Nursing, Chang Gung University, Taoyuan, Taiwan
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Singhal A, Borrelli B. Dental Disparities and Psychological Distress Among Mobility-Impaired Adults. Am J Prev Med 2017; 52:645-652. [PMID: 27989449 DOI: 10.1016/j.amepre.2016.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/03/2016] [Accepted: 10/14/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION More than one in five American adults has a disability, the most common being mobility impairment (MI). People with MI face significant barriers to healthcare access and are more likely to experience psychological distress. This study examined disparities in access to medical and dental care among people with MI and examine the mediational role of psychological distress on this relationship. METHODS Analyses were conducted on 36,697 adults (aged ≥18 years) responding to the 2014 National Health Interview Survey (analyzed in 2015). MI was defined as needing special equipment and having difficulty walking a quarter mile without equipment. Outcomes included having lost all natural teeth (edentulous), unmet dental needs, annual dental visit, and annual medical visit. Psychological distress was measured using the Kessler psychological distress (K6) scale. RESULTS Compared with adults without MI, adults with MI had greater odds of being edentulous (OR=2.10, 95% CI=1.82, 2.43), having unmet dental needs (OR=1.99, 95% CI=1.66, 2.40), and lower odds of having annual dental visits (OR=0.62, 95% CI=0.54, 0.71). However, adults with MI were significantly more likely to have annual medical visits (OR=2.31, 95% CI=1.90, 2.81) than adults without MI. Psychological distress partially, yet significantly, mediated the relationship between MI and outcomes. CONCLUSIONS People with MI have significant oral health needs and poor access to dental care, which are partially mediated by psychological distress. Results suggest that mental health services should be considered for inclusion in interventions and medical visits can be leveraged to improve oral health outcomes in this population.
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Affiliation(s)
- Astha Singhal
- Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, Massachusetts;.
| | - Belinda Borrelli
- Division of Behavioral Science Research, Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
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Horner-Johnson W, Dobbertin K. Dental insurance and dental care among working-age adults: differences by type and complexity of disability. J Public Health Dent 2016; 76:330-339. [DOI: 10.1111/jphd.12160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/11/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Willi Horner-Johnson
- Institute on Development & Disability, Oregon Health & Science University; Portland OR USA
| | - Konrad Dobbertin
- Institute on Development & Disability, Oregon Health & Science University; Portland OR USA
- Center for Health Systems Effectiveness, Oregon Health & Science University; Portland OR USA
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Kang Q, Chen G, Lu J, Yu H. Health Disparities by Type of Disability: Health Examination Results of Adults (18-64 Years) with Disabilities in Shanghai, China. PLoS One 2016; 11:e0155700. [PMID: 27196419 PMCID: PMC4873126 DOI: 10.1371/journal.pone.0155700] [Citation(s) in RCA: 8] [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: 11/02/2015] [Accepted: 05/03/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS There have been few studies on the disparities within the population with disabilities, especially in China. The aim of this study was to evaluate the differences in some health conditions among people with different types of disabilities in Shanghai. METHODS This study was conducted using data from the Shanghai Disabled Persons' Rehabilitation Comprehensive Information Platform. The records of 31,082 persons with disabilities who had undergone professional health examination were analyzed, and the prevalence and number of five diseases and five risk factors were examined. Logistic regression was used to explore disparities from two perspectives: 1) basic differences, unadjusted for other factors, and 2) differences after adjusting for key demographic covariates. A p-value < 0.05 was considered significant. RESULTS Individuals with visual disability had a high rate of refractive error (60.0%), and averaged 1.75 diseases of interest, which was the highest value among all disability types. The mean number of risk factors we measured was greatest (1.96) in the population with mental disability. There were significant differences (p < 0.05) between the hearing and speech impairment group and the other groups with respect to most health outcomes, except chronic pharyngitis, hepatic cysts, and high blood pressure. CONCLUSION Significant differences of selected health outcomes between groups with different types of disabilities remained after controlling for key demographic indicators. Further research is needed to explore the relationships between health conditions and disability types.
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Affiliation(s)
- Qi Kang
- School of Public Health, Fudan University, Shanghai 200032, P. R. China
| | - Gang Chen
- School of Public Health, Fudan University, Shanghai 200032, P. R. China
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, P. R. China
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai 200032, P. R. China
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, P. R. China
| | - Huijiong Yu
- Department of Rehabilitation, Shanghai Disabled Persons’ Federation, Shanghai 200126, P. R. China
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Horner-Johnson W, Dobbertin K, Beilstein-Wedel E. Disparities in dental care associated with disability and race and ethnicity. J Am Dent Assoc 2015; 146:366-74. [DOI: 10.1016/j.adaj.2015.01.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/20/2014] [Accepted: 01/18/2015] [Indexed: 12/13/2022]
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Scott HM, Havercamp SM. Race and health disparities in adults with intellectual and developmental disabilities living in the United States. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:409-418. [PMID: 25409129 DOI: 10.1352/1934-9556-52.6.409] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Research has documented disparities in health care and access for people with intellectual and developmental disabilities (IDD) and people in racial and ethnic minority groups. Though both populations are underserved, the additive impact of being both a member of a racial/ethnic minority and having IDD is largely unknown. This study uses data from a nationally representative survey to explore health service utilization among adults with IDD belonging to minority racial/ethnic groups compared to adults with IDD who are White. The results of this study indicated that racial/ethnic minority groups are disadvantaged in several essential areas of health care utilization and that Hispanic Americans are particularly underserved. Additional research is needed to identify and address the factors driving this difference.
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Havercamp SM, Scott HM. National health surveillance of adults with disabilities, adults with intellectual and developmental disabilities, and adults with no disabilities. Disabil Health J 2014; 8:165-72. [PMID: 25595297 DOI: 10.1016/j.dhjo.2014.11.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 09/29/2014] [Accepted: 11/04/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND People with disabilities experience worse health and poorer access to health care compared to people without disability. Large-scale health surveillance efforts have largely excluded adults with intellectual and developmental disability. This study expands knowledge of health status, health risks and preventative health care in a representative US sample comparing the health of adults with no disability to adults with intellectual and developmental disability and to adults with other types of disability. OBJECTIVES The purposes of this study were (1) to identify disparities between adults with intellectual and developmental disability and adults with no disability and (2) compare this pattern of disparities to the pattern between adults with other types of disability and adults without disability. METHODS This study compares health status, health risks and preventative health care in a national sample across three groups of adults: No Disability, Disability, and Intellectual and Developmental Disability. Data sources were the 2010 Behavior Risk Factor Surveillance Survey and the National Core Indicators Consumer Survey. RESULTS Adults with disability and with intellectual and developmental disability were more likely to report being in poor health compared to adults without disability. Disability and intellectual and developmental disability conferred unique health risks and health care utilization patterns. CONCLUSIONS Significant disparities in health and health care utilization were found for adults with disability and developmental disability relative to adults without disability. Disability training for health care providers and health promotion research that identifies disability as a demographic group is needed.
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Affiliation(s)
- Susan M Havercamp
- The Ohio State University Nisonger Center, 1581 Dodd Dr, Columbus, OH 43210, USA.
| | - Haleigh M Scott
- The Ohio State University Nisonger Center, 1581 Dodd Dr, Columbus, OH 43210, USA
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Peterson-Besse JJ, O'Brien MS, Walsh ES, Monroe-Gulick A, White G, Drum CE. Clinical preventive service use disparities among subgroups of people with disabilities: A scoping review. Disabil Health J 2014; 7:373-93. [DOI: 10.1016/j.dhjo.2014.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 04/14/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
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Andresen EM, Peterson-Besse JJ, Krahn GL, Walsh ES, Horner-Johnson W, Iezzoni LI. Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review. Womens Health Issues 2013; 23:e205-14. [PMID: 23816150 DOI: 10.1016/j.whi.2013.04.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 04/08/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Research has found some disparities between U.S. women with and without disabilities in receiving clinical preventive services. Substantial differences may also exist within the population of women with disabilities. The current study examined published research on Pap smears, mammography, and clinical breast examinations across disability severity levels among women with disabilities. METHODS Informed by an expert panel, we followed guidelines for systematic literature reviews and searched MEDLINE, PsycINFO, and Cinahl databases. We also reviewed in-depth four disability- or preventive service-relevant journals. Two reviewers independently extracted data from all selected articles. FINDINGS Five of 74 reviewed publications of met all our inclusion criteria and all five reported data on Pap smears, mammography, and clinical breast examination. Articles classified disability severity groups by functional and/or activity levels. Associations between disability severity and Pap smear use were inconsistent across the publications. Mammography screening fell as disability level increased according to three of the five studies. Results demonstrated modestly lower screening, but also were inconsistent for clinical breast examinations across studies. CONCLUSION Evidence is inconsistent concerning disparities in these important cancer screening services with increasing disability levels. Published studies used differing methods and definitions, adding to concerns about the evidence for screening disparities rising along with increasing disability. More focused research is required to determine whether significant disparities exist in cancer screening among women with differing disability levels. This information is essential for national and local public health and health care organizations to target interventions to improve care for women with disabilities.
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Affiliation(s)
- Elena M Andresen
- Department of Public Health & Preventive Medicine, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon 97239, USA.
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Jiang Y, Okoro CA, Oh J, Fuller DL. Sociodemographic and health-related risk factors associated with tooth loss among adults in Rhode Island. Prev Chronic Dis 2013; 10:E45. [PMID: 23537519 PMCID: PMC3614421 DOI: 10.5888/pcd10.110285] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Oral health is an integral component of overall health and well-being. Very little Rhode Island state-level information exists on the determinants of tooth loss. The objective of this study was to systematically identify sociodemographic characteristics, health behaviors, health conditions and disabilities, and dental insurance coverage associated with tooth loss among noninstitutionalized adults in Rhode Island. Methods We analyzed Rhode Island’s 2008 and 2010 Behavioral Risk Factor Surveillance System survey data in 2011. The survey had 4 response categories for tooth loss: none, 1 to 5, 6 or more but not all, and all. We used multinomial logistic regression models to assess the relationship between 4 risk factor domains and tooth loss. Results An estimated 57.6% of Rhode Island adults had all their teeth, 28.9% had 1 to 5 missing teeth, 8.9% had 6 to 31 missing teeth, and 4.6% were edentulous. Respondents who had low income, low education, unhealthy behaviors (ie, were former or current smokers and did not engage in physical activity), chronic conditions (ie, diabetes and obesity) or disabilities, and no dental insurance coverage were more likely to have fewer teeth compared with their referent groups. However, the association of these variables with tooth loss was not uniform by age group. Conclusion Adults who report risky health behaviors or impaired health may be considered target subpopulations for prevention of tooth loss and promotion of good oral health.
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Affiliation(s)
- Yongwen Jiang
- Center for Health Data and Analysis, Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908, USA.
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The characteristics of hospital emergency department visits made by people with mental health conditions who had dental problems. J Am Dent Assoc 2013; 144:617-24. [DOI: 10.14219/jada.archive.2013.0173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Predicting barriers to primary care for patients with disabilities: a mixed methods study of practice administrators. Disabil Health J 2013; 6:116-23. [PMID: 23507162 DOI: 10.1016/j.dhjo.2012.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/05/2012] [Accepted: 11/17/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND People with disabilities continue to be identified as a group who experience disparate health/health care. They are less likely to engage in some health care services. Structural barriers are often identified as one of the reasons for the underutilization of some health care services by people with disabilities. However, to date no study has been conducted to understand why structural barriers persist twenty years after the Americans with Disabilities Act (ADA) became law. OBJECTIVES We examined the relationship between primary care practice administrators' knowledge of the ADA and the number of accessibility barriers that patients with mobility disabilities might encounter. METHODS Primary care practice administrators who were members of a medical management organization were surveyed between December 20, 2011, and January 17, 2012. A mixed methods research design was employed. Data were analyzed using a Guttman scale, linear and multiple linear regression. RESULTS ADA knowledge questions conformed to a valid Guttman scale. There was a significant inverse relationship between practice administrators' knowledge of the ADA and the number of barriers reported in their clinics. Age of the administrators and buildings built before 1993 were also significant predictors of the number of barriers. CONCLUSION This study helps to identify medical practices that are more likely to have access barriers and have the greatest need for ADA compliance interventions. Results from this study highlight practice administrators' need for specific knowledge of the ADA as it applies to their medical practice. Efforts are needed to improve disability training for health professionals.
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Oliveira JS, Prado Júnior RR, de Sousa Lima KR, de Oliveira Amaral H, Moita Neto JM, Mendes RF. Intellectual disability and impact on oral health: a paired study. SPECIAL CARE IN DENTISTRY 2013; 33:262-8. [DOI: 10.1111/scd.12015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Raimundo Rosendo Prado Júnior
- Professor of the Masters Course in Health Sciences; Restorative Dentistry Department; Federal University of Piauí; Teresina Piauí Brazil
| | | | | | - José Machado Moita Neto
- Doctor of Chemistry; Chemistry Department; Federal University of Piauí; Teresina Piauí Brazil
| | - Regina Ferraz Mendes
- Professor of the Masters Course in Health Sciences; Restorative Dentistry Department; Federal University of Piauí; Teresina Piauí Brazil
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Accessible medical equipment for patients with disabilities in primary care clinics: why is it lacking? Disabil Health J 2013; 6:124-32. [PMID: 23507163 DOI: 10.1016/j.dhjo.2012.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/24/2012] [Accepted: 11/18/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous research has identified inaccessible medical equipment as a barrier to health care services encountered by people with disabilities. However, no research has been conducted to understand why medical practices lack accessible equipment. OBJECTIVES/HYPOTHESIS The purpose of this study was to examine practice administrators' knowledge of accessible medical equipment and cost of accessible medical equipment to understand why medical practices lack such equipment. Hypotheses were: 1) Practice administrators lacked knowledge about accessible medical equipment and 2) The cost of accessible medical equipment was too great compared to standard equipment for the clinic. METHODS This study was a mixed methods survey of primary care practice administrators. The sixty-three participates were members of a medical management organization. Data were collected between December 20, 2011 and January 17, 2012. Proportions, Guttman scalogram, and Spearman's Rho correlation analyses were utilized. RESULTS For this sample, less than half of the administrators knew that accessible equipment existed and a fourth knew what accessible equipment existed. There was a significant (p < 0.01), positive correlation between knowledge of accessible equipment and pieces of accessible equipment in the clinics. Because less than half of the administrators had ever considered purchasing accessible equipment, it was inconclusive if cost of accessible equipment was too great. CONCLUSION Practice administrators' lack of knowledge of accessible medical equipment emphasizes the need not only for more education about the availability of accessible equipment but also about the importance of accessible equipment for their patients with disabilities and for physicians who provide them care.
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Leroy R, Declerck D. Oral health-care utilization in adults with disabilities in Belgium. Eur J Oral Sci 2012; 121:36-42. [PMID: 23331422 DOI: 10.1111/eos.12015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reports on oral health-service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health-care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health-care utilization and socio-demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental-attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral-treatment needs.
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Affiliation(s)
- Roos Leroy
- Department of Oral Health Sciences, Oral Health Research Unit, KU Leuven, Leuven, Belgium.
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Leroy R, Declerck D. Objective and subjective oral health care needs among adults with various disabilities. Clin Oral Investig 2012. [PMID: 23192286 DOI: 10.1007/s00784-012-0879-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The present study explored the objective and subjective oral health care needs and the association between both among Belgian adults with disabilities. MATERIALS AND METHODS A two-stage sampling methodology was used to select a sample of adults (22-65 years old) with disabilities, from various types of residential settings, day care centers, and sheltered workplaces and spread over the ten provinces. Oral screenings were performed by 28 trained dentists; subjective oral health care needs were collected through questionnaires. RESULTS Seven hundred seven adults with disabilities were recruited; from 656 (93 %), permission was obtained for an oral examination. In 467 (78 %) and 407 (68 %) participants, dental plaque and calculus, respectively, were observed. In 343 (56 %) participants, untreated caries lesions (into dentine) were recorded; 203 (33 %) participants had 20 or less teeth. The prosthetic replacement of missing teeth was poor. Exactly 228 (40 %) participants stated that they had a problem in the oral region, and 264 (48 %) indicated that they were in need of an appointment with a dentist. Barriers to consult a dentist were reported by 244 (42 %); fear (n = 87; 37 %), followed by financial and transportation problems (both, n = 68; 29 %), was the most frequently reported barrier. CONCLUSIONS The preventive as well as curative oral care needs in Belgian adults with various forms of disabilities are very high. CLINICAL RELEVANCE Efforts to tackle these vast oral health care needs should take into account the differences in needs and demands between subgroups and should comprise the improvement of access to proper care.
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Affiliation(s)
- Roos Leroy
- Department of Oral Health Sciences, Oral Health Research Unit, KU Leuven, Kapucijnenvoer 7 blok a bus 7001, 3000, Leuven, Belgium,
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Pharr JR, Bungum T. Health disparities experienced by people with disabilities in the United States: a Behavioral Risk Factor Surveillance System study. Glob J Health Sci 2012; 4:99-108. [PMID: 23121746 PMCID: PMC4776960 DOI: 10.5539/gjhs.v4n6p99] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/30/2012] [Indexed: 11/12/2022] Open
Abstract
The Americans with Disabilities Act became law in 1990; since then research has shown that people with disabilities continue to experience barriers to health care. The purpose of this study was to compare utilization of preventive services, chronic disease rates, and engagement in health risk behaviors of participants with differing severities of disabilities to those without disabilities. This study was a secondary analysis of 2010 data collected in the Behavioral Risk Factor Surveillance System national survey in the United States. Rao Chi square test and logistic regression were employed. Participants with disabilities had significantly higher adjusted odds ratios for all chronic diseases, for physical inactivity, obesity and smoking. They were significantly more likely to participate in some preventive services (flu/pneumonia vaccination, HIV test) and significantly less likely to participate in other preventive services (mammogram, Pap test). Our findings suggest that people with disabilities are less able to fully participate in all preventive services offered.
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Hall AG, Bouldin ED, Andresen EM, Ali AK. Maintaining Employment Among Caregivers of Individuals on a Medicaid Waitlist for Services. JOURNAL OF DISABILITY POLICY STUDIES 2012. [DOI: 10.1177/1044207311420567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many individuals with developmental or intellectual and other disabilities are on waitlists to receive supportive services through state Medicaid waiver programs. Being waitlisted can place considerable burden on the ability of a caregiver to maintain employment outside the home. This article reports on results of a survey of 442 caregivers of individuals waitlisted for services within the Florida Medicaid program. Logistic regression was used to model characteristics of caregiver and clients that are associated with the need for additional supports in order for the caregiver to maintain employment. Male caregivers and caregivers in fair or poor health were more likely to report needing support. Caregivers of clients who had behavior problems or problems with self-care were also more likely to need support to maintain employment. Policy responses to these findings include a call for increased supports or prioritization of services for caregivers who are in poor health or those who care for individuals with particularly problematic behaviors.
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Discrepancy among Behavioral Risk Factor Surveillance System, Social Security, and functional disability measurement. Disabil Health J 2012; 5:60-3. [DOI: 10.1016/j.dhjo.2011.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 08/26/2011] [Accepted: 08/30/2011] [Indexed: 11/18/2022]
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Rouleau T, Harrington A, Brennan M, Hammond F, Hirsch M, Nussbaum M, Bockenek W. Receipt of dental care and barriers encountered by persons with disabilities. SPECIAL CARE IN DENTISTRY 2011; 31:63-7. [PMID: 21371067 DOI: 10.1111/j.1754-4505.2011.00178.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A study was conducted to describe the receipt of dental care by patients with disabilities and to understand their perspective with regard to barriers to dental care. Subjects for this study were recruited among patients with disabilities seen at Carolinas Rehabilitation's outpatient clinic. A questionnaire consisting of 66 questions was completed by 344 subjects; with the topics related to both medical and dental care. Among the study population, 57.2% of subjects reported being seen by a dentist within the last 12 months, versus 67.3% before they became disabled. The last dental appointment was a routine examination for 59.5% of the respondents. Since becoming disabled, 16.6% of subjects reported problems receiving dental care. Financial challenges were the primary problem followed by physical accessibility issues. Further research is required to discover how barriers to care can be overcome to assure that those with disabilities receive adequate dental care.
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Affiliation(s)
- Tanya Rouleau
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
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Rapalo DM, Davis JL, Burtner P, Bouldin ED. Cost as a barrier to dental care among people with disabilities: a report from the Florida behavioral risk factor surveillance system. SPECIAL CARE IN DENTISTRY 2010; 30:133-9. [PMID: 20618778 DOI: 10.1111/j.1754-4505.2010.00144.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many individuals who have disabilities or complex health conditions do not have adequate access to comprehensive oral health care. An examination of the literature indicates a variety of contributing factors. This study reports on cost of care as a barrier to oral health care. Data from the 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS) were used (n = 33,777). Respondents who reported activity limitation or the use of special equipment were considered to have a disability. Lack of access to dental care due to cost during the past year was assessed. More individuals with a disability reported not seeing a dentist due to cost versus people without disabilities (30% vs. 16%). After adjusting for confounding variables, Floridians with disabilities were 60% more likely to report cost as a barrier to dental care (OR = 1.60, 95% CI 1.32-1.94). Cost of dental care is an access to oral health barrier for Floridians with disabilities. Improving access to dental care for this population will require consideration of financial issues.
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Affiliation(s)
- Deborah M Rapalo
- Department of Epidemiology and Biostatistics, College of Public Health and Health Professions, University of Florida, Florida, USA
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Koo D, Thacker SB. In snow's footsteps: Commentary on shoe-leather and applied epidemiology. Am J Epidemiol 2010; 172:737-9. [PMID: 20720100 DOI: 10.1093/aje/kwq252] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The term shoe-leather epidemiology is often synonymous with field epidemiology or intervention epidemiology. All 3 terms imply investigations initiated in response to urgent public health problems and for which the investigative team does much of its work in the field (i.e., outside the office or laboratory). Alexander D. Langmuir is credited with articulating the concept of disease surveillance as it is applied to populations rather than individuals. He also founded the Epidemic Intelligence Service (EIS) Program in 1951, a 2-year training experience in applied epidemiology that places professionals in the field, domestically and internationally, in real-life situations. Today, 70-90 EIS officers are assigned each year to Centers for Disease Control and Prevention programs and to state and local health departments to meet the broad spectrum of challenges in chronic disease, injury prevention, violence, environmental health, occupational safety and health, and maternal and child health, as well as infectious diseases. Throughout their assignments, EIS officers are encouraged to strive for analytic rigor as well as public health consequence, which requires technical competence blended with good judgment and awareness of context. Effective applied epidemiologists must have skills beyond just epidemiology to improve a population's health; the field of applied epidemiology requires multiple team members, all having different but complementary skills, to be effective.
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Affiliation(s)
- Denise Koo
- Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Horner-Johnson W, Suzuki R, Krahn GL, Andresen EM, Drum CE. Structure of health-related quality of life among people with and without functional limitations. Qual Life Res 2010; 19:977-84. [PMID: 20467819 DOI: 10.1007/s11136-010-9664-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this study was to assess the factor structure of nine health-related quality of life (HRQOL) survey items among people with and without disabilities or functional limitations (FL) and determine whether factor loadings were similar for the two groups. METHODS Data were from US states and territories in the 2001 and 2002 Behavioral Risk Factor Surveillance System (BRFSS). Confirmatory factor analyses assessed fit of the data to a previously found factor structure. RESULTS A two-factor structure was confirmed, conceptually representing physical and mental health. Although this structure fit data for both people with and without FL, factor loadings were significantly different for the two groups. In all but one instance, factor loadings were higher for people with FL than for people without FL. CONCLUSIONS Results suggest that people with and without FL conceptualize physical and mental HRQOL similarly. However, the nine items analyzed appear to be a better reflection of the latent constructs of physical and mental HRQOL in the population of people with FL than those without FL.
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Affiliation(s)
- Willi Horner-Johnson
- Oregon Institute on Disability and Development, RRTC: Health and Wellness, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR 97239-3098, USA.
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Salinas TJ. Treatment of Edentulism: Optimizing Outcomes with Tissue Management and Impression Techniques. J Prosthodont 2009; 18:97-105. [DOI: 10.1111/j.1532-849x.2009.00438.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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