Gender inequalities in health and health care services use in Catalonia (Spain)

BACKGROUND AND OBJECTIVES: While socio-economically derived differences in health and health services use have long been a subject of study, differences based on gender, considered as the explicative variable, have scarcely been quantified from population-based data. The aim of this investigation was to analyse inequalities in health and health care services utilisation between men and women in Catalonia (Spain). DESIGN, SETTING, PARTICIPANTS, AND MEASURES: Data from the Catalan Health Interview Survey, a cross sectional survey conducted in 1994, were used. A total of 6604 women and 5641 men aged 15 years or over were included for analysis. Health related variables studied were self perceived health, restriction of activity (past two weeks), and presence of chronic conditions; health services use variables analysed were having visited a health professional (past two weeks), an optometrist (12 months), or a dentist (12 months); and hospitalisation (past 12 months). Age standardised proportions were computed according to gender, and prevalence odds ratios (OR) were derived from logistic regression equations. MAIN RESULTS: Women more frequently rated their health as fair or poor than men (29.8% v 21.4%; OR = 1.22; 95% CI: 1.10, 1.34). More women than men reported having restricted activity days (OR = 1.86; 95% CI: 1.59, 2.18) and chronic conditions (OR = 1.74; 95% CI: 1.60, 1.89). The proportion of women visiting a health professional was slightly greater than that for men (OR = 1.20; 95% CI: 1.09, 1.31), as was the proportion of women visiting an optometrist (OR = 1.21; 95% CI: 1.11, 1.33), and a dentist (OR = 1.43; 95% CI: 1.31, 1.55). The proportion of hospitalisation was lower in women (6.6%) than in men (7.7%; OR = 0.73; 95% CI: 0.63, 0.85). When health services use was analysed according to self perceived health, women declaring good health reported a greater probability of consulting a health professional (OR = 1.35; 95% CI: 1.20, 1.52). There were no differences in respect to hospitalisation, visits to the optometrist and to the dentist. CONCLUSIONS: These results indicate a pattern close to the inverse care law, as women, who express a lower level of health and thus would need more health care, are not, however, using health services more frequently than men.     

Population groups at high risk for poor oral self care: the basis for oral health promotion

OBJECTIVES: Identification of population groups at high risk for poor oral self-care in adults was needed in order to enable more focused planning of oral health promotion actions in Slovenia. METHODS: The study was based on the national health behaviour database in adults aged 25-64. Data collected in 2001 were used. The sample size was 15,379. The overall response rate was 64 %, and 8,392 questionnaires were eligible for oral self-care assessment. A complex indicator based on oral hygiene, frequency of visiting a dentist, and nutritional habits was derived. The outcome of interest was poor oral self-care. Logistic regression was used to test multivariate associations between several factors (gender, age, educational level, social class, etc.) and poor oral self-care. RESULTS: The overall prevalence of poor oral self-care was 6.9 %. The odds for this outcome were higher for men (OR(males vs. females) = 7.49, p < 0.001), (or participants with the lowest educational levels (OR(uncompleted primary vs. university) = 5.95, p < 0.001; OR(primary vs. university) = 4.95, p < 0.001), and for participants from the lowest social classes (OR(lower vs. upper-middle) = 6.20, p < 0.001; OR(labour vs. upper-middle) = 4.05, p = 0.001). CONCLUSIONS: Special attention should be paid to oral health promotion for men, for those with low educational level, and for those belonging to the lowest social classes.     

The Relationship of Oral Health with Progression of Physical Frailty among Older Adults: A Longitudinal Study Composed of Two Cohorts of Older Adults from the United Kingdom and United States

ObjectiveTo investigate the prospective associations between oral health and progression of physical frailty in older adults.DesignProspective analysis.Setting and ParticipantsData are from the British Regional Heart Study (BRHS) comprising 2137 men aged 71 to 92 years from 24 British towns and the Health, Aging, and Body Composition (HABC) Study of 3075 men and women aged 70 to 79 years.MethodsOral health markers included denture use, tooth count, periodontal disease, self-rated oral health, dry mouth, and perceived difficulty eating. Physical frailty progression after ∼8 years follow-up was determined based on 2 scoring tools: the Fried frailty phenotype (for physical frailty) and the Gill index (for severe frailty). Logistic regression models were conducted to examine the associations between oral health markers and progression to frailty and severe frailty, adjusted for sociodemographic, behavioral, and health-related factors.ResultsAfter full adjustment, progression to frailty was associated with dentition [per each additional tooth, odds ratio (OR) 0.97; 95% CI: 0.95–1.00], <21 teeth with (OR 1.74; 95% CI: 1.02–2.96) or without denture use (OR 2.45; 95% CI 1.15–5.21), and symptoms of dry mouth (OR ≥1.8; 95% CI ≥ 1.06–3.10) in the BRHS cohort. In the HABC Study, progression to frailty was associated with dry mouth (OR 2.62; 95% CI 1.05–6.55), self-reported difficulty eating (OR 2.12; 95% CI 1.28–3.50) and ≥2 cumulative oral health problems (OR 2.29; 95% CI 1.17–4.50). Progression to severe frailty was associated with edentulism (OR 4.44; 95% CI 1.39–14.15) and <21 teeth without dentures after full adjustment.Conclusions and ImplicationsThese findings indicate that oral health problems, particularly tooth loss and dry mouth, in older adults are associated with progression to frailty in later life. Additional research is needed to determine if interventions aimed at maintaining (or improving) oral health can contribute to reducing the risk, and worsening, of physical frailty in older adults.     

Sexual differences in oral health behaviour and factors associated with oral health behaviour in Japanese young adults

The aim of this study is to compare the state of oral health behaviour between genders and to analyse factors associated with oral health behaviour by gender in young adults. Anonymous questionnaire data were collected from 527 adults (245 men and 282 women) aged 20-29 years who consulted dentists in Chiba City. The Chi-square test, Mann-Whitney analysis, and logistic regression analysis were used to examine the differences in oral health behaviour and determinants of oral health behaviour between young men and young women. The rate of good behaviour among women were significantly higher than those among men in each oral health behaviour item (toothbrushing frequency p < 0.001; using dental floss p = 0.042; dental check-ups p < 0.001). In women, factors associated with each oral health behaviour were as follows: toothbrushing frequency (family composition p = 0.030); using dental floss (dental health knowledge p = 0.025, employment status p = 0.031), and dental check-ups (age group p = 0.024). In men, a significant relationship was seen only between using dental floss and age group p = 0.025). This study indicated that young women had better oral health behaviour and that more factors were associated with their oral health behaviour in comparison with young men.     

Lifestyle-Related Determinants of Hookah and Cigarette Smoking in Iranian Adults

To identify lifestyle-related determinants of hookah and cigarette smoking in Iranian adults, a total of 12,514 men and women aged ≥19 years in three counties in central Iran (Isfahan, Najafabad, Arak) were selected in multistage random sampling. Data on socio-demographic characteristics and lifestyle were collected in interviewer-administered questionnaires, as part of the baseline survey of the Isfahan Healthy Heart Program. Unhealthy lifestyle-related factors independently associated with cigarette and hookah smoking, were identified in sex-specific multivariate logistic regression analyses. High stress levels (OR: 1.55; 95% CI: 1.35–1.78 for men; OR: 1.63; 95% CI: 1.17–2.27 for women), family member smoking (OR: 1.61; 95% CI: 1.27–4.92 for men; OR: 2.49; 95% CI: 2.20–2.95 for women), and short/long sleep duration (OR: 1.18; 95% CI: 1.01–1.39 for men; OR: 1.52; 95% CI: 1.10–2.35 for women) were associated with cigarette smoking in both men and women. Poor diet was also related to cigarette smoking in men (OR: 1.55; 95% CI: 1.62–1.89). Family member smoking was associated with hookah smoking in both men (OR: 1.16; 95% CI: 1.05–3.12) and women (OR: 1.56; 95% CI: 1.02–4.92), and in addition high stress levels (OR: 2.87; 95% CI: 1.14–5.83) and short/long sleep duration (OR: 1.07; 95% CI: 1.02–2.41) were associated with hookah smoking in women. Unhealthy lifestyle-related factors co-occur with cigarette and hookah smoking in Iranian adults, likely increasing the risk for chronic health problems. Sex differences in the determinants of hookah and cigarette smoking may need to be taken into account in planning tobacco control strategies.     

A new measurement for optimal antenatal care: determinants and outcomes in Cameroon

A combined measure of optimal antenatal care can provide more information on the role it plays in maternal health. Our objectives were to investigate the determinants of a measure of optimal antenatal care and the associated pregnancy outcomes. Data on 7,557 women taken from the 2004 Demographic and Health Survey in Cameroon were used to develop a new measurement of optimal antenatal care based on four indicators: at least four visits, first visit in first trimester, last visit in third trimester and a professional provider of antenatal care. We studied the relationship of this new variable with other related variables in a multivariate analysis, taking into account the complex study design. Almost sixty six percent of the women had optimal antenatal care. Secondary or higher education (OR 1.74; 95% CI 1.28–2.36), greater wealth (OR 2.31; 95% CI 1.73–3.1), urban residence (OR 1.42; 95% CI 1.12–1.82) and parity of 3–4 (OR 0.79; 95% CI 0.62–0.99) were independently associated with optimal antenatal care. Women with optimal antenatal care were more likely to deliver in a health unit (OR 2.91; 95% CI 2.42–3.49), to be assisted by a skilled health worker during delivery (OR 1.88; 95% CI 1.49–2.37) and to have a baby with a normal birthweight (OR 1.62; 95% CI 1.11–2.38). Obtaining and using a new measure for ANC is feasible. The association of optimal antenatal care to education, wealth and residence in this study, consistent with others, highlights the role of the country’s development in maternal health.     

深圳市光明新区小学生口腔卫生知识知晓情况分析

目的 了解深圳市光明新区小学生口腔卫生知识知晓情况及龋病影响因素,为开展口腔卫生预防保健提供依据.方法 运用整群随机抽样方法,抽取公明第一小学和光明小学三年级及以上在校学生2218人,进行口腔卫生知识问卷调查.结果 三年级及以上小学生每天刷牙、每天刷牙2次及以上、每次刷牙3～5 min、正确的刷牙方式、选择正确的牙刷、早晚刷牙以及选择含氟牙膏的人数分别占调查人数的96.52％、61.03％、37.41％、35.02％、51.74％、61.92％和15.53％;听过口腔健康教育课、近两年使用氟化物、做过窝沟封闭、做过洁治、定期检查牙齿(至少半年1次)的人数分别占调查人数的42.23％、12.53％、9.42％、35.12％和44.15％.多因素Logistic回归分析显示,女性( OR=1.26,95％ CI:1.04 ～ 1.52)、年龄(OR=1.16,95％CI:1.08 ～1.25)为龋病的独立危险因素,而每次刷牙3 ～5 min(OR=0.81,95％ CI:0.66 ～0.98)和做过窝沟封闭(OR=0.47,95％ CI:0.35 ～0.63)为龋病的保护因素.结论 深入开展口腔健康教育,提高小学生口腔卫生知识知晓率,促成小学生养成良好口腔卫生习惯,广泛开展窝沟封闭等,能阻止以龋病为主的常见口腔疾病的发生发展.     

参与型口腔健康教育对口腔卫生知信行的影响

目的评价参与型口腔健康教育对牙周健康状况及相关知识、行为改善的影响。方法将北京市两个城区中8个社区或单位的300名15～64岁的志愿参加者分为实验组（参与组）和对照组（常规教育组）。参加者在基线、6个月和12个月时，接受牙周健康状况的检查和问卷调查。基线检查后，对所有参加者进行龈上洁治术。随后对实验组在专题小组访谈的基础上，进行小组讨论形式的参与型口腔健康教育，在6个月当中，提供在家使用的保健牙刷、牙间隙刷、牙膏和菌斑染色片。同时，提供专为口腔健康教育设计的阅读材料。对照组发给同样内容的健康教育阅读材料。最后比较两组间在牙周健康状况、口腔卫生知识和行为方面的改善情况。结果12个月后实验组牙石指数的均值明显低于对照组（P〈0．05），并有显著性差异。在口腔卫生知识和行为方面，实验组也在刷牙方法、选择保健牙刷、更换牙刷频率和使用牙间隙刷上比对照组提高了8．7％～31．3％。结论参与型口腔健康教育方法能明显改善牙周健康状况，能提高参与者的口腔卫生知识和行为。     

Short- and long-term mortality after acute myocardial infarction: comparison of patients with and without diabetes mellitus

Aims To compare short- and long-term mortality after a first acute myocardial infarction (AMI) in patients with and without diabetes mellitus. Methods and results A nationwide cohort of 2,018 diabetic and 19,547 nondiabetic patients with a first hospitalized AMI in 1995 was identified through linkage of the national hospital discharge register and the population register. Follow-up for mortality lasted until the end of 2000. At 28 days and 5 years respectively, absolute mortality risks were 18 and 53% in diabetic men, 12 and 31% in nondiabetic men, 22 and 58% in diabetic women, and 19 and 42% in nondiabetic women. Crude mortality was significantly higher in diabetic patients than in nondiabetic patients in both men (28-day hazard ratio (HR) 1.55; 95% confidence interval (CI) 1.32–1.81, 5-year HR 2.01; 95% CI 1.84–2.21) and women (28-day HR 1.19; 95% CI 1.03–1.37, 5-year HR 1.53; 95% CI 1.40–1.67). After multivariate adjustment, risk differences became nonsignificant at 28 days, but diabetes was still associated with a significantly higher long-term mortality in both men (28-day HR 1.16; 95% CI 0.99–1.36, 5-year HR 1.49; 95% CI 1.36–1.64) and women (28-day HR 1.12; 95% CI 0.97–1.28, 5-year HR 1.39; 95% CI 1.27–1.52). The interaction between diabetes mellitus and gender did not reach significance in the analyses. Conclusion Our findings in an unselected cohort covering a complete nation show a significantly higher long-term mortality after a first acute myocardial infarction in diabetic patients. Yet, short-term mortality is not significantly higher in diabetic patients. Risks appear to be equally elevated in men and women.     

An assessment of oral self-care in the student population of a Turkish university

OBJECTIVES: The aim of this study was to determine the oral health behavior of Turkish non-dental university students. STUDY DESIGN AND METHODS: A sample of 610 non-dental university students attending the University of Ondokuz Mayis in Samsun were randomly selected from the whole student population (n=12604) via the random number method. The students were asked to fill out a standardized self-completion questionnaire about daily frequency of toothbrushing, kind of toothbrush, frequency of toothbrush replacement, frequency of dental flossing, use of antibacterial rinse, or any other oral hygiene aid, receiving of oral hygiene instruction and frequency of oral check-up. The data were analysed using the SPSS version 12.0.1 statistical software package. RESULTS: Sixty-eight per cent of the students brushed their teeth two or more times per day. Two or more times a day toothbrushing was more common among females than males (P<0.001). Few subjects (3%) used dental floss daily. Forty per cent of students used only the toothpick as an interdental oral hygiene device. Thirty per cent of the students visited a dentist for preventive treatment at least once a year. There was no significant difference in regularity of visits to the dentist between females and males (P>0.05). CONCLUSION: This study indicated that self-preventive oral behaviour of the Turkish university student is at a lower level than in industrialized countries.     

Danish pupils' perceived satisfaction with the health dialogue: Associations with the office and work procedure of the school health nurse

The aim is to identify how environmental factors, perceivedby the pupils, are associated with the pupils' perceived satisfactionwith a good health dialogue. This article focuses on the pupils'perception of the health office and the work procedure of theschool health nurses. The present article is based on data fromthe 1994 Danish part of the WHO-collaborative study Health Behaviourin School-aged Children. A nation-wide random sample of pupils11, 13 and 15 years old (n = 4046) answered a standardized questionnaireabout perceived health, health behaviour, social situation,the school as a workplace and the health dialogue. The finalmodel of the multivariate logistic regression analysis revealedeight predictor variables of perceived satisfaction with thehealth dialogue and three confounder variables. The predictorswere: comfortable health office OR = 1.20 (95% CI 1.11–1.30),pupils sat by the desk OR = 1.12 (95% CI 1.03–1.23), pupilsinfluenced the content of the dialogue yes/no: OR = 1.43 (95%CI 1.27–1.60), yes/don't know: OR = 0.80 (95% CI 0.72–0.89),sufficient time OR = 1.33 (95% CI 1.23–1.44), the schoolhealth nurse listened carefully OR = 1.24 (95% CI 1.13–1.35),the school health nurse talked a lot OR = 0.91 (95% CI 0.85–0.98),gave good advice OR = 1.28 (95% CI 1.18–1.43), let thepupils talk OR = 1.17 (95% CI 1.07–1.28). The confounderswere: pupils' sex: female OR = 1.23 (95% CI 1.14–1.33);and age: low age OR = 1.20 (95% CI 1.07–1.35) or highage OR = 0.84 (95% CI 0.76–0.93), but not medium age,high school satisfaction OR = 1.53 (95% CI 1.31–1.77),and low school satisfaction OR = 0.74 (95% CI 0.63–0.87).     

Putting your money where your mouth is: Parents' valuation of good oral health of their children

The aim of this study was to investigate the parental willingness to invest in good oral health for their child in terms of money and time and to relate this to oral health related knowledge and behavioral aspects. 290 parents of 6-year-old children, participating in a RCT on caries preventive strategies in the Netherlands were asked to provide information on education, oral health habits, dietary habits, knowledge on dental topics, willingness to pay and perceived resistance against investing in preventive oral health actions for their children. Despite the fact that parents overall valued oral health for their child highly, still 12% of the parents were unwilling to spend any money, nor to invest any time by brushing their children's teeth to maintain good oral health for their child. Additionally, they indicated that they were unwilling to visit the dentist for preventive measures more than once a year. These children may certainly be considered at higher risk of developing oral diseases because worse oral hygiene habits and dietary habits were found in this group. Given the results, it may be necessary to differentiate in allocating caries prevention programmes to target parents or (school-based) children directly.     

Education,income, occupational status and health risk behaviour

Aim Socio-economic status is associated with a variety of health-related behaviours. In our study, we determined the independent effects of income, educational attainment and occupational status on overweight, smoking and physical activity in the German population. Subjects and methods The German National Health Interview and Examination Survey is a representative sample of the German adult population and includes 7,124 men and women. Prevalences of obesity, smoking and physical inactivity stratified for education, income and occupational status were calculated. Multiple logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for education, income, occupational status and health-related behaviour, adjusted for age and gender. Results Health risk behaviours were more prevalent in subjects with lower education, income or occupational status. After mutual adjustment, education, income and occupation were independently associated with physical inactivity. Low education was strongly associated with both obesity (OR: 2.58, 95% CI: 1.99–3.34) and smoking (OR: 2.09, 95% CI: 1.71–2.54). Low income was associated with smoking (OR: 1.40, 95% CI: 1.07–1.83), but not with obesity, and low occupational status was associated with obesity (OR: 1.42, 95% CI: 1.05–1.92), but not with smoking. High income or occupation could not compensate for the impact of low education on obesity and smoking. Conclusion Low socio-economic status is associated with health risk behaviours. Concerning obesity and smoking, education was more important than income or occupational status. Public health programmes to reduce these risk factors should focus on early-life health education.     

Preventive care visits with OB/GYNs and generalist physicians among reproductive-age women with chronic conditions

Objective

To examine services delivered during preventive care visits among reproductive-age women with and without chronic conditions by physician specialty.

Data Sources

National Ambulatory Medical Care Surveys (2011–2018).

Study Design

We examined provision of specific services during preventive care visits by physician specialty among reproductive-age female patients, overall and among women with five common chronic conditions (diabetes, hypertension, depression, hyperlipidemia, and asthma).

Data Collection/Extraction Methods

The sample included preventive visits to OB/GYNs or generalist physicians where the patient was female, age 18–44, and not pregnant.

Principal Findings

In OB/GYN preventive visits, reproductive health services were more likely to be provided, while non-reproductive health services were less likely to be provided, both among reproductive-age female patients overall and among those with chronic conditions. For example, pap tests were provided in 44.5% of OB/GYN preventive visits (95% CI: 40.6–48.4) and in 21.4% of generalist preventive visits (95% CI: 17.2–26.6). Lipid testing was provided in 2.8% of OB/GYN preventive visits (95% CI: 1.7–3.9) and in 30.3% of generalist preventive visits (95% CI: 26.1–34.6).

Conclusions

Understanding the full range of care received in preventive visits across settings could guide recommendations to optimize where reproductive-age women with chronic conditions seek care.     

Hmong Adults Self-Rated Oral Health: A Pilot Study

Since 1975, the Hmong refugee population in the U.S. has increased over 200%. However, little is known about their dental needs or self-rated oral health (SROH). The study aims were to: (1) describe the SROH, self-rated general health (SRGH), and use of dental/physician services; and (2) identify the factors associated with SROH among Hmong adults. A cross-sectional study design with locating sampling methodology was used. Oral health questionnaire was administered to assess SROH and SRGH, past dental and physician visits, and language preference. One hundred twenty adults aged 18–50+ were recruited and 118 had useable information. Of these, 49% rated their oral health as poor/fair and 30% rated their general health as poor/fair. Thirty-nine percent reported that they did not have a regular source of dental care, 46% rated their access to dental care as poor/fair, 43% visited a dentist and 66% visited a physician within the past 12 months. Bivariate analyses demonstrated that access to dental care, past dental visits, age and SRGH were significantly associated with SROH (P < 0.05). Multivariate analyses demonstrated a strong association between access to dental care and good/excellent SROH. About half of Hmong adults rated their oral health and access to dental care as poor. Dental insurance, access to dental care, past preventive dental/physician visits and SRGH were associated with SROH.     

Gender and health inequalities among adolescents and adults in Brazil, 1998.

OBJECTIVES: To assess the extent of gender inequalities in health status and health services utilization among adolescents and adults in Brazil. METHODS: A representative sample of 217,248 individuals from 15 to 64 years of age was obtained from the National Household Sample Survey (Pesquisa Nacional de Amostras por Domicílios, PNAD) conducted in 1998 by the Brazilian Institute of Geography and Statistics and funded by the Ministry of Health. The study focused on three outcome variables (self-assessed health status, medical visits, and hospitalizations (except childbirth)) and five exposure variables (age, gender, ethnicity, income, and education). Unconditional logistic regression and Mantel-Haenszel stratified analysis was employed. Prevalence rate ratios were calculated for each stratum. Confidence intervals were calculated using the Taylor series, with a 95% confidence interval (95% CI). RESULTS: Women were more likely to report fair or poor health than men (odds ratio (OR) = 1.33; 95% CI: 1.31-1.35). Gender disparities were significant for all ages, household income brackets, and education levels, and were always unfavorable to women (1.17 < or = OR < or = 1.44). Gender disparities for medical visits were higher for those in good health; tended to fall as age, income, and education increased; and were always favorable for women (1.12 < or = OR < or = 2.06). Gender disparities in hospitalization rates decreased with age, varied according to income and education level in each age group, and were always favorable for women (1.16 < or = OR < or = 1.66). CONCLUSIONS: The difference in self-reported health status for men and women became even greater after adjusting for socioeconomic variables, suggesting that poorer women have more pronounced, relative differences than men do. The impact of structural determinants, such as education and income, is considerably smaller than the social construct of gender, although the former are more important predictors. Women use health services more often than men do, which is consistent with their health needs. However, medical visit rates show an inverse relationship to health care needs, suggesting an inequitable access to outpatient care, mainly preventive care.     

Oral Health, Oral Pain, and Visits to the Dentist: Neighborhood Influences among a Large Diverse Urban Sample of Adults

The objective of this study was to assess the association between oral health and individual-level characteristics as well as both socioeconomic position (SEP) and service provision characteristics at the neighborhood level. Multilevel logistic analysis was undertaken of data from the Neighbourhood Effects on Health and Well-being Study in Toronto comprising 2,412 participants living in 47 neighborhoods and 87 census tracts. Three oral health outcomes were investigated: last dental visit, self-rated oral health, and self-rated oral pain. Results indicated that SEP was significantly associated with no dental visits in the last year, poor self-rated oral health, and experiencing oral pain after adjusting for age, gender, and immigrant status. Lack of dental insurance was associated with no visits to the dentist in the last year and poor self-rated oral health; however, no association was observed with oral pain. In adjusted regression models, few neighborhood level variables were significantly associated with dental visits and self-rated oral health and no neighborhood variables were associated with oral pain. Based on these results, SEP appears to be important in evaluating oral health outcomes. While insignificant in this study, neighborhood factors are important when considering the impact of service provision on oral health.     

Relevancia clínica del cepillado dental y su relación con la caries

AimTo determine the impact and clinical relevance of tooth brushing on oral health.DesignPrevalence study.LocationFontiñas Health Centre. (Santiago de Compostela, Spain). Prevalence study (n=281 children aged 5–14 years.Odontological examination according to WHO methodology, to determine the frequency of tooth brushing, frequency of sweet consumption and their impact on the prevalence of caries.Statistical analysisLogistic regression and estimation of the relative prevalence difference (RPD) and the Number Needed to Treat in order to prevent one additional bad outcome (NNT).ResultsThe children who never brush their teeth have a 40% (95% CI: 24.3%–57.8%) of early caries, while those who brush their teeth several times a day have 15.3% (95% CI: 9.4%–23.7%). An association between not brushing the teeth and caries in primary teeth (OR=2.3; 95% CI:1.05–5.3) was observed after adjusting for age, sweet consumption and visits to the dentist. The same occurred with final teeth (OR=3.9; 95% CI:1.4–10.3).The RPD was 62%(95% CI: 30%–79%), meaning that prevalence of caries is 62% lower in children who brush their teeth several times a day as compared to those who never brush their teeth. The NNT is 4 (95% CI: 2.4–14), so for every 4 children who brush their teeth several times a day, there is one less case of caries, compared to those who never brush their teeth. There is a dose-response relationship between prevalence of caries and brushing frequency. The same effect was observed with definitive caries: RPD=55% (95% CI:16%–76%), NNT=5 (95% CI:2.8–53.3).ConclusionsTooth brushing is related to oral health, with a major clinical impact. The positive effect of tooth brushing was superior to that of a correct diet.     

Factors associated with edentulousness in an elderly population in Valencia (Spain)

Objective

To determine the prevalence of edentulism and its association with various socioeconomic factors and oral health habits in the population aged 65-74 years old in the region of Valencia.

Methods

A cross sectional study was designed. Thirty-four primary health centers and five nursing homes were chosen at random in the region of Valencia (10-15 voluntary participants per sampling point). Clinical examinations were carried out by three calibrated dentists (kappa > 0.85) in the same centers. The total sample consisted of 531 individuals (235 men and 296 women).

Results

The percentage of toothlessness was 20.7% and the mean number of natural teeth present was 14.92. The prevalence of edentulism was significantly higher (p <0.05) in men, institutionalized persons, those with no schooling, those with poor oral hygiene, those who visited the dentist regularly and those living in peri-urban/rural areas. In a multivariate logistic regression model with edentulism as the dependent variable, the following factors were identified as significant independent variables: institutionalization (odds ratio [OR] = 2.88), poor oral hygiene (OR = 2.35), regular visits to the dentist (OR = 2.34) and age (OR = 1.19).

Conclusion

Edentulousness is a complex phenomenon that involves distinct social and economic factors.     

Mother–Child Interactions and the Associations with Child Healthcare Utilization in Low-Income Urban Families

Studies have demonstrated that low-income families often have disproportionately high utilization of emergency department (ED) and hospital services, and low utilization of preventive visits. A possible contributing factor is that some mothers may not respond optimally to their infants’ health needs, either due to their own responsiveness or due to the child’s ability to send cues. These mother–child interactions are measurable and amenable to change. We examined the associations between mother–child interactions and child healthcare utilization among low-income families. We analyzed data from the Nurse-Family Partnership trial in Memphis, TN control group (n = 432). Data were collected from child medical records (birth to 24 months), mother interviews (12 and 24 months postpartum), and observations of mother–child interactions (12 months postpartum). We used logistic and ordered logistic regression to assess independent associations between mother–child interactions and child healthcare utilization measures: hospitalizations, ED visits, sick-child visits to primary care, and well-child visits. Better mother–child interactions, as measured by mother’s responsiveness to her child, were associated with decreased hospitalizations (OR: 0.51; 95% CI: 0.32, 0.81), decreased ambulatory-care-sensitive ED visits (OR: 0.65, 95% CI: 0.44, 0.96), and increased well-child visits (OR: 1.55, 95% CI: 1.06, 2.28). Mother’s responsiveness to her child was associated with child healthcare utilization. Interventions to improve mother–child interactions may be appropriate for mother–child dyads in which child healthcare utilization appears unbalanced with inadequate primary care and excess urgent care. Recognition of these interactions may also improve the care clinicians provide for families.