Trends in use of dental care provider types and services in the United States in 2000-2016: Rural-urban comparisons

BackgroundThe authors conducted a study to assess recent trends in dental care provider mix (type of dental professionals visited) and service mix (types of dental procedures) use in the United States and to assess rural-urban disparities.MethodsData were from the 2000 through 2016 Medical Expenditure Panel Survey. The sample was limited to respondents who reported at least 1 dental visit to a dental professional in the survey year (N = 138,734 adults ≥ 18 years). The authors estimated rates of visiting 3 dental professionals and undergoing 5 dental procedures and assessed the time trends by rural-urban residence and variation within rural areas. Multiple logistic regression was used to assess the association between rural and urban residence and service and provider mix.ResultsA decreasing trend was observed in visiting a general dentist, and an increasing trend was observed in visiting a dental hygienist for both urban and rural residents (trend P values < .001). An increasing trend in having preventive procedures and a decreasing trend in having restorative and oral surgery procedures were observed only for urban residents (trend P values < .001). The combined data for 2000 through 2016 showed that rural residents were less likely to receive diagnostic services (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.72 to 0.93) and preventive services (AOR, 0.87; 95% CI, 0.78 to 0.96), and more likely to receive restorative (AOR, 1.11; 95% CI, 1.02 to 1.21) and oral surgery services (AOR, 1.23; 95% CI, 1.11 to 1.37).ConclusionsAlthough preventive dental services increased while surgical procedures decreased from 2000 through 2016 in the United States, significant oral health care disparities were found between rural and urban residents.Practical ImplicationsThese results of this study may help inform future initiatives to improve oral health in underserved communities. By understanding the types of providers visited and dental services received, US dentists will be better positioned to meet their patients’ oral health needs.     

工业氟污染区人群氟斑牙的调查

目的 了解工业氟污染区人群氟斑牙情况。方法 对调查区内随机抽取的不同年龄组的7182名居民氟斑牙患病情况、尿氟含量与当地环境氟水平之间的关系进行分析。结果 氟斑牙平均检出率达47.86％;尿氟平均含量为1.47±1.07mg/L。当地环境要素中的大气、农作物和土壤含氟量分别超过相应的标准值或背景值,而饮用水及茶水的氟含量均在正常水平。结论 工业氟污染是引起该地区人群氟斑牙流行的主要原因     

The association between vitamin D levels and caries experience in children and youth participating in National Health and Nutrition Examination Survey 2011-2016: A cross-sectional study

BackgroundGiven equivocal findings from existing nationally representative studies, the authors sought to determine associations between vitamin D levels and caries experience in US children using updated National Health and Nutrition Examination Survey data.MethodsThe authors used data from 2011-2016 National Health and Nutrition Examination Survey. Vitamin D status was assessed on the basis of the sufficiency thresholds of 50 and 75 nmol/L for serum 25-hydroxyvitamin D (25[OH]D) recommended by the Institute of Medicine (now National Academy of Medicine) and Endocrine Society, respectively. Caries experience was defined as the total number of decayed or filled tooth surfaces (dfs) and decayed, missing, or filled tooth surfaces (DMFS) and a binary measure of any dfs and DMFS. Associations between 25(OH)D and any or total dfs and DMFS were examined in children aged 2 through 5, 6 through 8, 9 through 11, and 12 through 18 years, using multivariable logistic and linear regression models after adjustment for covariates.ResultsChildren aged 2 through 5 years with 25(OH)D above 75 nmol/L experienced fewer total dfs (β = –1.94; 95% CI, –3.60 to –0.28) than those with 25(OH)D below 75 nmol/L. Children 6 through 8 years with 25(OH)D above 75 nmol/L had lower presence of any dfs (odds ratio, 0.59; 95% CI, 0.36 to 0.95) than those with 25(OH)D below 75 nmol/L, and those with 25(OH)D above 50 nmol/L had lower presence of any DMFS (odds ratio, 0.38; 95% CI, 0.19 to 0.79) than those with 25(OH)D below 50 nmol/L. There were no associations of 25(OH)D status with either any or total DMFS in children 12 through 18 yearsConclusionsThere were no consistent associations of 25(OH)D status with caries experience across age groups.Practical ImplicationsVitamin D status was not associated consistently with reduced caries experience.     

Sexual experiences in relation to HPV vaccination status in female high school students in Sweden

Abstract

Objectives To investigate sexual experiences, sexually transmitted infections (STIs) and use of condoms in relation to human papillomavirus (HPV)-vaccination status in female high school students.

Methods In 2013, 355 female students with a median age of 18 years from randomly selected high schools in Sweden answered a classroom questionnaire on sexual experiences and HPV-vaccination status.

Results In total 227/348 (65%) of the women reported having received at least one HPV vaccine dose. Median age at first intercourse was 15 and 16 years respectively, in the 141/227 (62%) vaccinated after, and the 86/227 (38%) vaccinated before their sexual debut. There were no differences between the HPV-vaccinated and non-vaccinated groups regarding condom use, STIs, and experiences of oral and anal sex, or friends- with-benefit relationships. However, having had sexual intercourse and ‘one-night stands’ were more common in the vaccinated group (both p < 0.05).

Conclusion Many students (62%) were vaccinated against HPV, with two-thirds after their sexual debut. There were no differences in condom use and STIs, and only a few differences in sexual experiences between the HPV-vaccinated and non-vaccinated groups. Initiating HPV vaccination before sexual debut is important, as is information about the link between HPV, sexual behaviour and cancer.     

Occupational burnout and work factors in community and hospital midwives: A survey analysis

Background

community-based midwifery practice has been promoted in the UK maternity policy over the last decade as a means of increasing continuity of care. However, there have been growing concerns to suggest that the community-based continuity model may not be sustainable due to the high levels of occupational burnout in midwives resulted by increased on-call work.

Aims

this paper attempted to identify work factors associated with the levels of burnout in community midwives as compared to hospital midwives, aiming at contributing to the debate of organising sustainable midwifery care.

Methods

a statistical analysis was conducted drawing on data from a survey of all midwives working at one Hospital Trust in England (n=238). Occupational burnout was measured using the Maslach Burnout Inventory (MBI).

Results

the sample midwives (n=128, 54%) had significantly higher levels of burnout compared to the reference groups. Multiple regression analysis identified as follows: (1) high levels of occupational autonomy were a key protective factor of burnout, and more prevalent in the community, (2) working hours were positively associated with burnout, and community midwives were more likely to have higher levels of stress recognition, and (3) support for work-life-balance from the Trust had a significant protective effect on the levels of burnout.

Conclusion

the results should be taken into account in the maternity policy in order to incorporate continuity of care and sustainable organisation of midwifery care.     

丽水市高危人群艾滋病危险因素调查分析

目的了解丽水市高危人群与艾滋病相关的若干因素。方法通过问卷调查丽水市高危人群的人口学和行为学特征,了解她们艾滋病基本知识掌握情况及对艾滋病及感染者(病人)的态度等;采集静脉血检测H IV抗体。结果问卷调查高危人群149人,9人拒绝回答;平均年龄为(24.1±4.0)岁;文化程度初中及初中以下占78.6%;艾滋病知晓率60.80%;每次都使用或经常使用安全套的比例达到90.0%;未发现静脉吸毒者;采血149份H IV抗体均为阴性。结论丽水市高危人群安全套使用率较高,且目前艾滋病感染率仍处于较低水平,但艾滋病基本知识知晓率偏低,必须加强干预力度。     

Occupational skin diseases in cleaning and kitchen employees: Course and quality of life after measures of secondary individual prevention

Background: Cleaning and kitchen employees have an increased risk of suffering from occupational dermatoses. Prevention including improving individual skin care and skin protection behavior, health education, optimizing diagnostics and therapy as well as avoidance of occupational skin disease (BK 5101) is important. Patients and methods: Participants in the courses were patients suspected of having an occupational skin disease. Besides socio‐demographic and diseaserelated data, health‐related quality of life (QL) was measured using the SF‐36 and Skindex‐29. One year later all participants were interviewed by telephone about the course of their skin disease. Results: Out of 212 participants, 84.0 % were female. The mean age was 41.6 (SD = 10.8) years.168 patients (79.2 %) suffered from hand dermatitis,with irritant contact dermatitis being the predominant diagnosis (46.2 %,n = 98).One year later 65.4 % (n = 85) of the patients interviewed still suffered from hand der‐matitis.9.2 % (n = 12) had meanwhile quit their job due to the skin disease.QL was impaired in all age groups being lower with increasing age of the patients. Conclusions: The follow‐up confirmed the positive impact of the skin protection courses on patients' skin disease and well‐being. Occupational skin diseases impair health‐related quality of life in these professions but disease severity does not seem to play a key role.