Journal of public health dentistry最新文献_第8页

An interprofessional school-based initiative to increase access to oral health care in underserved Florida counties 一项以学校为基础的跨专业倡议，旨在增加服务不足的佛罗里达州各县获得口腔保健的机会

IF 2.3 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of public health dentistry

Pub Date : 2023-03-09 DOI: 10.1111/jphd.12562

Elías M. Morón DDS, MPH, MHL, MHM, Richard Singer DMD, MS, PhD

OBJECTIVE

To examine and describe the effect of an oral health education program on school-based nurses' acquisition of oral health knowledge.

METHODS

Three-hour synchronous videoconference sessions provided training for nurses to conduct oral health risk assessments, screen for oral diseases, deliver oral health education, apply fluoride varnish, and refer children identified in need of further assessment and treatment to a dentist. Oral health knowledge acquisition was assessed by comparing pre-training and post-training examination scores. Analyses included descriptive statistics and the Wilcoxon signed-rank test.

RESULTS

Seventeen nurses from Suwannee, Lafayette, and Hamilton counties participated in the oral health education training program. Analyses of the school-based nurses' test results showed a significant increase in correct answers on the post-training test (93%) compared to the pre-training test (56%). Six hundred forty-one children from six elementary public schools received oral health education, oral screenings, and fluoride varnish applications. Fifty-eight percent of the children had untreated caries, 43% had treated caries, 15% had sealant on permanent molars, and 3% required urgent care. Nurses successfully referred children identified in need of further assessment and treatment to a dentist.

CONCLUSIONS

The synchronous videoconference oral health training program was effective in improving school-based nurses' oral health knowledge. The knowledge acquired by school-based nurses via oral health training programs can be leveraged to increase access to oral health care for vulnerable and unserved school-aged populations.

目的探讨口腔健康教育项目对校本护士口腔健康知识获取的影响。方法通过3小时的同步视频会议，培训护士进行口腔健康风险评估、口腔疾病筛查、口腔健康教育、涂氟化物清漆，并将需要进一步评估和治疗的儿童转介给牙医。通过比较训练前和训练后的考试成绩来评估口腔健康知识习得情况。分析包括描述性统计和Wilcoxon符号秩检验。结果来自苏旺尼县、拉斐特县和汉密尔顿县的17名护士参加了口腔健康教育培训项目。校本护士测试结果分析显示，培训后测试的正确率(93%)明显高于培训前测试的正确率(56%)。来自6所公立小学的641名儿童接受了口腔健康教育、口腔筛查和氟化物清漆应用。58%的儿童龋齿未得到治疗，43%的儿童龋齿得到治疗，15%的儿童在恒磨牙上使用了密封剂，3%的儿童需要紧急护理。护士成功地将确定需要进一步评估和治疗的儿童转介给牙医。结论同步视频会议口腔健康培训项目能有效提高校本护士口腔健康知识水平。学校护士通过口腔卫生培训项目获得的知识可用于增加弱势和未得到服务的学龄人口获得口腔卫生保健的机会。

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引用次数: 0

Engaging new partners in human papillomavirus (HPV) vaccine promotion: Considerations for training private practice dental professionals in HPV vaccine promotion 在人类乳头瘤病毒(HPV)疫苗推广中加入新的合作伙伴:在HPV疫苗推广中培训私人执业牙科专业人员的考虑

IF 2.3 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of public health dentistry

Pub Date : 2023-03-09 DOI: 10.1111/jphd.12566

Natoshia Askelson PhD, MPH, Grace Ryan PhD, MPH, Susan McKernan PhD, DMD, MS, Aaron Scherer PhD, MS, Eliza Daly MPH, Lejla Avdic BA

Objectives

With rates of the human papillomavirus (HPV) vaccination remaining low and rates of oropharyngeal cancer rising, engaging new partners to promote vaccination is necessary. We aimed to identify dental hygienists' and dentists' knowledge about HPV, the HPV vaccine, and preferences for continuing education.

Methods

This mixed-methods study recruited dental hygienists and dentists working in private practice in Iowa to participate in a mailed cross-sectional survey (dental hygienists) and qualitative telephone interviews (dental hygienists and dentists). Survey and interview topics included existing knowledge about HPV vaccination, HPV vaccination promotion efforts, barriers to HPV vaccine promotion, and preferences for continuing education (CE).

Results

We received 470 surveys from dental hygienists (response rate = 22.6%) and interviewed 19 dental hygienists and 20 dentists. Vaccine efficacy and safety, along with communication strategies, were key topics of interest for CE. Dental hygienists' most commonly identified barriers were lack of knowledge (67%) and low comfort levels (42%).

Conclusions

Knowledge was identified as a key barrier to providing a strong recommendation for HPV vaccination and convenience was the most important factor to consider for any future CE. Our team is in the process of designing a CE course based on this information to help dental professionals effectively engage in HPV vaccine promotion in their practices.

由于人乳头瘤病毒(HPV)疫苗接种率仍然很低，而口咽癌的接种率正在上升，有必要与新的合作伙伴合作，促进疫苗接种。我们的目的是确定牙科保健员和牙医对HPV、HPV疫苗的知识以及对继续教育的偏好。方法采用邮寄横断面调查(牙科卫生员)和定性电话访谈(牙科卫生员和牙医)的方式，对在爱荷华州私人诊所工作的牙科卫生员和牙医进行混合方法研究。调查和访谈主题包括对HPV疫苗接种的现有知识，HPV疫苗接种推广工作，HPV疫苗推广的障碍以及继续教育(CE)的偏好。结果共收到口腔卫生员调查表470份，回复率为22.6%，对19名口腔卫生员和20名牙医进行了访谈。疫苗效力和安全性以及传播策略是CE感兴趣的关键主题。牙科保健师最常见的障碍是缺乏知识(67%)和低舒适度(42%)。结论:知识被认为是提供强烈推荐HPV疫苗接种的关键障碍，方便性是考虑任何未来CE的最重要因素。我们的团队正在设计一个基于这些信息的CE课程，以帮助牙科专业人员在他们的实践中有效地参与HPV疫苗的推广。

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引用次数: 0

Racial/ethnic disparities in preventive dental services use and dental caries among children 预防牙科服务使用和儿童龋齿方面的种族/族裔差异

IF 2.3 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of public health dentistry

Pub Date : 2023-03-07 DOI: 10.1111/jphd.12563

Huabin Luo PhD, Mark E. Moss DDS, PhD, Wanda Wright DDS, MSD, Michael Webb DDS MEd, Vanessa Pardi DDS, PhD, Suzanne Lazorick MD, MPH

Objective

To assess disparities in preventive dental service use in four major racial/ethnic groups and assess whether racial/ethnic and income-related disparities among children were reduced from 2016 to 2020.

Methods

Data were from the 2016 and 2020 National Survey of Children's Health (NSCH). The outcomes of interest were having dental sealants, fluoride treatment, and dental caries in the past 12 months. Racial/ethnic groups included non-Hispanic (NH) whites, blacks, Hispanics, Asians, and others. Family income level was categorized as below or above the 200% federal poverty level (low-income vs. high-income). Children ages 2–17 were included (N = 161,539). All data were self-reported by parents/guardians. We estimated the trends of racial/ethnic disparities in having fluoride treatment, dental sealants, and dental caries from 2016 to 2020 and tested two 2-way interactions (i.e., year by race/ethnicity, year by income) and one 3-way interaction (year by income by race/ethnicity) to assess the change in disparities from 2016 to 2020.

Results

Overall, no significant trends in receipt of fluoride treatment, dental sealants, or having dental caries were found from 2016 to 2020 among the racial/ethnic groups, except for a decreasing trend in dental sealants for Asian American children (p = 0.03). Overall, NH white children were more likely to have received preventive dental services than children from minority groups (all p < 0.05); Asian American children (AOR = 1.31) were more likely to have dental caries than NH white children.

Conclusion

Disparities in receipt of evidence-based preventive services by children persisted. Continuous efforts are needed to promote the use of preventive dental services among children of minority populations.

目的评估2016年至2020年四个主要种族/族裔儿童预防牙科服务使用的差异，并评估种族/族裔和收入相关的儿童差异是否减少。方法数据来源于2016年和2020年全国儿童健康调查(NSCH)。关注的结果是在过去12个月内使用牙密封剂、氟化物治疗和龋齿。种族/民族群体包括非西班牙裔(NH)白人、黑人、西班牙裔、亚洲人等。家庭收入水平被划分为低于或高于200%联邦贫困线(低收入与高收入)。包括2-17岁的儿童(N = 161,539)。所有数据均由家长/监护人自行报告。我们估计了2016年至2020年氟化物治疗、牙科密封剂和龋齿方面种族/民族差异的趋势，并测试了两种双向交互作用(即按种族/民族、按收入)和一种三向交互作用(按收入、按种族/民族)，以评估2016年至2020年差异的变化。结果总体而言，2016年至2020年，除了亚裔美国儿童使用牙科密封剂的趋势有所下降(p = 0.03)外，种族/族裔群体在接受氟化物治疗、使用牙科密封剂或龋齿方面没有明显的趋势。总体而言，NH白人儿童比少数族裔儿童更有可能接受预防性牙科服务(p < 0.05);亚裔美国儿童(AOR = 1.31)患龋率高于非裔美国白人儿童。结论儿童接受循证预防服务的差异持续存在。需要继续努力促进少数民族儿童使用预防性牙科服务。

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引用次数: 0

Trends in dental insurance claims in the United States in the context of the COVID-19 pandemic: A 3-year perspective (2019–2022) COVID-19大流行背景下美国牙科保险索赔趋势:三年展望(2019-2022)

IF 2.3 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of public health dentistry

Pub Date : 2023-03-07 DOI: 10.1111/jphd.12561

Gerardo Maupome DDS, MSc, PhD, Allison C. Scully DDS, MS, Juan F. Yepes DDS, MD, DrPH, George J. Eckert MAS, Timothy Downey MS

Objectives

We showed in a previous analysis the patterns of disruption for private dental insurance claims in the United States caused by the SARS-CoV-2 pandemic in 2020. The present report examines trends during 2020 and 2021, that is, contrasting perspectives during 2019 with the acute phase of the pandemic in 2020, and 2021.

Methods

Private dental insurance paid claims from a data warehouse were obtained, encompassing a 5% random sample of records between January 2019 and December 2021 for child and adult insureds who filed a claim in 2019, 2020, and 2021. We classified claims into one of four categories based on the likelihood of being associated with urgent/emergency care.

Results

The precipitous reduction in dental care claims in March–June 2020 recovered to almost pre-pandemic levels by the fall of 2020. However, a downward decline in private dental insurance claims started in the late fall of 2020 and continued through 2021. Differential impacts in dental care categories—in terms of urgency of care—were evident 2021, closely resembling previous trends in 2020.

Conclusions

Dental care claims from the first year of the 2020 SARS-CoV-2 pandemic were contrasted with perspectives in 2021. A downward trend in demand/availability changes in dental care insurance claims set in for 2021, perhaps linked to perceptions of the overall economic situation. Such downward trend has continued overall, even after considering seasonal changes and the acceleration of the pandemic during the Delta, Omicron, and other variants.

我们在之前的分析中展示了2020年SARS-CoV-2大流行导致的美国私人牙科保险索赔中断模式。本报告审查了2020年和2021年的趋势，即将2019年与2020年和2021年大流行急性阶段的前景进行对比。方法从数据仓库中获取私人牙科保险支付的索赔，其中包括2019年1月至2021年12月期间2019年、2020年和2021年提交索赔的儿童和成人被保险人的5%随机样本。我们根据与紧急/紧急护理相关的可能性将索赔分为四类之一。结果2020年3月至6月期间牙科保健索赔的急剧减少，到2020年秋季几乎恢复到大流行前的水平。然而，私人牙科保险索赔从2020年秋末开始下降，并持续到2021年。就护理的紧迫性而言，2021年牙科护理类别的差异影响很明显，与2020年的趋势非常相似。结论将2020年SARS-CoV-2大流行第一年的牙科保健索赔与2021年的观点进行了对比。牙科保健保险索赔的需求/可用性变化将在2021年出现下降趋势，这可能与对整体经济形势的看法有关。即使考虑到季节性变化以及三角洲、欧米克隆和其他变种期间大流行的加速，这种下降趋势总体上仍在继续。

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引用次数: 1

The future of Aboriginal and Torres Strait Islander oral health lies in the footprints of the past: Re-framing oral health discourse 原住民和托雷斯海峡岛民口腔健康的未来在于过去的足迹：重新构建口腔健康话语。

IF 2.3 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of public health dentistry

Pub Date : 2023-03-04 DOI: 10.1111/jphd.12570

Brianna Poirier BAH, MSc, PhD, Joanne Hedges MPH, Lisa Jamieson BDS, MCommDent, PhD

Objective

The history of oral health research and dental care provision for Aboriginal and Torres Strait Islander Peoples has been framed by oppressive colonial values and wrought with maltreatment and unethical behavior. This commentary aims to collate evidence regarding the healthy history of Aboriginal and Torres Strait Islander oral health, the implications of colonization on oral health, and the current portrayal of oral health.

Conclusion

We argue the need to reframe deficit focused discussions of Aboriginal and Torres Strait Islander oral health to strengths-based narratives by critically engaging with the ways in which the future of Aboriginal and Torres Strait Islander oral health lies in the footprints of the past.

目的：原住民和托雷斯海峡岛民口腔健康研究和牙科护理的历史一直受到压迫性殖民价值观的影响，并伴随着虐待和不道德行为。本评论旨在整理有关原住民和托雷斯海峡岛民口腔健康史、殖民化对口腔健康的影响以及口腔健康现状的证据。结论：我们认为，有必要通过批判性地探讨原住民和托雷斯海峡岛民口腔健康的未来如何植根于过去的足迹，将以赤字为重点的原住民和托雷斯群岛岛民口腔卫生讨论重新定义为基于优势的叙事。

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引用次数: 1

Adverse outcomes associated with opioid prescription by dentists in the Veterans Health Administration: A national cross-sectional study from 2015 to 2018 退伍军人健康管理局牙医处方阿片类药物相关的不良后果:2015年至2018年的一项全国性横断面研究

IF 2.3 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of public health dentistry

Pub Date : 2023-02-17 DOI: 10.1111/jphd.12560

Pooja A. Solanki MPH, Colin C. Hubbard PhD, Linda Poggensee MS, Charlesnika T. Evans PhD, MPH, Katie J. Suda PharmD, MS, FCCP

Objectives

Opioids prescribed by dentists have been associated with serious adverse events, including opioid-related overdose and mortality. However, the downstream outcomes of opioids prescribed by dentists to Veterans who are at high risk for opioid misuse and overdose have yet to be determined.

Methods

This was a national cross-sectional analysis of opioids associated with dental visits within the Veterans Health Administration from 2015 to 2018. Overprescribing was defined per guidelines as >120 morphine milligram equivalents (MME) or >3 days supply. The association of dental visit and patient characteristics was modeled separately for opioid-related poisoning and all-cause mortality using logistic regression.

Results

Of 137,273 Veterans prescribed an opioid by a dentist, 0.1% and 1.1% were associated with opioid-related poisoning and mortality, respectively. There was no difference in opioid poisoning within 6 months for Veterans with opioid prescriptions >120 MME (aOR = 1.25 [CI: 0.89–1.78]), but poisoning decreased in Veterans prescribed opioids >3-days supply (aOR = 0.68 [CI: 0.49–0.96]). However, Veterans with opioids >120 MME were associated with higher odds of mortality within 6 months (aOR = 1.17 [95% CI: 1.05–1.32]) while there was no difference in prescriptions >3-days supply (aOR = 1.12 [CI: 0.99–1.25]).

Conclusion

Serious opioid-related adverse events were rare in Veterans and lower than other reports in the literature. Since nonopioid analgesics have superior efficacy for the treatment of acute dental pain, prescribing opioid alternatives may decrease opioid-related poisoning. Strategies for dentists to identify patients at high risk should be incorporated into the dental record.

目的牙医开具的阿片类药物与严重不良事件相关，包括阿片类药物过量和死亡。然而，牙医给有阿片类药物滥用和过量风险的退伍军人开的阿片类药物的下游结果尚未确定。方法:对2015年至2018年退伍军人健康管理局内与牙科就诊相关的阿片类药物进行全国性横断面分析。根据指南，过量处方被定义为120吗啡毫克当量(MME)或3天的供应量。使用logistic回归分别对阿片类药物相关中毒和全因死亡率进行了牙科就诊和患者特征的关联建模。结果在137,273名由牙医开具阿片类药物处方的退伍军人中，0.1%和1.1%分别与阿片类药物相关中毒和死亡有关。服用阿片类药物120 MME的退伍军人6个月内阿片类药物中毒发生率无差异(aOR = 1.25 [CI: 0.89-1.78])，服用阿片类药物3 d的退伍军人6个月内阿片类药物中毒发生率下降(aOR = 0.68 [CI: 0.49-0.96])。然而，服用阿片类药物120 MME的退伍军人在6个月内的死亡率较高(aOR = 1.17 [95% CI: 1.05-1.32])，而处方3天的供应没有差异(aOR = 1.12 [CI: 0.99-1.25])。结论严重阿片类药物相关不良事件在退伍军人中罕见，低于文献中其他报道。由于非阿片类镇痛药在治疗急性牙痛方面具有优越的疗效，处方阿片类替代药物可能会减少阿片类药物相关中毒。牙医识别高风险患者的策略应纳入牙科记录。

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引用次数: 0

Calibration and reliability testing of a novel asynchronous photographic plaque scoring system in young children 一种新型异步摄影斑块评分系统在幼儿中的校准和可靠性测试

IF 2.3 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of public health dentistry

Pub Date : 2023-02-13 DOI: 10.1111/jphd.12557

David M. Avenetti DDS, MSD, MPH, Molly A. Martin MD, MAPP, Stuart A. Gansky MS, DrPH, Francisco J. Ramos-Gomez DDS, MS, MPH, Susan Hyde DDS, MPH, PhD, Rebecca Van Horn RDH, BA, Bonnie Jue DDS, Genesis F. Rosales MSW, Nancy F. Cheng MS, MS, Caroline H. Shiboski DDS, PhD, MPH

Objectives

The Simplified Oral Hygiene Index for Maxillary Incisors (OHI-MIS) is a novel plaque scoring system adapted for young children. This study describes calibration training and testing used to establish the inter- and intra-rater reliability for OHI-MIS measured from clinical photographs.

Methods

Two raters from the Coordinated Oral Health Promotion Chicago (CO-OP) and one from the Behavioral EConomics for Oral health iNnovation (BEECON) randomized controlled trials (RCTs) underwent calibration with gold standard raters, followed by annual re-calibration. Raters from CO-OP also completed inter-rater reliability testing; all three raters completed intra-rater reliability testing rounds. Photographs were obtained from children aged 9–39 months.

Results

All three raters achieved greater than 0.77 Lin's Concordance Correlation (LCC) versus gold standard consensus during calibration. All three raters had LCC ≥0.83 at recalibration 1 year later. CO-OP trial raters scored 604 photos (151 sets of 4 photographs); mostly both raters were somewhat/very confident in their scoring (≥89%), describing the most photos as “clear” (90% and 81%). The CO-OP inter-rater LCC for total OHI-MIS score was 0.86, changing little when low quality or confidence photos were removed. All three raters demonstrated high intra-rater reliability (≥0.83).

Conclusions

The OHI-MIS plaque scoring system on photos had good reliability within and between trials following protocol training and calibration. OHI-MIS provides a novel asynchronous plaque scoring system for use in young children. Non-clinicians in field or clinical settings can obtain photographs, offering new opportunities for research and clinical care.

目的上颌切口简化口腔卫生指数（OHI-MIS）是一种适用于幼儿的新型牙菌斑评分系统。本研究描述了校准训练和测试，用于建立从临床照片中测量的OHI-MIS的评分者间和评分者内可靠性。方法芝加哥口腔健康促进协调会（CO-OP）的两名评分员和口腔健康创新行为经济学（BEECON）的一名随机对照试验（RCT）的评分员采用金标准评分员进行校准，然后每年重新校准。CO-OP的评分员还完成了评分员之间的可靠性测试；三位评分者都完成了评分者内部的可靠性测试。照片来自9–39岁的儿童月。结果三位评分者在校准过程中均达到了大于0.77的林一致性相关（LCC）与金标准一致性。所有三名评分者在重新校准1时LCC≥0.83 一年后。CO-OP试验评分员对604张照片（151组，共4张照片）进行评分；大多数情况下，两位评分者对自己的评分都有一定/非常的信心（≥89%），称大多数照片“清晰”（90%和81%）。OHI-MIS总分的CO-OP评分者LCC为0.86，当删除低质量或置信度照片时变化不大。三位评分者均表现出较高的评分者内部可靠性（≥0.83）。结论OHI-MIS斑块照片评分系统在方案训练和校准后的试验内和试验之间具有良好的可靠性。OHI-MIS提供了一种用于幼儿的新型异步斑块评分系统。现场或临床环境中的非临床医生可以获得照片，为研究和临床护理提供了新的机会。

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引用次数: 1

Topical fluoride hesitancy among caregivers: Development of a content-valid topical fluoride hesitancy identification item pool 护理人员局部氟化物犹豫:内容有效的局部氟化物犹豫识别项目池的开发

IF 2.3 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of public health dentistry

Pub Date : 2023-01-31 DOI: 10.1111/jphd.12558

Todd C. Edwards PhD, Adam Carle PhD, MA, Darragh Kerr MPH, Richard M. Carpiano PhD, MPH, Daisy Patiño Nguyen RDH, MS, Joshua C. Orack MPH, Donald L. Chi DDS, PhD

Objectives

To develop a content-valid set of items to characterize different types of topical fluoride hesitancy among caregivers. We will use this information to develop and test tailor-made interventions directed to caregivers with varied types and levels of topical fluoride hesitancy, to ultimately improve child oral health.

Methods

Caregivers participated in three study activities, in the following order: (1) semi-structured concept elicitation interviews (n = 56), (2) cognitive interviews (n = 9), and (3) usability interviews (n = 3). Interviews were conducted via telephone and audio-recorded and transcribed for qualitative analysis. Twelve pediatric dental providers and researchers participated in item review. An assessment of reading level of items was made with goal of 6th grade reading level or less.

Results

Based on elicitation interviews, we initially developed 271 items, which the investigative team evaluated for conceptual clarity, specificity to topical fluoride hesitancy, and sensitivity to potential interventions. After four rounds of review and cognitive interviews, we retained 33 items across five previously identified domains. Changes after cognitive interviews included item revision to improve comprehension and item re-ordering to avoid order effects. Changes after usability testing including clarification regarding referent child for families with multiple children. The reading level of the item pool is grade 3.2.

Conclusions

The resulting 33-item fluoride hesitancy item pool is content valid and will address an important need for identifying and addressing topical fluoride hesitancy in the context of dental research and clinical practice. Next steps include psychometric evaluation to assess scale and test–retest reliability and construct validity.

目的开发一套内容有效的项目来表征护理人员不同类型的局部氟化物犹豫。我们将利用这些信息开发和测试针对不同类型和程度的局部氟化物犹豫的护理人员量身定制的干预措施，以最终改善儿童口腔健康。方法护理人员按照半结构化概念启发访谈(n = 56)、认知访谈(n = 9)和可用性访谈(n = 3)的顺序，参与了三项研究活动。访谈是通过电话进行的，录音和转录用于定性分析。12名儿童牙科服务提供者和研究人员参与了项目审查。以六年级阅读水平或以下为目标，对项目的阅读水平进行评估。基于启发性访谈，我们最初开发了271个项目，调查小组评估了这些项目的概念清晰度、对局部氟化物犹豫的特异性以及对潜在干预措施的敏感性。经过四轮回顾和认知访谈，我们保留了先前确定的五个领域的33个项目。认知访谈后的变化包括项目修订以提高理解能力和项目重新排序以避免顺序效应。可用性测试后的变化，包括澄清有多个孩子的家庭的参考孩子。项目池的阅读等级为3.2级。结论所得的33项氟化物犹豫项目库内容有效，将解决牙科研究和临床实践中识别和解决局部氟化物犹豫的重要需求。接下来的步骤包括心理测量评估，以评估量表和重测信度和结构效度。

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引用次数: 2

Explaining income inequities in tooth loss among Brazilian adults 解释巴西成年人牙齿脱落的收入不平等

IF 2.3 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of public health dentistry

Pub Date : 2023-01-26 DOI: 10.1111/jphd.12556

Rafael Aiello Bomfim DDS, MDS, PhD, Helena Mendes Constante DDS, MDS, PhD, Andreia Morales Cascaes DDS, MDS, PhD

Objective

To determine the extent to which individual and contextual variables explain income inequities in tooth loss in Brazilian adults.

Methods

A nationally representative sample of 65,784 Brazilian adults aged 18–59 who participated in the Brazilian National Health Survey 2019 was analyzed. Self-reported tooth loss was the outcome. Per capita income was the main exposure, and minimum wage was the cutoff point. Individual covariates included sex, race, and schooling, dental visits, smoking status, use of dental floss, and self-reported chronic conditions. Contextual covariates included access to treated water and geographic region of residence. Blinder-Oaxaca decomposition analysis was used to estimate the share of each factor in income-related tooth loss inequities by age groups.

Results

Age-standardized tooth loss showed large income inequities. The average difference in tooth loss related to income inequities in the 18-34-year-old group was 0.50 (95% CI 0.39; 0.60), increasing to 4.51 (95% CI 4.09; 4.93) in the 45–59 years. Individual and contextual covariates explained almost 90% of income inequities in the 45–59 year group. Use of dental floss, schooling, and geographic region of residence (a proxy for human development level) had a higher proportion of contribution to the inequities examined.

Conclusions

Individual and contextual covariates (proxy for human development level and water fluoridation coverage) explained a large share of income-related tooth loss inequities. Tailored strategies to act at both levels can help reduce tooth loss inequities among Brazilian adults.

目的确定个体和背景变量在多大程度上解释巴西成年人牙齿脱落中的收入不平等。方法对参与2019年巴西国家健康调查的65784名18-59岁巴西成年人的全国代表性样本进行分析。结果是自己报告的牙齿脱落。人均收入是主要的风险敞口，最低工资是临界点。个体协变量包括性别、种族和学校教育、牙科就诊、吸烟状况、牙线使用和自我报告的慢性病。情境协变量包括获得处理过的水和居住的地理区域。Blinder Oaxaca分解分析用于估计各因素在各年龄组与收入相关的牙齿脱落不平等中所占的份额。结果年龄标准化的牙齿脱落显示出巨大的收入不平等。18-34岁组与收入不平等相关的牙齿脱落的平均差异为0.50（95%CI 0.39；0.60），45-59岁组增至4.51（95%CI 4.09；4.93）年。个体和情境协变量解释了45-59岁人群中近90%的收入不平等年份组。牙线的使用、学校教育和居住地理区域（代表人类发展水平）对所调查的不平等现象的贡献比例更高。结论个体和情境协变量（代表人类发展水平和饮水氟化覆盖率）解释了很大一部分与收入相关的牙齿脱落不平等。在这两个层面采取量身定制的行动策略可以帮助减少巴西成年人的牙齿脱落不平等现象。

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引用次数: 0

Food insecurity and consumption of cariogenic foods in mothers and their two-year-old children in Appalachia 阿巴拉契亚地区母亲及其两岁儿童的粮食不安全和食用致龋齿食品

IF 2.3 4区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of public health dentistry

Pub Date : 2023-01-25 DOI: 10.1111/jphd.12559

Deesha Bhaumik MS, Casey D. Wright PhD, Teresa A. Marshall PhD, Katherine Neiswanger PhD, Daniel W. McNeil PhD, Andrew D. Jones PhD, John R. Shaffer PhD, Mary L. Marazita PhD, Betsy Foxman PhD

Objectives

To describe the association between household food insecurity and intake of cariogenic foods that increase risk of dental caries.

Methods

Cross-sectional analysis of 842 mothers in Appalachia and their children participating in the Center for Oral Health Research Cohort 2 between 2011 and 2017 when their children were ~ 24 months of age. Mothers completed a telephone interview regarding cariogenic food consumption and food insecurity. Associations between food insecurity and daily food intake were adjusted for education, income, state residence, and daily snacking.

Results

After adjustment for household income, state residence, daily snacking, and maternal education, mothers from moderately/severely food insecure households drank on average ½ more sugar-sweetened beverage servings per day (p = 0.005) and children drank almost 1/3 servings more (p = 0.006). Further, mothers and children from moderately/severely food insecure households had lower, but not statistically significant, daily average consumption of vegetables (mothers: 1/5 less of a vegetable serving per day, children: ~1/10 less) and fruits (mothers: 1/5 less of a fruit serving per day, children: ~ 1/10 les) and elevated consumption of sweets (mothers: ~ 1/25 more sweet servings per day, children: ~ 2/25 more); differences based on state residence were noted.

Conclusions

Food insecurity is associated with higher consumption of foods that increase risk of dental caries, but this association is modified by maternal education, income, and state residence. Food insecurity, and its socioeconomic determinants, should be considered when designing and implementing interventions to prevent dental caries.

目的描述家庭食品不安全与摄入增加龋齿风险的致龋食品之间的关系。方法对2011年至2017年参加口腔健康研究中心队列2的阿巴拉契亚地区842名母亲及其孩子进行横断面分析，当时她们的孩子年龄为~ 24个月。母亲们完成了一项关于龋齿食品消费和食品不安全的电话采访。食品不安全与每日食物摄入量之间的关系根据教育程度、收入、州居住地和每日零食摄入量进行了调整。结果在调整家庭收入、国家住所、日常零食和母亲教育后，中度/重度粮食不安全家庭的母亲平均每天多饮用1/ 2的含糖饮料(p = 0.005)，儿童多饮用近1/3的含糖饮料(p = 0.006)。此外，来自中等/严重粮食不安全家庭的母亲和儿童的平均每日蔬菜消费量(母亲每天少吃1/5的蔬菜，儿童少吃1/10)和水果消费量(母亲每天少吃1/5的水果，儿童少吃1/10的水果)较低，但在统计上不显著，糖果消费量增加(母亲每天多吃1/25的甜食，儿童多吃2/25的甜食);他们注意到不同国家居住的差异。结论:食品不安全与增加龋齿风险的较高食品消费相关，但这种关联受母亲教育程度、收入和居住地的影响。在设计和实施预防龋齿的干预措施时，应考虑粮食不安全及其社会经济决定因素。

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引用次数: 1