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Essex W, Mera J, Comiford A, Winters A, Feder MA. Assessing the Feasibility, Acceptability, and Effectiveness of a Pilot Hepatitis C Screening Program at Food Distribution Sites in Cherokee Nation, Oklahoma. J Community Health 2023; 48:982-993. [PMID: 37531046 PMCID: PMC10558369 DOI: 10.1007/s10900-023-01264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/03/2023]
Abstract
Compared with other racial and ethnic groups in the United States, American Indian and Alaska Native (AI/AN) people experience the highest incidence of acute hepatitis c (HCV). Cherokee Nation Health Services (CNHS) implemented a pilot health screening program from January through May 2019 to assess whether conducting HCV and other preventive health screenings at food distribution sites is a feasible, acceptable, and effective strategy to increase health screening among underserved community members. Data were collected among 340 eligible participants. Most (76%) participants reported being very comfortable receiving health screenings at food distribution sites and that getting screened at food distribution sites is very easy (75.4%). Most (92.1%, n = 313) participants received HCV screening, with 11 (3.5%) individuals testing positive for HCV antibodies. Of the 11 HCV seropositive individuals, six were confirmed to have active HCV infection of which four initiated treatment. Most (55.7%) participants exhibited a body mass index in the obese range, 33.1% exhibited high hemoglobin A1C (> 6.0), 24.5% exhibited high (> 200) cholesterol, 44.6% exhibited high blood pressure ( > = 140/90), and 54.8% did not have a current primary care provider. This project demonstrated that conducting HCV and other health screenings at food distribution sites within Cherokee Nation was an effective strategy to engage AI/AN people in preventive health screenings. Future programs are needed to scale-up preventive health screenings outside of traditional medical facilities as these types of screenings may help to decrease the HCV disparities among AI/AN people.
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Affiliation(s)
- Whitney Essex
- Department of Infectious Diseases, Cherokee Nation Outpatient Health Center, Cherokee Nation Health Services, 19600 East Ross St, Tahlequah, Ok, 74464, USA.
| | - Jorge Mera
- Department of Infectious Diseases, Cherokee Nation Outpatient Health Center, Cherokee Nation Health Services, 19600 East Ross St, Tahlequah, Ok, 74464, USA
| | - Ashley Comiford
- Department of Infectious Diseases, Cherokee Nation Outpatient Health Center, Cherokee Nation Health Services, 19600 East Ross St, Tahlequah, Ok, 74464, USA
| | - Amanda Winters
- Cardea Services, 1809 7th Ave #600, Seattle, WA, 98101, USA
| | - Molly A Feder
- Cardea Services, 1809 7th Ave #600, Seattle, WA, 98101, USA
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Guo Y, Woodard J, Zhang Y, Staras SAS, Gordan VV, Gilbert GH, McEdward DL, Shenkman E. Patients' comfort with and receipt of health risk assessments during routine dental visits: Results from the South Atlantic region of the US National Dental Practice-Based Research Network. Community Dent Oral Epidemiol 2023; 51:854-863. [PMID: 35851866 PMCID: PMC10792993 DOI: 10.1111/cdoe.12773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To understand patients' comfort with health risk assessments (HRAs) and patient and dentist factors associated with the provision of HRAs. METHODS In this cross-sectional study, 857 patients seen by 30 dental practitioners in the United States National Dental Practice-Based Research Network reported their comfort receiving HRA for six risk factors (tobacco use, alcohol use, dietary sugar intake, human immunodeficiency virus risks, human papillomavirus risks and existing medical conditions) and whether they discussed any of the risk factors during their visits. Multi-level logistic models were used to examine the impacts of patient, practitioner, practice characteristics on the (1) number of risk factors patients were comfortable discussing and (2) number of risk factors assessed in the current dental visit. RESULTS Only a small percentage (4%) of patients reported being uncomfortable receiving any HRA during their dental visits. However, over half of the patients (53%) reported that they did not receive any HRAs during the current visit. In the regression analyses, patients who were older, male and from the suburban were more likely to be comfortable with more HRAs. Dentists were more likely to provide HRA if they were younger, not non-Hispanic white, less likely to feel that providing HRAs was beyond their scope of practice, yet more likely to feel occasional discomfort in providing HRA. CONCLUSIONS Interventions should focus on reducing dental practitioner perception that conducting HRAs is beyond their scope of practice and standardizing screening assessments for multiple risk factors.
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Affiliation(s)
- Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road; Gainesville, FL 32608
| | - Jennifer Woodard
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road; Gainesville, FL 32608
| | - Yahan Zhang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32610
| | - Stephanie A. S. Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road; Gainesville, FL 32608
| | - Valeria V. Gordan
- Department of Restorative Dental Sciences, College of Dentistry, University of Florida, 1395 Center Drive; Gainesville, FL 326010-0415
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama, 1919 7th Ave S, Birmingham, AL 35294
| | - Deborah L. McEdward
- National Dental Practice-Based Research Network, Restorative Dental Sciences, University of Florida, 1395 Center Drive; Gainesville, FL 326010-0415
| | - Elizabeth Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road; Gainesville, FL 32608
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Borgnakke WS, Poudel P. Diabetes and Oral Health: Summary of Current Scientific Evidence for Why Transdisciplinary Collaboration Is Needed. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.709831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This Perspective provides a brief summary of the scientific evidence for the often two-way links between hyperglycemia, including manifest diabetes mellitus (DM), and oral health. It delivers in a nutshell examples of current scientific evidence for the following oral manifestations of hyperglycemia, along with any available evidence for effect in the opposite direction: periodontal diseases, caries/periapical periodontitis, tooth loss, peri-implantitis, dry mouth (xerostomia/hyposalivation), dysbiosis in the oral microbiome, candidiasis, taste disturbances, burning mouth syndrome, cancer, traumatic ulcers, infections of oral wounds, delayed wound healing, melanin pigmentation, fissured tongue, benign migratory glossitis (geographic tongue), temporomandibular disorders, and osteonecrosis of the jaw. Evidence for effects on quality of life will also be reported. This condensed overview delivers the rationale and sets the stage for the urgent need for delivery of oral and general health care in patient-centered transdisciplinary collaboration for early detection and management of both hyperglycemia and oral diseases to improve quality of life.
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Change in Denture Procedures after Implementation of National Health Insurance Coverage for the Elderly in Korea: A Nationwide Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052283. [PMID: 33669019 PMCID: PMC7967673 DOI: 10.3390/ijerph18052283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 12/03/2022]
Abstract
Background: Dental health is an important factor in daily life routines and is closely associated with maintaining a health-related quality of life. This study examined denture procedure changes after implementation of the National Health Insurance (NHI) Coverage of Dentures for the elderly. Methods: We used the “Korean Community Health Survey (KCHS)” developed by the Korea Centers for Diseases Control and Prevention. We analyzed the association between policy implementation and dental health-related outcomes using difference-in-differences (DID) analysis to compare patients aged ≥75 with those 65–74 years before and after coverage. Results: A comparison of age groups and coverage periods showed that patients aged ≥75 years had higher (OR: 1.038, 95% CI: 1.021–1.055) procedure rates after coverage. In particular, elderly patients on medical aid had significantly higher denture procedure rates, while those without oral health screening were more likely to have denture procedures. Conclusions: This study determined the impact of the NHI Coverage of Denture procedure policy for the elderly and found increased denture treatments in the elderly. This policy appeared to positively affect older patients by increasing denture procedures for low-income and medical aid beneficiaries. Hence, the government needs to increase oral health examination and dental health policies for the elderly.
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Hakeem FF, Bernabé E, Sabbah W. Self-rated oral health and frailty index among older Americans. Gerodontology 2020; 38:185-190. [PMID: 33231321 DOI: 10.1111/ger.12513] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/05/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the association between self-rated oral health and frailty index among older American adults aged 60 years and over. MATERIALS AND METHODS Data from the National Health and Nutrition and Examination Survey from 2011 to 2014 were used. Self-rated oral health was assessed based on a single question "rate the health of your teeth and gum". A frailty index of 49-items covering multiple systems was created. Age, gender, ethnicity, poverty-income ratio, education, poor nutritional intake and smoking were used as covariates. Weighted negative binomial regression was used to test the association between self-rated oral health and frailty index adjusting for the covariates. RESULTS A dose response relationship was observed between self-rated oral health and frailty index. The rate ratios (RR) of frailty index were 1.03 (95% CI 0.95-1.13), 1.15 (95% CI 1.05-1.25), 1.30 (95% CI 1.17-1.45) and 1.41(95% CI 1.28-1.54) for participants who rated their oral health very good, good, fair or poor, respectively, compared with those who rated their oral health excellent after adjusting for covariates. CONCLUSION Poorer self-rated oral health is associated with higher rates of frailty index. This highlights the importance of oral health as a predictor of frailty and the adequacy of using self-rated oral health in health surveys and clinical practices when conducting a comprehensive clinical oral examination is not feasible.
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Affiliation(s)
- Faisal F Hakeem
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Preventive Dental Sciences, College of Dentistry, Taibah University Dental College & Hospital, Madinah, Saudi Arabia
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Obeng IS, Ogamba IK. Service integration for improved diabetic and dental care: exploring an effective model for optimising health outcomes. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-07-2020-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study identifies and synthesizes existing literature on the integration of diabetic and dental services and explores a service integration model for optimising diabetic patient health outcomes and improving healthcare systems in low and middle-income countries.Design/methodology/approachPeer-reviewed literature that analysed the integration of health services regarding dental and medical services were reviewed. The articles were identified using the Academic Search Complete, Business Source Complete, CINAHL Complete, Google Scholar and MEDLINE databases and screened using the PRISMA guidelines.FindingsA total of 40 full-text articles were examined for eligibility out of which 26 were selected for analysis. Diabetes was shown to contribute significantly to the global disease burden and this is also reflected in most low and middle-income countries. It is found that the integration of medical and dental services could help alleviate this burden. Hence, locally adapted Rainbow-Modified Integrated Care model is proposed to fill this integration gap.OriginalityThe integration of dental and medical services has been proven to be useful in improving diabetic patient outcomes. Hence, the need to facilitate cross-professional collaboration between dentists and physicians cannot be overemphasised and this can be extended and locally adapted by different health systems across the world.Practice ImplicationsThe integration of dental and diabetic services using models such as the Rainbow Model of Integrated Care is recommended to optimise health outcomes of diabetic patients and enhancing service delivery, especially in resource-poor healthcare systems.
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Aronoff-Spencer E, Asgari P, Finlayson TL, Gavin J, Forstey M, Norman GJ, Pierce I, Ochoa C, Downey P, Becerra K, Agha Z. A comprehensive assessment for community-based, person-centered care for older adults. BMC Geriatr 2020; 20:193. [PMID: 32503440 PMCID: PMC7275322 DOI: 10.1186/s12877-020-1502-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Many health and social needs can be assessed and met in community settings, where lower-cost, person-centered, preventative and proactive services predominate. This study reports on the development and implementation of a person-centered care model integrating dental, social, and health services for low-income older adults at a community dental clinic co-located within a senior wellness center. Methods A digital comprehensive geriatric assessment (CGA) and referral system linking medical, dental, and psychosocial needs by real-time CGA-derived metrics for 996 older adults (age ≥ 60) was implemented in 2016–2018 as part of a continuous quality improvement project. This study aims to describe: 1) the development and content of a new CGA; 2) CGA implementation, workflows, triage, referrals; 3) correlations between CGA domains, and adjusted regression models, assessing associations with self-reported recent hospitalizations, emergency department (ED) visits, and clinically-assessed dental urgency. Results The multidisciplinary team from the senior wellness and dental centers planned and implemented a CGA that included standard medical history along with validated instruments for functional status, mental health and social determinants, and added oral health. Care navigators employed the CGA with 996 older adults, and made 1139 referrals (dental = 797, care coordination = 163, social work = 90, mental health = 32). CGA dimensions correlated between oral health, medical status, depressive symptoms, isolation, and reduced quality of life (QoL). Pain, medical symptoms, isolation and depressive symptoms were associated with poorer self-reported health, while general health was most strongly correlated with lower depressive symptoms, and higher functional status and QoL. Isolation was the strongest correlate of lower QoL. Adjusted odds ratios identified social and medical factors associated with recent hospitalization and ED visits. General and oral health were associated with dental urgency. Dental urgency was most strongly associated with general health (AOR = 1.78,95%CI [1.31, 2.43]), dental symptoms (AOR = 2.39,95%CI [1.78, 3.20]), dental pain (AOR = 2.06,95%CI [1.55–2.74]), and difficulty chewing (AOR = 2.80, 95%CI [2.09–3.76]). Dental symptoms were associated with recent ED visits (AOR = 1.61, 95%CI [1.12–2.30]) or hospitalizations (AOR = 1.47, 95%CI [1.04–2.10]). Conclusion Community-based inter-professional care is feasible with CGAs that include medical, dental, and social factors. A person-centered care model requires coordination supported by new workflows. Real-time metrics-based triage process provided efficient means for client review and a robust process to surface needs in complex cases.
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Affiliation(s)
| | - Padideh Asgari
- Gary and Mary West Health Institute, 10350 N. Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Tracy L Finlayson
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA.
| | - Joseph Gavin
- Serving Seniors, 1525 Fourth Avenue, San Diego, CA, 92101, USA
| | - Melinda Forstey
- Gary and Mary West Senior Dental Center, 1525 Fourth Avenue - second floor, San Diego, CA, 92101, USA
| | - Gregory J Norman
- Gary and Mary West Health Institute, 10350 N. Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Ian Pierce
- Gary and Mary West Health Institute, 10350 N. Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Carlos Ochoa
- Serving Seniors, 1525 Fourth Avenue, San Diego, CA, 92101, USA
| | - Paul Downey
- Serving Seniors, 1525 Fourth Avenue, San Diego, CA, 92101, USA
| | - Karen Becerra
- Gary and Mary West Senior Dental Center, 1525 Fourth Avenue - second floor, San Diego, CA, 92101, USA
| | - Zia Agha
- Gary and Mary West Health Institute, 10350 N. Torrey Pines Road, La Jolla, CA, 92037, USA
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Hoang H, Feike S, Lynden T, Barnett T, Crocombe L. Oral health needs of older migrants with culturally and linguistically diverse backgrounds in developed countries: A systematic review. Australas J Ageing 2019; 39:193-208. [PMID: 31811698 DOI: 10.1111/ajag.12759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 06/02/2019] [Accepted: 11/12/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify and synthesise the available evidence regarding the oral health needs of and the oral health promotion provided for older, cultural and linguistically diverse (CALD) migrants in developed countries. METHOD Databases were searched using search terms to identify all relevant English-language research studies published between 2000 and January 2018. RESULTS Thirty-nine articles met the review criteria. Thirty-three papers reported on the oral health needs of CALD older migrants and 6 on oral health programs provided for older migrants. CONCLUSIONS Cultural and linguistically diverse older migrants have high oral health needs and poor oral status and face a variety of barriers in accessing oral health care in their host countries. Recommendations to improve their access to oral health programs include building transcultural dental training into the educational requirements of dental students and developing oral health promotion programs that include culturally and linguistically customised information.
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Affiliation(s)
- Ha Hoang
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Suzanne Feike
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Tanya Lynden
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Tony Barnett
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Len Crocombe
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
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Northridge ME, Chakraborty B, Salehabadi SM, Metcalf SS, Kunzel C, Greenblatt AP, Borrell LN, Cheng B, Marshall SE, Lamster IB. Does Medicaid Coverage Modify the Relationship between Glycemic Status and Teeth Present in Older Adults? J Health Care Poor Underserved 2019; 29:1509-1528. [PMID: 30449760 DOI: 10.1353/hpu.2018.0109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Understanding the relationships among diabetes, teeth present, and dental insurance is essential to improving primary and oral health care. Participants were older adults who attended senior centers in northern Manhattan (New York, N.Y.). Sociodemographic, health, and health care information were obtained via intake interviews, number of teeth present via clinical dental examinations, and glycemic status via measurement of glycosylated hemoglobin (HbA1c). Complete data on dental insurance coverage status for 785 participants were available for analysis (1,015 after multiple imputation). For participants with no dental insurance and any private/other dental insurance, number of teeth present is less for participants with diabetes than for participants without diabetes; however, for participants with Medicaid coverage only, the relationship is reversed. Potential explanations include the limited range of dental services covered under the Medicaid program, inadequate diabetes screening and monitoring of Medicaid recipients, and the poor oral and general health of Medicaid recipients.
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Zhang Q, Northridge ME, Jin Z, Metcalf SS. Modeling Accessibility of Screening and Treatment Facilities for Older Adults using Transportation Networks. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2018; 93:64-75. [PMID: 29556112 PMCID: PMC5856470 DOI: 10.1016/j.apgeog.2018.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Increased lifespans and population growth have resulted in an older U.S. society that must reckon with the complex oral health needs that arise as adults age. Understanding accessibility to screening and treatment facilities for older adults is necessary in order to provide them with preventive and restorative services. This study uses an agent-based model to examine the accessibility of screening and treatment facilities via transportation networks for older adults living in the neighborhoods of northern Manhattan, New York City. Older adults are simulated as socioeconomically distinct agents who move along a GIS-based transportation network using transportation modes that mediate their access to screening and treatment facilities. This simulation model includes four types of mobile agents as a simplifying assumption: walk, by car, by bus, or by van (i.e., a form of transportation assistance for older adults). These mobile agents follow particular routes: older adults who travel by car, bus, and van follow street roads, whereas pedestrians follow walkways. The model enables the user to focus on one neighborhood at a time for analysis. The spatial dimension of an older adult's accessibility to screening and treatment facilities is simulated through the travel costs (indicated by travel time or distance) incurred in the GIS-based model environment, where lower travel costs to screening and treatment facilities imply better access. This model provides a framework for representing health-seeking behavior that is contextualized by a transportation network in a GIS environment.
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Affiliation(s)
- Qiuyi Zhang
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261, USA
| | - Mary E. Northridge
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261, USA
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, NY 10010, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Zhu Jin
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261, USA
| | - Sara S. Metcalf
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261, USA
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Chakraborty B, Widener MJ, Mirzaei Salehabadi S, Northridge ME, Kum SS, Jin Z, Kunzel C, Palmer HD, Metcalf SS. Estimating peer density effects on oral health for community-based older adults. BMC Oral Health 2017; 17:166. [PMID: 29284462 PMCID: PMC5746985 DOI: 10.1186/s12903-017-0456-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/11/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND As part of a long-standing line of research regarding how peer density affects health, researchers have sought to understand the multifaceted ways that the density of contemporaries living and interacting in proximity to one another influence social networks and knowledge diffusion, and subsequently health and well-being. This study examined peer density effects on oral health for racial/ethnic minority older adults living in northern Manhattan and the Bronx, New York, NY. METHODS Peer age-group density was estimated by smoothing US Census data with 4 kernel bandwidths ranging from 0.25 to 1.50 mile. Logistic regression models were developed using these spatial measures and data from the ElderSmile oral and general health screening program that serves predominantly racial/ethnic minority older adults at community centers in northern Manhattan and the Bronx. The oral health outcomes modeled as dependent variables were ordinal dentition status and binary self-rated oral health. After construction of kernel density surfaces and multiple imputation of missing data, logistic regression analyses were performed to estimate the effects of peer density and other sociodemographic characteristics on the oral health outcomes of dentition status and self-rated oral health. RESULTS Overall, higher peer density was associated with better oral health for older adults when estimated using smaller bandwidths (0.25 and 0.50 mile). That is, statistically significant relationships (p < 0.01) between peer density and improved dentition status were found when peer density was measured assuming a more local social network. As with dentition status, a positive significant association was found between peer density and fair or better self-rated oral health when peer density was measured assuming a more local social network. CONCLUSIONS This study provides novel evidence that the oral health of community-based older adults is affected by peer density in an urban environment. To the extent that peer density signifies the potential for social interaction and support, the positive significant effects of peer density on improved oral health point to the importance of place in promoting social interaction as a component of healthy aging. Proximity to peers and their knowledge of local resources may facilitate utilization of community-based oral health care.
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Affiliation(s)
- Bibhas Chakraborty
- Center for Quantitative Medicine, Duke-National University of Singapore (Duke-NUS) Medical School, Singapore, 169857 Singapore
| | - Michael J. Widener
- Department of Geography and Planning, University of Toronto, Toronto, ON M5S 1S8 Canada
| | - Sedigheh Mirzaei Salehabadi
- Center for Quantitative Medicine, Duke-National University of Singapore (Duke-NUS) Medical School, Singapore, 169857 Singapore
| | - Mary E. Northridge
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, NY 10010 USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032 USA
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261 USA
| | - Susan S. Kum
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261 USA
| | - Zhu Jin
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261 USA
| | - Carol Kunzel
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032 USA
- Section of Population Oral Health, Columbia University College of Dental Medicine, New York, NY 10032 USA
| | - Harvey D. Palmer
- Department of Political Science, The State University of New York at Buffalo, Buffalo, NY 14260 USA
| | - Sara S. Metcalf
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261 USA
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Guan M. Measuring the effects of socioeconomic factors on mental health among migrants in urban China: a multiple indicators multiple causes model. Int J Ment Health Syst 2017; 11:10. [PMID: 28070220 PMCID: PMC5217273 DOI: 10.1186/s13033-016-0118-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/29/2016] [Indexed: 11/10/2022] Open
Abstract
Objectives Since 1978, rural–urban migrants mainly contribute Chinese urbanization. The purpose of this paper is to examine the effects of socioeconomic factors on mental health of them. Their mental health was measured by 12-item general health questionnaire (GHQ-12). Methods The study sample comprised 5925 migrants obtained from the 2009 rural-to-urban migrants survey (RUMiC). The relationships among the instruments were assessed by the correlation analysis. The one-factor (overall items), two-factor (positive vs. negative items), and model conducted by principal component analysis were tested in the confirmatory factor analysis (CFA). On the basis of three CFA models, the three multiple indicators multiple causes (MIMIC) models with age, gender, marriage, ethnicity, and employment were constructed to investigate the concurrent associations between socioeconomic factors and GHQ-12. Results Of the sample, only 1.94% were of ethnic origin and mean age was 31.63 (SD = ±10.43) years. The one-factor, two-factor, and three-factor structure (i.e. semi-positive/negative/independent usefulness) had good model fits in the CFA analysis and gave order (i.e. 2 factor>3 factor>1 factor), which suggests that the three models can be used to assess psychological symptoms of migrants in urban China. All MIMIC models had acceptable fit and gave order (i.e. one-dimensional model>two-dimensional model>three-dimensional model). Conclusions There were weak associations of socioeconomic factors with mental health among migrants in urban China. Policy discussion suggested that improvement of socioeconomic status of rural–urban migrants and mental health systems in urban China should be highlighted and strengthened. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0118-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Guan
- Family Issues Center at Xuchang University, School of Business, Xuchang University, Road Bayi 88, Xuchang, Henan China
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Northridge ME, Metcalf SS. Enhancing implementation science by applying best principles of systems science. Health Res Policy Syst 2016; 14:74. [PMID: 27716275 PMCID: PMC5050576 DOI: 10.1186/s12961-016-0146-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/20/2016] [Indexed: 12/02/2022] Open
Abstract
Background Implementation science holds promise for better ensuring that research is translated into evidence-based policy and practice, but interventions often fail or even worsen the problems they are intended to solve due to a lack of understanding of real world structures and dynamic complexity. While systems science alone cannot possibly solve the major challenges in public health, systems-based approaches may contribute to changing the language and methods for conceptualising and acting within complex systems. The overarching goal of this paper is to improve the modelling used in dissemination and implementation research by applying best principles of systems science. Discussion Best principles, as distinct from the more customary term ‘best practices’, are used to underscore the need to extract the core issues from the context in which they are embedded in order to better ensure that they are transferable across settings. Toward meaningfully grappling with the complex and challenging problems faced in adopting and integrating evidence-based health interventions and changing practice patterns within specific settings, we propose and illustrate four best principles derived from our systems science experience: (1) model the problem, not the system; (2) pay attention to what is important, not just what is quantifiable; (3) leverage the utility of models as boundary objects; and (4) adopt a portfolio approach to model building. To improve our mental models of the real world, system scientists have created methodologies such as system dynamics, agent-based modelling, geographic information science and social network simulation. To understand dynamic complexity, we need the ability to simulate. Otherwise, our understanding will be limited. The practice of dynamic systems modelling, as discussed herein, is the art and science of linking system structure to behaviour for the purpose of changing structure to improve behaviour. A useful computer model creates a knowledge repository and a virtual library for internally consistent exploration of alternative assumptions. Conclusion Among the benefits of systems modelling are iterative practice, participatory potential and possibility thinking. We trust that the best principles proposed here will resonate with implementation scientists; applying them to the modelling process may abet the translation of research into effective policy and practice. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0146-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary E Northridge
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, 433 First Avenue, Room 726, New York, NY, 10010, USA.
| | - Sara S Metcalf
- Department of Geography, The State University of New York at Buffalo, 115 Wilkeson Quad, Ellicott Complex, North Campus, Buffalo, NY, 14261, USA
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Third Places for Health Promotion with Older Adults: Using the Consolidated Framework for Implementation Research to Enhance Program Implementation and Evaluation. J Urban Health 2016; 93:851-870. [PMID: 27562878 PMCID: PMC5052145 DOI: 10.1007/s11524-016-0070-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study extends the concept of third places to include community sites where older adults gather, often for meals or companionship. The Consolidated Framework for Implementation Research guided program implementation and evaluation. Depending upon health promotion program needs, the physical infrastructure of a site is important, but a supportive director (champion) can often overcome identified deficits. Senior centers may be locally classified into four types based upon eligibility requirements of residents in affiliated housing and services offered. Participants who attend these centers differ in important ways across types by most sociodemographic as well as certain health and health care characteristics.
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Marshall SE, Northridge ME, Lamster IB. Dr. Marshall Responds. JOURNAL OF THE CALIFORNIA DENTAL ASSOCIATION 2015; 43:701-702. [PMID: 26819979 PMCID: PMC4770900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Marshall S, Schrimshaw EW, Metcalf SS, Greenblatt AP, De La Cruz L, Kunzel C, Northridge ME. Evidence From ElderSmile for Diabetes and Hypertension Screening in Oral Health Programs. JOURNAL OF THE CALIFORNIA DENTAL ASSOCIATION 2015; 43:379-387. [PMID: 26451080 PMCID: PMC4594879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The ElderSmile clinical program was initiated in northern Manhattan in 2006. ElderSmile is a comprehensive community-based program offering education, screening and treatment services for seniors in impoverished communities. Originally focused on oral health, ElderSmile was expanded in 2010 to include diabetes and hypertension education and screening. More than 1,000 elders have participated in the expanded program to date. Quantitative and qualitative findings support a role for dental professionals in screening for these primary care sensitive conditions.
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Northridge ME, Metcalf SS, Birenz SS, Kunzel C, Wang H, Schrimshaw EW, Marshall SE. The Impact of Medicaid Expansion on Oral Health Equity for Older Adults: A Systems Perspective. JOURNAL OF THE CALIFORNIA DENTAL ASSOCIATION 2015; 43:369-77. [PMID: 26457047 PMCID: PMC4596543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper uses a collaborative, interdisciplinary systems science inquiry to explore implications of Medicaid expansion on achieving oral health equity for older adults. Through an iterative modeling process oriented toward the experiences of both patients and oral health care providers, complex feedback mechanisms for promoting oral health equity are articulated that acknowledge the potential for stigma as well as disparities in oral health care accessibility. Multiple factors mediate the impact of Medicaid expansion on oral health equity.
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Northridge ME, Yu C, Chakraborty B, Port Greenblatt A, Mark J, Golembeski C, Cheng B, Kunzel C, Metcalf SS, Marshall SE, Lamster IB. A community-based oral public health approach to promote health equity. Am J Public Health 2015; 105 Suppl 3:S459-65. [PMID: 25905852 PMCID: PMC4455510 DOI: 10.2105/ajph.2015.302562] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored the interrelationships among diabetes, hypertension, and missing teeth among underserved racial/ethnic minority elders. METHODS Self-reported sociodemographic characteristics and information about health and health care were provided by community-dwelling ElderSmile participants, aged 50 years and older, who took part in community-based oral health education and completed a screening questionnaire at senior centers in Manhattan, New York, from 2010 to 2012. RESULTS Multivariable models (both binary and ordinal logistic regression) were consistent, in that both older age and Medicaid coverage were important covariates when self-reported diabetes and self-reported hypertension were included, along with an interaction term between self-reported diabetes and self-reported hypertension. CONCLUSIONS An oral public health approach conceptualized as the intersection of 3 domains-dentistry, medicine, and public health-might prove useful in place-based assessment and delivery of services to underserved older adults. Further, an ordinal logit model that considers levels of missing teeth might allow for more informative and interpretable results than a binary logit model.
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Affiliation(s)
- Mary E Northridge
- At the time this article was written, Mary E. Northridge, Ariel Port Greenblatt, Janet Mark, and Cynthia Golembeski were with the New York University College of Dentistry, New York, NY. Chenchen Yu, Bibhas Chakraborty, Bin Cheng, and Ira B. Lamster were with the Mailman School of Public Health, Columbia University, New York. Carol Kunzel and Stephen E. Marshall were with the College of Dental Medicine, Columbia University. Sara S. Metcalf was with the University at Buffalo, The State University of New York, Buffalo
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Health risks and changes in self-efficacy following community health screening of adults with serious mental illnesses. PLoS One 2015; 10:e0123552. [PMID: 25875181 PMCID: PMC4395322 DOI: 10.1371/journal.pone.0123552] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/04/2015] [Indexed: 12/21/2022] Open
Abstract
Physical health screenings were conducted by researchers and peer wellness specialists for adults attending publicly-funded community mental health programs. A total of 457 adults with serious mental illnesses attended health fairs in 4 U.S. states and were screened for 8 common medical co-morbidities and health risk factors. Also assessed were self-reported health competencies, medical conditions, and health service utilization. Compared to non-institutionalized U.S. adults, markedly higher proportions screened positive for obesity (60%), hypertension (32%), diabetes (14%), smoking (44%), nicotine dependence (62%), alcohol abuse (17%), drug abuse (11%), and coronary heart disease (10%). A lower proportion screened positive for hyperlipidemia (7%). Multivariable random regression analysis found significant pre- to post-screening increases in participants’ self-rated abilities for health practices, competence for health maintenance, and health locus of control. Screening identified 82 instances of undiagnosed diabetes, hypertension or hyperlipidemia, and 76 instances where these disorders were treated but uncontrolled. These results are discussed in the context of how this global public health approach holds promise for furthering the goal of integrating health and mental health care.
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Huang YC, Chu CL, Ho CS, Lan SJ, Chen WY, Liang YW, Hsieh YP. Factors affecting institutionalized older peoples' self-perceived dry mouth. Qual Life Res 2014; 24:685-91. [PMID: 25150709 PMCID: PMC4349962 DOI: 10.1007/s11136-014-0792-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/29/2022]
Abstract
Purpose The purpose of this study was to determine the factors affecting institutionalized older peoples’ self-perceived dry mouth. Methods This cross-sectional study was conducted on elderly residents at 22 long-term care facilities. A total of 165 questionnaires were returned from 13 senior citizen welfare institutions (SCWIs) and nine nursing homes. Multiple logistic regression analysis was used to analyze the data obtained. Results The results showed that the type of long-term care (LTC) facility, regular oral examinations, wearing dentures, and the ability to chew sticky foods affected self-perceived dry mouth. This study determined an association between the type of LTC facility where the participants lived and self-perceived dry mouth. Conclusions The results indicated the importance of providing oral care in order to improve and prevent dry mouth among institutionalized older people living in SCWIs who do not undergo regular oral examinations, wear dentures, and have difficulty chewing sticky foods.
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Affiliation(s)
- Ying-Chia Huang
- Department of Healthcare Administration, Asia University, Taichung City, Taiwan, ROC,
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Widener MJ, Northridge ME, Chakraborty B, Marshall SE, Lamster I, Kum S, Metcalf SS. Patterns of chronic conditions in older adults: exploratory spatial findings from the ElderSmile program. Am J Prev Med 2014; 46:643-8. [PMID: 24842741 PMCID: PMC4028605 DOI: 10.1016/j.amepre.2014.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/08/2014] [Accepted: 01/19/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND The increasing prevalence of primary care-sensitive conditions, notably diabetes and hypertension, among older adults presents a challenge to the public health community. Systems science conceptualizations of health, along with considerations of the social and environmental context in which older adults live, are needed before effective interventions can be designed and implemented. PURPOSE To examine whether spatial patterns exist in hemoglobin A1c and blood pressure measurements among participants in ElderSmile, a community-based oral health and primary care screening program. METHODS Two spatial statistical methods, global Moran's I and Cuzick-Edwards tests, were used to determine if there were significant spatial patterns among ElderSmile participants residing in northern Manhattan during 2010-2012. The analyses were conducted in 2013. RESULTS Significant spatial patterns of hemoglobin A1c values and potential diabetes cases, and possibly blood pressure measurements, were found among ElderSmile participants residing in northern Manhattan. CONCLUSIONS The presence of spatial patterns allows for the identification of subpopulations in need of additional resources, and can assist in informing advanced spatial and statistical analyses. Screening data collected from an ongoing community-based program can be used to understand broader patterns of urban health.
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Affiliation(s)
- Michael J Widener
- Department of Geography, University of Cincinnati, Cincinnati, Ohio.
| | - Mary E Northridge
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, New York
| | - Bibhas Chakraborty
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore; Department of Biostatistics, Columbia University, New York, New York
| | - Stephen E Marshall
- College of Dental Medicine and Mailman School of Public Health, Columbia University, New York, New York
| | - Ira Lamster
- College of Dental Medicine and Mailman School of Public Health, Columbia University, New York, New York
| | - Susan Kum
- Department of Geography, State University of New York at Buffalo, Buffalo, New York
| | - Sara S Metcalf
- Department of Geography, State University of New York at Buffalo, Buffalo, New York
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