Community dentistry and oral epidemiology最新文献_第7页

Sociocultural determinants of children's oral health among immigrants in Canada 加拿大移民中儿童口腔健康的社会文化决定因素

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2024-05-04 DOI: 10.1111/cdoe.12972

Rana Dahlan, Babak Bohlouli, Humam Saltaji, Bukola Salami, Maryam Amin

Objective

A conceptual model was designed and tested to predict immigrant children's oral health in Canada by examining parental acculturation and perceived social support (PSS) using structural equation modelling.

Methods

A convenience sample of first-generation immigrant parents and their children aged 2–12 years were recruited by multilingual community workers in Edmonton, Canada. Parents completed a validated questionnaire on demographics, child's oral health (OH) behaviours, parental acculturation and PSS. Dental examinations determined children's dental caries rate using DMFT/dmft index. Structural equation modelling (SEM) was used to analyse the data.

Results

A total of 336 families participated in this study. The average parental acculturation level was 10.46 with a maximum of 15, and the average PSS was 63.27 with a maximum of 75. SEM showed that 77% of the variance of DMFT/dmft scores in children was explained by parental PSS, acculturation level, immigration-related variables, socioeconomic variables and children's OH behaviours. The direct effect of parental PSS was associated with a significantly reduced rate of dental caries (β = −.076, p-value = .008) and lower sugar consumption (β = −.17, p-value = .04). While the mediation effect of parental acculturation on PSS was associated with positive OH behaviours of children (e.g., toothbrushing frequency and dental care utilization), the indirect effect was negatively associated with caries rate (β = .77, p-value = .00).

Conclusions

The direct effect of Parental Perceived Stress Scale (PSS) was associated with more favourable oral health behaviours and a lower prevalence of dental caries, while the mediation effect of acculturation was linked to a higher prevalence of dental caries.

目的通过使用结构方程模型研究父母的文化适应性和感知的社会支持（PSS），设计并测试了一个概念模型，以预测加拿大移民儿童的口腔健康状况。方法在加拿大埃德蒙顿，多语言社区工作者招募了第一代移民父母及其 2-12 岁的子女作为方便样本。家长们填写了一份经过验证的调查问卷，内容包括人口统计学、儿童口腔健康（OH）行为、家长的文化适应性和PSS。牙科检查采用 DMFT/dmft 指数确定儿童的龋齿率。研究采用结构方程模型（SEM）对数据进行分析。父母的文化适应程度平均为 10.46，最高为 15，PSS 平均为 63.27，最高为 75。SEM 显示，父母 PSS、文化适应水平、移民相关变量、社会经济变量和儿童 OH 行为解释了儿童 DMFT/dmft 分数变异的 77%。父母 PSS 的直接效应与龋齿率显著降低（β = -.076，p 值 = .008）和糖消耗量降低（β = -.17，p 值 = .04）相关。结论家长感知压力量表（PSS）的直接效应与更有利的口腔健康行为和更低的龋齿患病率相关，而文化程度的中介效应与更高的龋齿患病率相关。

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引用次数: 0

Enhancing children's participation in dental research: A commentary 促进儿童参与牙科研究：评论

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2024-05-01 DOI: 10.1111/cdoe.12970

Nona Attaran Kakhki, Peter Garber, Olawale Dudubo, Asma Salem, Franco A. Carnevale, Mary Ellen Macdonald

The concept of childhood has evolved over the years, inspired by the United Nations Convention on the Rights of the Child in 1989, shifting from developmental models to a conception of childhood that recognizes children as moral agents. This evolution highlights the importance of respecting children's agency and their right to be heard in matters that are related to them. In conventional health research, however, children's voices are often inadequately accessed. In this commentary, we discuss the imperative to recognize children's agency in dental research and a shift from research on children to research with and by children. Moreover, we underscore the importance of actively seeking and listening to children's voices and recognizing their agency in shaping research and healthcare practices in the field of dentistry. Further, we explore the application of participatory research approaches in dental research and provide examples of studies that have involved children in various capacities. We conclude this commentary by emphasizing the potential benefits of participatory research in both qualitative and quantitative dental studies to promote deeper understanding, clearer communication, and stronger advocacy regarding children's interests. Primarily, we call for greater recognition of children's agency in dental research and advocate for more inclusive and child-centred research methodologies.

在 1989 年联合国《儿童权利公约》的启发下，童年的概念多年来不断演变，从发展模式转变为承认儿童是道德主体的童年概念。这一演变凸显了尊重儿童能动性的重要性，以及他们在与自身相关的事务中发表意见的权利。然而，在传统的健康研究中，儿童的声音往往得不到充分表达。在这篇评论中，我们讨论了在牙科研究中承认儿童主体性的必要性，以及从针对儿童的研究转变为与儿童共同研究和由儿童进行研究的转变。此外，我们还强调了积极寻求和倾听儿童声音的重要性，并承认他们在影响牙科领域的研究和医疗实践中的作用。此外，我们还探讨了参与式研究方法在牙科研究中的应用，并提供了儿童以各种身份参与研究的实例。在本评论的最后，我们强调了参与式研究在定性和定量牙科研究中的潜在益处，以促进对儿童利益更深入的理解、更清晰的沟通和更有力的宣传。首先，我们呼吁在牙科研究中更多地承认儿童的能动性，并倡导更具包容性和以儿童为中心的研究方法。

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引用次数: 0

How well do parents identify their child's baby teeth? Engagement and accuracy of parent-reported information on a tooth checklist survey 父母识别孩子乳牙的能力如何？牙齿检查表调查中家长报告信息的参与度和准确性

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2024-04-28 DOI: 10.1111/cdoe.12971

Mona Le Luyer, Molly E. Boll, Simone A. M. Lemmers, Samantha J. Stoll, Alison G. Hoffnagle, Andrew D. A. C. Smith, Erin C. Dunn

<div> <section> <h3> Objectives</h3> <p>Naturally exfoliated primary teeth are being increasingly collected in child development studies. Most of these odontological collections and tooth biobanks use parent-reported information from questionnaires or tooth checklists to collect data on offspring teeth. To the best of the authors' knowledge, no studies have assessed parental engagement in tooth checklists, nor parental accuracy in identifying their child's baby tooth. This study aimed to evaluate these dimensions by analysing data from the about this tooth checklist returned with donated primary teeth in a natural experimental study called STRONG (the Stories Teeth Record of Newborn Growth).</p> </section> <section> <h3> Methods</h3> <p>Parental self-reported information were analysed on checklists returned with 825 primary teeth belonging to 199 children. The percentage of blank answers was calculated for each question. The accuracy of parents-reported tooth identification was evaluated by comparing parental ratings to researchers' ratings. Reliability of researchers' tooth identification was first evaluated by calculating intra-observer and inter-observer agreements, as well as Cohen's Kappa values. The percentage of accuracy of parents' tooth identification (relative to researcher's) was then calculated, and logistic regressions were used to evaluate if time elapsed between when exfoliation occurred and the checklist was completed associated with parental accuracy in tooth identification.</p> </section> <section> <h3> Results</h3> <p>Parents returned 98.4% of the checklists and completed 74.9% to 97.7% of the questions. Excellent reliability was demonstrated for researchers' intra- and inter-rater tooth identification (agreement percentages >90%; Cohen's Kappa values >.83). Moderate accuracy of parents-reported tooth identifications was found, with parents correctly identifying 49.5% of the donated tooth. Better parental accuracies were highlighted for partial identifications (87.1% of correct jaw, 75.6% of correct tooth type, and 65.8% of correct lateralization). Logistic regressions showed the odds of correct parental identifications decreased on average by 1.8% every 30 days of distance between tooth exfoliation and checklist completion.</p> </section> <section> <h3> Conclusions</h3> <p>While parental engagement is high, parents-reported tooth identifications have moderate accuracy, which decreases over time. High accuracy is however found for partial identifications. Parent-reported information on the accompanying questionnaire of naturally exfoliated primary teeth collection or tooth biobanks, even when filled in a l

目的在儿童发育研究中，越来越多地收集自然脱落的乳牙。这些牙科学收集和牙齿生物库大多使用调查问卷或牙齿核对表中父母报告的信息来收集后代牙齿的数据。据作者所知，还没有研究评估过家长对牙齿检查表的参与度，以及家长识别孩子乳牙的准确性。本研究旨在通过分析在一项名为 STRONG（新生儿生长故事牙齿记录）的自然实验研究中，随捐赠的乳牙一起交回的关于该牙齿检查表的数据，对这些方面进行评估。方法：对 199 名儿童的 825 颗乳牙交回的检查表上的家长自我报告信息进行分析。每个问题都计算了空白答案的百分比。通过比较家长评分和研究人员评分，评估家长报告的牙齿识别准确性。首先通过计算观察者内部和观察者之间的一致性以及 Cohen's Kappa 值来评估研究人员牙齿识别的可靠性。然后计算家长识别牙齿的准确率（相对于研究人员的准确率），并使用逻辑回归评估从脱落发生到完成核对表之间的时间间隔是否与家长识别牙齿的准确率有关。结果家长交回了 98.4% 的核对表，完成了 74.9% 到 97.7% 的问题。研究人员对牙齿的内部识别和相互识别具有极高的可靠性（一致率为 90%；Cohen's Kappa 值为 0.83）。家长报告的牙齿识别准确率为 49.5%。家长对部分牙齿识别的准确率较高（87.1%的颌骨识别正确，75.6%的牙齿类型识别正确，65.8%的侧位识别正确）。逻辑回归显示，从牙齿脱落到完成核对表之间的距离每隔 30 天，家长正确识别的几率平均下降 1.8%。不过，部分识别的准确率较高。应鼓励家长在自然脱落原牙收集或牙齿生物库的随附调查表上报告信息，即使是在脱落发生很长时间后填写。不过，专家鉴定牙齿仍应是最佳做法。

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引用次数: 0

Incentivizing dental services in healthy behaviour Medicaid waivers 在健康行为医疗补助豁免中激励牙科服务

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2024-04-28 DOI: 10.1111/cdoe.12965

Jason Semprini

Objective

In the United States, adult dental benefits are optional in the state-managed, public insurance program, Medicaid. States also have the option to adapt their Medicaid program via waivers which pair healthy behaviour incentives (HBI) with cost-sharing. These waivers have proven ineffective, but the empirical evidence has ignored differences between states. This study aims to evaluate the impact of four state's HBI Medicaid waiver on dental visits among low-income adult population subject to incentives and cost-sharing requirements by the HBI waiver.

Methods

Analysing biannual data from the Behavioural Risk Factor Surveillance System's Oral Health module (2008–2018) with a Difference-in-Differences design, this study estimated the effect of a Healthy Behaviour Incentive waiver on the probability of visiting the dentist in the past year. The three states that implemented an HBI Waiver (Indiana, Michigan and Wisconsin) were analysed separately. Secondary outcomes included being uninsured and having all teeth extracted. Matrix Completion methods accounted for dynamic treatment and tested for non-common trends. Inference was based on randomization inference tests.

Results

Only in Michigan was an HBI waiver consistently associated with a significant increase in the probability of a dental visit (Est. = 5.6%-points, p = .01). There was little convincing evidence that HBI waivers were associated with being uninsured or having all teeth extracted.

Conclusions

Between 2010 and 2019, many states have implemented an HBI waiver, each with a different approach to incentivizing dental visits. These implementation differences may explain the heterogeneous effects by state. More work is needed to evaluate how Medicaid waivers impact health outcomes in low-income populations.

目标在美国，成人牙科福利在州政府管理的公共保险计划--医疗补助计划中是可选的。各州也可以通过豁免来调整其医疗补助计划，将健康行为激励（HBI）与费用分担结合起来。事实证明，这些豁免措施效果不佳，但实证证据却忽略了各州之间的差异。本研究旨在评估四个州的健康行为激励医疗补助豁免计划对低收入成年人口看牙医的影响，这些低收入成年人口受到健康行为激励豁免计划的激励和费用分担要求的约束。本研究采用差分设计，分析了行为风险因素监测系统口腔健康模块（2008-2018 年）的半年期数据，估计了健康行为激励豁免计划对过去一年看牙医概率的影响。对实施健康行为激励豁免的三个州（印第安纳州、密歇根州和威斯康星州）分别进行了分析。次要结果包括无保险和牙齿全部拔除。矩阵完成法考虑了动态治疗并测试了非共同趋势。结果只有密歇根州的 HBI 减免计划与牙科就诊概率的显著增加有关（估计值 = 5.6%-点，p = .01）。几乎没有令人信服的证据表明 HBI 豁免与无保险或拔光牙齿有关。结论从 2010 年到 2019 年，许多州都实施了 HBI 豁免，每个州都采用了不同的方法来激励看牙医。这些实施差异可能解释了各州的不同效果。还需要做更多的工作来评估医疗补助豁免如何影响低收入人群的健康结果。

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引用次数: 0

Dental caries and school readiness in 5-year-olds: A birth cohort data linkage study 5 岁儿童的龋齿和入学准备：出生队列数据关联研究

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2024-04-28 DOI: 10.1111/cdoe.12968

Erin Giles, Samuel Relins, Kara Gray-Burrows, Sarah R Baker, Peter F. Day

Objective

To describe the association between dental caries and school readiness in 5-year-old children taking part in the Born in Bradford (BiB) birth cohort, UK.

Methods

The Early Years Foundation Stage Profile (EYFSP) assesses the school readiness of young children and is strongly predictive of future academic attainment. Children are recorded as ‘emerging’ (below expected), ‘expected’, or ‘exceeding’ in five key learning areas. The Oral Health Survey of 5-year-olds (OHS5) is undertaken biennially in England, assessing caries experience at a dentine threshold (d₃mft). EYFSP and OHS5 were available for a proportion of children participating in BiB. Odds ratios and confidence intervals for caries experience were established, and odds ratios adjusted for significant sociodemographic variables.

Results

EYFSP and OHS5 data were available for 2.5% (n = 346) BiB participants. Nearly half (45.2%) had caries. A measure of socio-economic status, receiving free school meals, was the only demographic variable strongly related to caries experience (OR: 2.8, 95% CI: 1.6–4.9). After adjustment, children ‘emerging’ in EYFSP learning areas had 1.6- to 2.2-fold (95% CI: 1.0–3.8) higher odds of experiencing caries. Children ‘exceeding’ EYFSP learning areas had 2.3- to 4-fold (95% CI: 0.1–0.9) lower odds of caries experience.

Conclusion

This is the first study to explore the association between caries experience and school readiness using a holistic assessment tool. The association was found across different learning areas and was comparable to and independent of socio-economic status. The findings indicate oral health-related absenteeism is not a causative factor. EYFSP shows potential to enhance the targeting of preventive interventions at a child, class or school level.

方法 "幼儿基础阶段档案"（EYFSP）对幼儿的入学准备情况进行评估，对幼儿未来的学业成绩有很强的预测性。儿童在五个关键学习领域的表现被记录为 "崭露头角"（低于预期）、"达到预期 "或 "超过预期"。英格兰每两年进行一次 5 岁儿童口腔健康调查（OHS5），评估牙本质阈值（d3mft）的龋齿情况。有一部分参加 BiB 的儿童可以获得 EYFSP 和 OHS5 的数据。结果2.5%（n = 346）的 BiB 参与者获得了 EYFSP 和 OHS5 数据。近一半（45.2%）的人患有龋齿。社会经济地位的衡量标准--接受免费校餐--是唯一与龋病经历密切相关的人口统计学变量（OR：2.8，95% CI：1.6-4.9）。经过调整后，在《幼儿发展纲要》学习领域 "崭露头角 "的儿童发生龋齿的几率要高出1.6-2.2倍（95% CI：1.0-3.8）。结论这是第一项使用整体评估工具探讨龋齿经历与入学准备之间关系的研究。该研究在不同的学习领域都发现了相关性，并且与社会经济地位相当，也不受社会经济地位的影响。研究结果表明，与口腔健康有关的缺勤并不是致病因素。欧洲青少年口腔健康计划 "显示了在儿童、班级或学校层面提高预防干预措施针对性的潜力。

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引用次数: 0

Experiences of dental behaviour support techniques: A qualitative systematic review 牙科行为支持技术的经验：定性系统回顾

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2024-04-28 DOI: 10.1111/cdoe.12969

Andrew Geddis-Regan, Aisyah Binti Ahmad Fisal, James Bird, Isabel Fleischmann, Caoimhin Mac Giolla Phadraig

Background

Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences.

Aim

To explore and synthesize qualitative literature related to patient experience of dental behaviour support.

Methods

A PROSPERO-registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified.

Results

Twenty-three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy-reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision.

Conclusion

Qualitative research has been under-utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient-reported experiences of care.

背景对患者或护理者报告的使用牙科行为支持（DBS）技术进行牙科治疗的经历知之甚少。目的探索并综合与患者牙科行为支持体验相关的定性文献。方法对定性文章进行了PROSPERO注册的系统性综述。研究通过MEDLINE、Embase和PsycINFO进行识别，由两名审稿人进行筛选，并提取数据以总结其中的定性研究结果。结果共纳入 23 项研究。这些研究主要通过与儿童家长的交谈来探讨儿童牙科护理的经验（16 项），尤其是关于儿科牙科全身麻醉（DGA）的经验（8 项）。关于成人牙科全身麻醉经历的研究（7 项）涵盖了一系列技术。九项研究探讨了更广泛的牙科护理经验，并未研究特定的 DBS 方法。专题综合确定了适用于所有已确定研究的五个主题：信任和治疗联盟支持有效的护理服务；考虑到信息共享通常会减轻预期焦虑；控制和自主减少了焦虑；DBS 技术的治疗成功和失败的感知存在差异；DBS 技术对患者产生的积极和消极影响超出了直接护理服务的范围。除儿科 DGA 外，人们对大多数 DBS 技术的护理经验知之甚少。与患者建立信任并赋予患者自主权似乎有助于患者获得积极的护理体验。

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引用次数: 0

Self-perceived quality of social roles, activities and relationships predicts incident gingivitis 社会角色、活动和人际关系的自我认知质量可预测牙龈炎的发生。

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2024-04-23 DOI: 10.1111/cdoe.12966

Benjamin W. Chaffee

Objectives

While physical health status is known to impact social functioning, a growing literature suggests that social well-being may affect oral health. This investigation evaluated whether self-perceived quality of social roles, activities and relationships (social well-being) influences gingival inflammation.

Methods

Data were from the Population Assessment of Tobacco and Health Study, a nationally representative cohort of US adults, biennial waves 4 (2017) to 6 (2021). Social well-being was derived from the validated PROMIS Global-10 survey instrument, categorized for this longitudinal analysis as high, moderate or low. The main outcome was incident self-reported gum bleeding (dichotomous, proxy for gingivitis). Survey-weighted logistic regression modelling adjusted for overall health status, sociodemographic (e.g. age, sex, race/ethnicity), socioeconomic (e.g. income, education) and behavioural (e.g. tobacco, alcohol) confounders and was used to predict marginal mean gum bleeding incidence.

Results

Cross-sectionally at wave 4 (N = 23 679), gum bleeding prevalence was higher along a stepwise gradient of decreasing satisfaction with social activities and relationships (extremely satisfied: 20.4%; not at all: 40.1%). Longitudinally, among participants who had never reported gum bleeding through wave 4 (N = 9695), marginal predicted new gum bleeding at wave 6 was greater with each category of lower wave 4–5 social well-being (high: 7.6%; moderate: 8.6%; low: 12.4%). Findings were robust to alternative model specifications. Results should be interpreted considering study limitations (e.g. potential unmeasured confounding; outcome by self-report).

Conclusions

Social functioning may affect physical health. Specifically, social roles, activities and relationships may influence inflammatory oral conditions, like gingivitis. Confirmatory research is warranted, along with policies and interventions that promote social well-being.

目的众所周知，身体健康状况会影响社会功能，但越来越多的文献表明，社会幸福感可能会影响口腔健康。这项调查评估了自我感觉的社会角色、活动和关系质量（社会幸福感）是否会影响牙龈炎症。方法数据来自烟草与健康人口评估研究，这是一项具有全国代表性的美国成年人队列研究，每两年进行一次，第 4 波（2017 年）至第 6 波（2021 年）。社会福利来自经过验证的 PROMIS Global-10 调查工具，在本次纵向分析中分为高、中、低三个等级。主要结果是自我报告的牙龈出血事件（二分法，代表牙龈炎）。调查加权逻辑回归模型调整了总体健康状况、社会人口（如年龄、性别、种族/民族）、社会经济（如收入、教育）和行为（如烟草、酒精）等干扰因素，用于预测牙龈出血的边际平均发生率。结果在第 4 次调查中（样本数 = 23 679），牙龈出血发生率随着对社交活动和人际关系满意度的逐步降低而升高（非常满意：20.4%；完全不满意：40.1%）。纵向来看，在第 4 波从未报告过牙龈出血的参与者中（N = 9695），第 4-5 波社会幸福感越低，第 6 波新牙龈出血的边际预测值就越高（高：7.6%；中：8.6%；低：12.4%）。研究结果对其他模型规格具有稳健性。在解释结果时应考虑到研究的局限性（如潜在的未测量混杂因素；结果由自我报告）。具体来说，社会角色、活动和人际关系可能会影响口腔炎症，如牙龈炎。有必要进行确认性研究，同时制定促进社会福祉的政策和干预措施。

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引用次数: 0

Barriers to dental utilization among Medicaid-enrolled young children from primary care practices in Northeast Ohio 俄亥俄州东北部初级保健机构中参加医疗补助计划的幼儿使用牙科服务的障碍。

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2024-04-22 DOI: 10.1111/cdoe.12964

David Selvaraj, Neel Agarwal, Jeffrey M. Albert, Suchitra Nelson

Objectives

To evaluate the individual and community factors that contribute to dental utilization among young children on Medicaid utilizing the Anderson Model and the Socio-Ecological Framework.

Methods

This observational cross-sectional study was conducted using baseline data (socio-demographics, clinical dental need) from a cluster-randomized hybrid effectiveness-implementation trial among 1021 child–parent dyads recruited from primary care practices across northeast Ohio. The baseline data were then linked to dental Medicaid claims data (categorized as any dental visit, volume, and type in the past 12 months) and ICD-10 codes from the child's EHR data (individual-level) together with Dental Health Provider Shortage Area (HPSA) status and Area Deprivation Index (ADI) which were obtained at the neighbourhood-level using home address of each dyad (community-level). Multivariable analyses using generalized estimating equations (GEE) accounted for clustering by practice, and models included individual-level alone, and individual + community-level factors to evaluate their effects on dental utilization.

Results

Medicaid claims data indicated that among the 1021 children (mean age: 4.3 ± 1.1 years; 54.4% males; 43.8% Black, Non-Hispanic), a majority of children were seeing the dentist at least once a year by the age of 4 (56.1%). The mean ADI of their neighbourhoods was 109.22 (20.2) and 27.5% lived in a HPSA area. The GEE analyses revealed that individual factors such as older children, parents being married, and continuous Medicaid enrollment were associated with significantly higher dental utilization. Among community factors, being in a HPSA had an OR = 1.53 (CI: 1.03, 2.27) associated with higher dental utilization.

Conclusions

Being in a HPSA was associated with higher dental utilization possibly due to dentists or safety net dental clinics in these areas accepting Medicaid-eligible children.

方法：本观察性横断面研究使用了从俄亥俄州东北部的初级保健实践中招募的 1021 个儿童-家长二人组的基线数据（社会人口统计学、临床牙科需求）。然后，将基线数据与牙科医疗补助（Medicaid）报销数据（按过去 12 个月内的任何牙科就诊次数、数量和类型分类）和儿童电子病历数据中的 ICD-10 编码（个人层面）以及牙科保健提供者短缺地区（HPSA）状况和地区贫困指数（ADI）联系起来，这些数据是根据每个二人组的家庭住址在邻里层面获得的（社区层面）。结果医疗补助申请数据显示，在 1021 名儿童（平均年龄：4.3 ± 1.1 岁；54.4% 为男性；43.8% 为非西班牙裔黑人）中，大多数儿童在 4 岁之前每年至少看一次牙医（56.1%）。他们所在社区的平均 ADI 为 109.22（20.2），27.5% 的儿童生活在 HPSA 地区。GEE 分析表明，孩子年龄较大、父母已婚和连续参加医疗补助计划等个人因素与牙科使用率明显较高有关。在社区因素中，居住在 HPSA 地区与较高的牙科使用率相关的 OR = 1.53 (CI: 1.03, 2.27)。

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引用次数: 0

Impact of income and financial subsidies on oral health care utilization among persons with disabilities in Singapore 收入和财政补贴对新加坡残疾人口腔保健使用情况的影响。

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2024-04-21 DOI: 10.1111/cdoe.12962

Sharon Hui Xuan Tan, Gabriel Keng Yan Lee, Charlene Enhui Goh, Huei Jinn Tong, Janice Cheah Ping Chuang, Kok-Yang Ang, David Guang Xu Lim, Xiaoli Gao

<div> <section> <h3> Background/Aim(s)</h3> <p>Globally, studies have shown that the dental disease burden among persons with intellectual and/or developmental disabilities (IDD) is high and can be attributed to lower utilization levels of dental services. The aim of the study was to assess the influence of income and financial subsidies on the utilization of dental care services among persons with IDD in Singapore.</p> </section> <section> <h3> Methods</h3> <p>Between August 2020 and August 2021, a cross-sectional study was conducted via centres offering Early Intervention Programme for Infants and Children, special education schools and adult associations in Singapore serving persons with IDD. A sample of 591 caregivers of children and adults with IDD completed the survey. Data on sociodemographic information, oral health behaviours and dental utilization were collected. Financial subsidy status was assessed by the uptake of a government-funded, opt-in Community Health Assist Scheme (CHAS) for low-income families that provided a fixed subsidy amount for dental services in the primary care setting. Statistical analysis was carried out using univariable, multiple logistic regression and modified Poisson regression. Propensity score matching was carried out in R version 4.0.2 to assess the impact of financial subsidies on oral health care utilization among persons with IDD.</p> </section> <section> <h3> Results</h3> <p>Compared to those with lower gross monthly household incomes, the adjusted prevalence ratios of having at least one dental visit in the past year, having at least one preventive dental visit in the past year, and visiting the dentist at least once a year for persons with IDD with gross monthly household incomes of above SGD$4000 were 1.28 (95% CI 1.08–1.52), 1.48 (95% CI 1.14–1.92) and 1.36 (95% CI 1.09–1.70), respectively. Among those who were eligible for CHAS Blue subsidies (247 participants), 160 (62.0%) took up the CHAS Blue scheme and 96 (35.4%) visited the dentist at least yearly. There was no statistically significant difference in the utilization of dental services among individuals enrolled in the CHAS Blue subsidy scheme among those eligible for CHAS Blue subsidies.</p> </section> <section> <h3> Conclusion</h3> <p>Higher household income was associated with a higher prevalence of dental visits in the past year, preventive dental visits in the past year, and at least yearly dental visits. CHAS Blue subsidies alone had limited impact on dental utilization among persons with IDD who were eligible for subsidies.</p>

背景/目的在全球范围内，研究表明智力和/或发育障碍（IDD）患者的牙科疾病负担很重，这可能是由于牙科服务的利用率较低所致。本研究旨在评估收入和财政补贴对新加坡智障人士使用牙科保健服务的影响。方法在2020年8月至2021年8月期间，通过新加坡为智障人士提供婴幼儿早期干预计划的中心、特殊教育学校和成人协会开展了一项横断面研究。共有 591 名智障儿童和成人的照顾者完成了调查。调查收集了有关社会人口学信息、口腔健康行为和牙科使用情况的数据。财政补贴状况是通过低收入家庭是否参加政府资助、可选择参加的 "社区卫生援助计划"（CHAS）来评估的。统计分析采用单变量、多元逻辑回归和修正泊松回归法进行。在 R 4.0.2 版本中进行了倾向得分匹配，以评估财政补贴对 IDD 患者口腔保健利用率的影响。结果与家庭月总收入较低的人群相比，家庭月总收入在4000新元以上的智障人士在过去一年至少看一次牙医、过去一年至少看一次预防性牙医和每年至少看一次牙医的调整流行率分别为1.28（95% CI 1.08-1.52）、1.48（95% CI 1.14-1.92）和1.36（95% CI 1.09-1.70）。在合資格領取醫療輔助隊藍卡津貼的 247 名參加者中，有 160 人 (62.0%) 參加了醫療輔助隊藍卡計劃，96 人 (35.4%) 至少每年看一次牙醫。结论家庭收入越高，过去一年看牙医、过去一年预防性看牙医以及至少每年看牙医的比例越高。CHAS Blue补贴本身对符合补贴条件的IDD患者的牙科使用率影响有限。

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引用次数: 0

Challenges and way forward for implementation of sugar taxation in the Middle East and North Africa (MENA) 中东和北非（MENA）实施糖税的挑战和前进之路

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2024-04-08 DOI: 10.1111/cdoe.12955

Hazem Abbas, Carol C. Guarnizo-Herreño, Maha El Tantawi, Georgios Tsakos, Marco A. Peres

Background

Over consumption of added sugar beyond the World Health Organization (WHO) recommended level of 10% of daily energy intake has well-established negative health consequences including oral diseases. However, the average consumption of added sugar in the Middle East and North Africa region (MENA—World Bank's regional classification) is 70% higher than the WHO recommended level. Imposing taxes on added sugar has been proposed by the WHO to decrease its consumption. Yet, only 21.6% of the total MENA population are covered by taxation policies targeting added sugar.

Challenges

Well-recognized challenges for the implementation of sugar taxation in MENA include the tactics used by the food and beverage industry to block these type of policies. However, there are also other unfamiliar hurdles specific to MENA. Historically, there have been incidents of protest and riots partially sparked by increased price of basic commodities, including sugar, in MENA countries. This may affect the readiness of policy makers in the region to impose added sugar taxes. In addition, there are also cultural, lifestyle and consumption behavioural barriers to implementing added sugar taxation. Ultra-processed foods and sugar-sweetened-beverages (SSBs) rich in added sugar are perceived by many in MENA as essential treats regardless of their health risks. Furthermore, some countries even provide subsidies for added sugar. Also, (oral) healthcare providers generally do not engage in policy advocacy mainly due to limited training on health policy.

Ways forward

Here, we discuss these challenges and suggest some ways forward such as (1) support from a health-oriented political leadership, (2) raising public awareness about the health risks of over consumption of sugar, (3) transparency during the policy-cycle development process, (4) providing a free and safe environment for a community dialogue around the proposed policy, (5) training of (oral) healthcare professionals on science communication and policy advocacy in local lay language/dialect, ideally evidence informed from local/regional studies, (6) selecting the appropriate political window of opportunity to introduce a sugar tax policy, and (7) clear and strict conflict of interest regulations to limit the influence of commercial players on health policy.

背景添加糖的摄入量超过世界卫生组织（WHO）建议的每日能量摄入量的 10%，会对健康造成负面影响，包括口腔疾病。然而，中东和北非地区（中东和北非--世界银行的地区分类）添加糖的平均消费量比世卫组织建议的水平高出 70%。世卫组织建议对添加糖征税，以减少其消费量。挑战在中东和北非地区实施糖税面临的公认挑战包括食品和饮料行业为阻挠此类政策而采取的策略。然而，中东和北非地区还存在其他特有的陌生障碍。历史上，中东和北非国家曾发生过抗议和骚乱事件，部分起因是包括糖在内的基本商品价格上涨。这可能会影响该地区决策者征收额外糖税的意愿。此外，在征收添加糖税方面还存在文化、生活方式和消费行为方面的障碍。在中东和北非地区，许多人将富含添加糖的超加工食品和含糖饮料（SSB）视为必不可少的美食，而不考虑其健康风险。此外，一些国家甚至为添加糖提供补贴。此外，（口腔）保健服务提供者一般不参与政策倡导，这主要是由于他们在卫生政策方面接受的培训有限。前进的道路在此，我们讨论了这些挑战，并提出了一些前进的道路，例如：（1）来自以健康为导向的政治领导层的支持；（2）提高公众对过度食用糖的健康风险的认识；（3）在政策周期制定过程中保持透明度；（4）提供一个自由、安全的环境，让社区围绕拟议的政策进行对话、(5) 对（口腔）医疗保健专业人员进行科学传播和政策宣传方面的培训，使用当地的非专业语言/方言，最好能从当地/区域研究中获得证据；(6) 选择适当的政治机会窗口，引入糖税政策；以及 (7) 制定明确严格的利益冲突法规，限制商业参与者对健康政策的影响。

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引用次数: 0