Access to oral care --- A systematic review of a continuing public health issue among older adults

Oral health is essential for the general well being of the individual and collectively for the health of the population. Oral health can be maintained by routine dental care and visits to dental professionals, but accessing professional dental care may be a continuing difficulty in vulnerable older adult population. Many older adults are not frequent users of dental care, though oral health is crucial to their well-being and overall health. Access to care is the timely use of personal health services to achieve the best possible health outcomes. ^ Objectives: The aims of this review are to (i) to analyze and elucidate the relationship between socio-economic disparities in gender, ethnicity, poverty status, education and the continuing public issue of access to oral care, (ii) to identify the underlying causes through which these factors can affect access to oral care. This review will provide a knowledgeable basis for development of interventions to provide adequate access to oral care in older adults and implementing policies to ensure access to oral care; through highlighting the various socio economic factors that affect access to oral care among older adults. ^ Methods: This paper used a purposeful review of literature on socioeconomic disparities in access to oral care among older adults. The references considered in this review included all the relevant articles, surveys and reports published in English language, since the year 1985 to 2010, in the United States. The articles selected were scrutinized for relevancy to the topic of access to oral care and which included discussions of the effects of gender, ethnicity, poverty status, educational status in accessing oral care. ^ Results: Evidence confirmed the continuing disparity in access to oral care among older adults. The possible links identified were gender inequality, ethnic differences, income levels and educational differences affecting access to oral care. The underlying causes linking these factors with access to oral care were established. ^ Conclusion: The analysis of the literature review findings supported the prevalence of disparities in gender, ethnicity, income and education with its possible links affecting access to oral care. The underlying causes helped to understand the reasons behind this growing issue of inaccessible oral care. Further research is needed to develop policies and target dental public health efforts towards specific problem areas ensuring equitable access to oral services and consequently, improve the health of older adults.^

Objective assessment of the built environment and its relationship to physical activity and obesity

The role of physical activity in the promotion of individual and population health has been well documented in research and policy publications. Significant research activities have produced compelling evidence for the support of the positive association between physical activity and improved health. Despite the knowledge about these public health benefits of physical activity, over half of US adults do not engage in physical activity at levels consistent with public health recommendations. Just as physical inactivity is of significant public health concern in the US, the prevalence of obesity (and its attendant co-morbidities) is also increasing among US adults.^ Research suggests racial and ethnic disparities relevant to physical inactivity and obesity in the US. Various studies have shown more favorable outcomes among non-Hispanic whites when compared to other minority groups as far as physical activity and obesity are concerned. The health disparity issue is especially important because Mexican-Americans who are the fastest growing segment of the US population are disproportionately affected by physical inactivity and obesity by a significant margin (when compared to non-Hispanic whites), so addressing the physical inactivity and obesity issues in this group is of significant public health concern. ^ Although the evidence for health benefits of physical activity is substantial, various research questions remain on the potential motivators for engaging in physical activity. One area of emerging interest is the potential role that the built environment may play in facilitating or inhibiting physical activity.^ In this study, based on an ongoing research project of the Department of Epidemiology at the University of Texas M. D. Anderson Cancer Center, we examined the built environment, measured objectively through the use of geographical information systems (GIS), and its association with physical activity and obesity among a cohort of Mexican- Americans living in Harris County, Texas. The overall study hypothesis was that residing in dense and highly connected neighborhoods with mixed land-use is associated with residents’ increased participation in physical activity and lowered prevalence of obesity. We completed the following specific aims: (1) to generate a land-use profile of the study area and create a “walkability index” measure for each block group within the study area; (2) to compare the level of engagement in physical activity between study participants that reside in high walkability index block groups and those from low walkability block groups; (3) to compare the prevalence of obesity between study participants that reside in high walkability index block groups and those from low walkability block groups. ^ We successfully created the walkability index as a form of objective measure of the built environment for portions of Harris County, Texas. We used a variety of spatial and non-spatial dataset to generate the so called walkability index. We are not aware of previous scholastic work of this kind (construction of walkability index) in the Houston area. Our findings from the assessment of relationships among walkability index, physical activity and obesity suggest the following, that: (1) that attempts to convert people to being walkers through health promotion activities may be much easier in high-walkability neighborhoods, and very hard in low-walkability neighborhoods. Therefore, health promotion activities to get people to be active may require supportive environment, walkable in this case, and may not succeed otherwise; and (2) Overall, among individuals with less education, those in the high walkability index areas may be less obese (extreme) than those in the low walkability area. To the extent that this association can be substantiated, we – public health practitioners, urban designers, and policy experts – we may need to start thinking about ways to “retrofit” existing urban forms to conform to more walkable neighborhoods. Also, in this population especially, there may be the need to focus special attention on those with lower educational attainment.^

Sudden Infant Death disparities: A systematic review on health education and policy recommendations for decreasing Sudden Infant Death in the African-American community

Objective: To perform a systematic review of the literature on SIDS and SUID deaths concentrated in the African-American community, describe health education and policy recommendations and recommend a new approach that may aid in decreasing the disparity of infant mortality in the African-American community. ^ Methods: The PubMed database was systematically searched to identify relevant articles for final review and analysis. Using the CASP 2006 system to critique literature, twelve articles were found that met inclusion and exclusion criteria. ^ Results: Evidence in the literature confirmed there was a current disparity among African Americans' infant mortality rates in comparison to other US ethnic groups. The underlying reasons for these disparities included the following maternal and infant characteristics: mothers younger than eighteen, having more than one live infant, having a high school education or less, never been married, and have infants born preterm or with low birth weight. Maternal smoking, substance abuse, and breastfeeding did not have a significant impact on infant sleep environments among African Americans. ^ Conclusion: Tailored health education programs at the community level, better access to pre-pregnancy and prenatal care, and increased maternal perception of risk that is relevant to the infants sleeping environment are all possible solutions that may decrease African American infant mortality rates.^

Addressing teenage pregnancy in rural areas: A case study from Liberty County, Texas

This study explores the issue of teenage pregnancy in a case study of Liberty County, a rural area in Texas with no public health department. It also describes the decision-making process and barriers faced in the beginning phases of adopting a sexual education program, and sets forth an implementation plan for two school districts on disseminating an evidence-based, comprehensive curriculum. Methods include a review of epidemiological data surrounding teenage pregnancy on the national, state, and county level; a literature review of factors related to teenage pregnancy and past interventions implemented in a rural community; a policy review of past and current bills in Legislature; and an analysis of barriers and decision making in implementing an evidence based program through qualitative observations, discussions with community members during meetings, presentations, and discussions. Results of this study indicate that there is a lack of research conducted in rural areas in the field of teenage pregnancy prevention and sexual education programs. Barriers experienced in Liberty County are shown to be consistent in scientific literature such as funding, logistical issues, and problems approaching the School Board in adopting a comprehensive sexual education program. This study fills a large gap in the literature on rural adolescents and attempts to analyze the process of decision-making in a rural area related to adoption of sexual education programming. In order to relieve this health disparity, further research should focus on rural areas to gain insight on the attitudes and behaviors of rural adolescents and beliefs among community stakeholders.^

Tuberculosis in Texas correctional facilities between 2005--2009

It has been well documented that inmates incarcerated in prisons and correctional facilities exhibit higher incidence and prevalence of mycobacterium tuberculosis (TB) disease than the general population. This has public health implications because correctional systems may serve as reservoirs for TB disease that can lead to TB outbreaks in the facilities or can be spread to the general public once inmates are released. Although Texas has one of the largest correctional systems in both the US and the world, little is known about TB prevalence and incidence among Texas inmates. The purpose of this study was to elucidate the relationship between TB incidence and incarceration in Texas correctional facilities and investigate differences in various demographic factors. ^ The study used the national TB database from the US Centers for Disease Control and Prevention (CDC) to calculate and compare the overall incidences of TB disease among correctional facility inmates and similar non-inmates in Texas during 2005–2009. Data were also stratified by age, gender, race/ethnicity, birth status, and HIV status and compared between inmates and non-inmates using chi-squared analysis and relative risks with 95% confidence intervals to assess any significant differences. ^ Results suggest that the overall TB incidence among Texas correctional facility inmates per year (88.6 per 100,000) was significantly higher than that of Texas non-inmates (6.3 per 100,000); a 14 fold difference. Relative risk analyses by gender, race/ethnicity, and those with HIV infection found that the TB incidences for all these demographics were significantly and consistently higher in inmates compared to non-inmates. In particular, Hispanic inmates were more likely to develop TB than their non-inmate counterparts by a relative risk of 23.9 (95% CI 19.4–29.4). Likewise, both male and female inmates were more likely to develop TB than non-inmates (RR = 10.2, 95% CI 8.5–12.2; RR = 20.8, 95% CI 12.2–25.3, respectively), although female inmates unconventionally exhibited a higher TB incidence and relative risk than males inmates, which has not been shown. Among those with HIV infections, correctional facility inmates were 2.6 times were likely to develop TB disease than non-inmates (95% CI 1.5–4.4). ^ Inmates in Texas correctional facilities have a higher incidence of TB than non-inmates. Part of this higher risk may be because a large proportion of inmates come from populations already at high risks for TB, such as foreign born immigrants, those infected with HIV, and low SES groups such as many racial/ethnic minorities. Thus, these results may be used as a basis for more controlled and detailed research in the area, and to further characterize incarceration as a risk factor for TB incidence. They may also bring much needed attention about this health disparity to public health officials, legislators, and health administrators to expand and improve TB control in Texas correctional facilities, particularly among inmates released to the community, and reduce the risk of TB transmission to the general population.^

Black/white disparities in infant mortality rates in the U.S.: A quality of care perspective

The infant mortality rate for non-Hispanic Black infants in the U.S. is 13.63 deaths per 1,000 live births while the IMR for non-Hispanic White persons in the U.S. is 5.76 deaths per 1,000 live births. Black women are 2 times as likely as White women to deliver preterm infants and Black women are 2 times as likely as White women to deliver low birth weight infants (weighing less than 2,500 grams at birth). Differential underlying risk factors among mothers of different racial/ethnic groups for delivering pre-term and low birth weight infants have been historically accepted as the cause of racial disparities in IMRs. However, differential underlying risk status may not be the only major causative factor. Differential or unequal access to and provision of care is widely speculated to be a leading contributing factor to the wide racial disparity in infant mortality.2 This paper conducts a systematic review of existing literature investigating racial disparities in obstetrical care provided by healthcare practitioners to evaluate whether inequities in healthcare services provided to pregnant mothers and their neonates exist. The search terms "racial disparities obstetrical care," "racial differences quality of prenatal care," and "infant mortality racial disparities" were entered into the EBSCO Medline, Ovid Medline, PubMed, and Academic Search Complete databases, and articles between years 1990–2011 were selected for abstract review. The only articles included were those that used statistical methods to assess whether racial inequalities were present in the obstetrical services provided to pregnant women. My literature search returned 5 articles. Four of the five studies yielded significant racial differences in obstetrical care. However, the one study that used a large, nationally representative valid sample did not represent significant differences. Thus, this review provides initial evidence for racial disparities in obstetrical care, but concludes that more studies are needed in this area. Not all of the studies reviewed were consistent in the use and measurement of services, and not all studies were significant. The policy and public health implications of possible racial disparities in obstetrical care include the need to develop standard of care protocols for ALL obstetrical patients across the United States to minimize and/or eliminate the inequities and differences in obstetrical services provided.^

Systematic review of mobile dental vans

Objectives. To assess the reach and effectiveness of mobile dental vans as a delivery method by providing access to underserved populations. ^ Methods. A literature review was conducted to identify mobile delivery methods whose aims are to address the increasing oral health disparity concern. Forty articles met the inclusion criteria. Of the 40 articles, only 7 analyzed the reach and coverage of the mobile dental clinics. Data was compiled from the literature to compare and assess the different mobile dental care delivery methods. ^ Results. There is a correlation between transportation barriers and lack of access to healthcare. Mobile dentistry helps to delivery dental care to vulnerable populations. ^ Conclusion. Mobile dental clinics are an effective method in improving access to care in underserved populations, as well as increasing overall oral health in these individuals.^

Shifting the focus: Addressing breast cancer disparities at the health care organization level

The purpose of this study was to understand the scope of breast cancer disparities within the Texas Medical Center. The goal was to increase the awareness of breast cancer disparities at the health care organization level, and to foster the development of organizational interventions to reduce breast cancer disparities. The study seeks to answer the following questions: 1. Are hospitals in the Texas Medical Center implementing interventions to reduce breast cancer disparities? 2. What are their interventions for reducing the effects of non clinical factors on breast cancer treatment disparities? 3. What are their measures for monitoring, continuously improving, and evaluating the success of their interventions? ^ This research project was designed as a mixed methods case study. Quantitative breast cancer data for the years 2000-2009 was obtained from the Texas Cancer Registry (TCR). Qualitative data collection and analysis was done by conducting a total of 20 semi-structured interviews of administrators, physicians and nurses at five hospitals (A, B, C, D and E) in the Texas Medical Center (TMC). For quantitative analysis, the study was limited to early stage breast cancer patients: local and regional. The dependent variable was receipt of standard treatment: Surgery (Yes/No), BCS vs Mastectomy, Chemotherapy (Yes/No) and Radiation after BCS (Yes/No). The main independent variable was race: non-Hispanic White (NHW) , non-Hispanic Black (NHB), and Hispanic. Other covariates included age at diagnosis, diagnosis date, percent poverty, grade, stage, and regional nodes. Multivariate logistic regression was used to test the adjusted association between receipt of standard care and race. Qualitative data was analyzed with the Atlas.ti7 software (ATLAS.ti GmbH, Berlin). ^ Though there were significant differences by race for all dependent variables when the data was analyzed as a single group of all hospitals; at the level of the individual hospitals the results were not consistent by race/ethnicity across all dependent variables for hospitals A, B, and E. There were no racial differences in adjusted analysis for receipt of chemotherapy for the individual hospitals of interest in this study. For hospitals C and D, no racial disparities in treatment was observed in adjusted multivariable analysis. All organizations in this study were aware of the body of research which shows that there are disparities in breast cancer outcomes for patient population groups. However, qualitative data analysis found that there were differences in interest among hospitals in addressing breast cancer disparities in their patient population groups. Some organizations were actively implementing directed measures to reduce the breast cancer disparity gap in outcomes for patients, and others were not. Despite the differences in levels of interest, quantitative data analysis showed that organizations in the Texas Medical Center were making progress in reducing the burden of breast cancer disparities in the patient populations being served.^

Determinación de la relación de expansión en suelos de Mendoza (Argentina)

El objetivo fue lograr Índices de Corte ajustados a los suelos de las regiones en estudio y relacionar los mismos con determinaciones sencillas de laboratorio como volumen de sedimentación. Se observó en la región una gran disparidad de métodos para calcular el plano proyecto a obtener y la aplicación de valores de relación corte/relleno sin validación local. El trabajo se realizó en la provincia de Mendoza. Se relevaron 22 parcelas en las zonas irrigadas por los ríos Mendoza y Tunuyán. Los valores promedio de relación de expansión obtenidos, de acuerdo con el tipo de suelo, fueron: arenoso 1,04; franco 1,4; arcilloso 1,71; franco-arenoso 1,29; francoarcillo- limoso 1,71; franco-arcilloso 1,64 y franco-limoso 1,34, respectivamente.

El espacio público urbano : entre la disputa y la dominación

El concepto de espacio público, cuya actual tendencia expansiva lo carga de abundante ambigüedad, a menudo es tratado en la geografía desde una perspectiva ineludible y sombría. Este conjunto de argumentos han conformado en estos últimos veinte años una retórica sobre la pérdida del espacio público, condenándolo a un destino poco prometedor. Proponemos abordarlo en la Ciudad de Mendoza desde una perspectiva posible y dinámica, donde el espacio público constantemente se esté rehaciendo y redefiniendo entre conflictos, disputas y acuerdos cotidianos en la sociedad, que adquieren prácticas socio-espaciales específicas.

La educación, base para el desarrollo y la seguridad a escala humana

Las teorías sobre el desarrollo son en realidad un dinámico debate acerca de la relación población/recursos, de las condiciones de inequidad a escala planetaria y al interior de las naciones, y de las formas de superarlas. Para avanzar hacia el desarrollo humano, es prioritario enfocar las acciones en la superación de las carencias que afectan la situación personal de los ciudadanos y eliminar los obstáculos que impiden su bienestar en relación con las condiciones medioambientales en las que transcurre su vida. La educación es comprendida como el eje fundamental para alcanzar niveles de desarrollo aceptables, asegurando superar situaciones de exclusión social. Sobre la base de encuestas en cuatro establecimientos educativos del Gran Mendoza, se analizan las relaciones existentes entre las representaciones, de los adolescentes y sus familias sobre la importancia de la educación como medio optimizador de las situaciones socioeconómicas y los proyectos de capacitación futura, tanto a nivel terciario como universitario.

La iniciativa privada en los delitos sexuales [Bs. As. 1863-1921]

Los delitos sexuales entre la segunda mitad del siglo XIX y principios del XX presentan problemas particulares en relación a la posibilidad de su imputación y castigo vinculados a la forma particular como se conciben estos crímenes. Propongo, a partir del análisis de expedientes judiciales, problematizar algunas de estas cuestiones partiendo desde el análisis de su concepción como "dependientes de iniciativa privada" y por tanto la necesidad de una "acusación particular" que implicó largos debates en los tribunales ya que la interpretación de esta situación tuvo más de una lectura posible: quedaban satisfechos los requerimientos de la ley con la denuncia o debía continuarse la participación de la parte hasta la misma sentencia, es decir, llegar hasta la vista de acusación? En este contexto se pone entonces en discusión la participación del Agente Fiscal en el proceso en tanto acusador y por lo tanto el interés del Estado como tal en la persecución de estos crímenes. Busco, simultáneamente mostrar las discusiones que se dieron en la práctica penal, que reflejan distintas formas de interpretar y pensar estos delitos; las razones implícitas en su persecución y castigo o por el contrario de su finalización y falta de pena

La iniciativa privada en los delitos sexuales [Bs. As. 1863-1921]

Los delitos sexuales entre la segunda mitad del siglo XIX y principios del XX presentan problemas particulares en relación a la posibilidad de su imputación y castigo vinculados a la forma particular como se conciben estos crímenes. Propongo, a partir del análisis de expedientes judiciales, problematizar algunas de estas cuestiones partiendo desde el análisis de su concepción como "dependientes de iniciativa privada" y por tanto la necesidad de una "acusación particular" que implicó largos debates en los tribunales ya que la interpretación de esta situación tuvo más de una lectura posible: quedaban satisfechos los requerimientos de la ley con la denuncia o debía continuarse la participación de la parte hasta la misma sentencia, es decir, llegar hasta la vista de acusación? En este contexto se pone entonces en discusión la participación del Agente Fiscal en el proceso en tanto acusador y por lo tanto el interés del Estado como tal en la persecución de estos crímenes. Busco, simultáneamente mostrar las discusiones que se dieron en la práctica penal, que reflejan distintas formas de interpretar y pensar estos delitos; las razones implícitas en su persecución y castigo o por el contrario de su finalización y falta de pena

La iniciativa privada en los delitos sexuales [Bs. As. 1863-1921]

Los delitos sexuales entre la segunda mitad del siglo XIX y principios del XX presentan problemas particulares en relación a la posibilidad de su imputación y castigo vinculados a la forma particular como se conciben estos crímenes. Propongo, a partir del análisis de expedientes judiciales, problematizar algunas de estas cuestiones partiendo desde el análisis de su concepción como "dependientes de iniciativa privada" y por tanto la necesidad de una "acusación particular" que implicó largos debates en los tribunales ya que la interpretación de esta situación tuvo más de una lectura posible: quedaban satisfechos los requerimientos de la ley con la denuncia o debía continuarse la participación de la parte hasta la misma sentencia, es decir, llegar hasta la vista de acusación? En este contexto se pone entonces en discusión la participación del Agente Fiscal en el proceso en tanto acusador y por lo tanto el interés del Estado como tal en la persecución de estos crímenes. Busco, simultáneamente mostrar las discusiones que se dieron en la práctica penal, que reflejan distintas formas de interpretar y pensar estos delitos; las razones implícitas en su persecución y castigo o por el contrario de su finalización y falta de pena

U-Pb, trace element, and Hf isotope analysis for Macquarie Island detrital zircon

Oceanic zircon trace element and Hf-isotope geochemistry offers a means to assess the magmatic evolution of a dying spreading ridge and provides an independent evaluation of the reliability of oceanic zircon as an indicator of mantle melting conditions. The Macquarie Island ophiolite in the Southern Ocean provides a unique testing ground for this approach due to its formation within a mid-ocean ridge that gradually changed into a transform plate boundary. Detrital zircon recovered from the island records this change through a progressive enrichment in incompatible trace elements. Oligocene age (33-27 Ma) paleo-detrital zircon in ophiolitic sandstones and breccias interbedded with pillow basalt have trace element compositions akin to a MORB crustal source, whereas Late Miocene age (8.5 Ma) modern-detrital zircon collected from gabbroic colluvium on the island have highly enriched compositions unlike typical oceanic zircon. This compositional disparity between age populations is not complimented by analytically equivalent eHf data that primarily ranges from 14 to 13 for sandstone and modern-detrital populations. A wider compositional range for the sandstone population reflects a multiple pluton source provenance and is augmented by a single cobble clast with eHf equivalent to the maximum observed composition in the sandstone (~17). Similar sandstone and colluvium Hf-isotope signatures indicate inheritance from a similar mantle reservoir that was enriched from the depleted MORB mantle average. The continuity in Hf-isotope signature relative to trace element enrichment in Macquarie Island zircon populations, suggests the latter formed by reduced partial melting linked to spreading-segment shortening and transform lengthening along the dying spreading ridge.