Predictors of oral health quality of life in older adults

There is limited information regarding oral health status and other predictors of oral health-related quality of life. An association between oral health status and perceived oral health-related quality of life (OHQOL) might help clinicians motivate patients to prevent oral diseases and improve the outcome of some dental public health programs. This study evaluated the relationship between older persons' OHQOL and their functional dentition, caries, periodontal status, chronic diseases, and some demographic characteristics. A group of 733 low-income elders (mean age 72.7 [SD = 4.71, 55.6% women, 55.1% members of ethnic minority groups in the U.S. and Canada) enrolled in the TEETH clinical trial were interviewed and examined as part of their fifth annual visit for the trial. OHQOL was measured by the Geriatric Oral Health Assessment Index (GOHAI); oral health and occlusal status by clinical exams and the Eichner Index; and demographics via interviews. Elders who completed the four-year assessment had an average of 21.5 teeth (SD = 6.9), with 8.5 occluding pairs (SD = 4.6), and 32% with occlusal contacts in all four occluding zones. Stepwise multiple regressions were conducted to predict total GOHAI and its subscores (Physical, Social, and Worry). Functional dentition was a less significant predictor than ethnicity and being foreign-born. These variables, together with gender, years since immigrating, number of carious roots, and periodontal status, could predict 32% of the variance in total GOHAI, 24% in Physical, 27% in Social, and 21% in the Worry subscales. These findings suggest that functional dentition and caries influence older adults' OHQOL, but that ethnicity and immigrant status play a larger role.

Fish contaminants through the tribal perspective : an ethnography of the Keweenaw Bay Indian Community's tribal fish harvest

It has been well documented that many tribal populations and minority groups across the nation have been identified as being at high risk of the adverse health effects created by consuming fish that have been contaminated with mercury, PCBs, DDT, dioxins, and other chemicals. Although fish consumption advisories are intended to inform fish consumers of risks associated with specific species and water bodies, advisories have been the subject of both environmental injustices and treaty rights’ injustices. This means that understanding fish contaminants, through community perspectives is essential to good environmental policy. This study examined the fish contaminant knowledge, impacts on fishing and fish consumption, and the factors that contribute to harvesting decisions and behaviors in one tribal nation in the Upper Peninsula of Michigan, the Keweenaw Bay Indian Community. Using ethnographic methods, participant observation and semi-structured interviewing, fieldnotes were kept and all interviews were fully transcribed for data analysis. Among seventeen fishermen and women, contaminants are poorly understood, have had a limited impact on subsistence fishing but have had a substantial impact on commercial fishing activity. But ultimately, all decisions and behaviors are based on their own criteria and within a larger context of knowledge and understanding: the historical and cultural context. The historical context revealed that advisories are viewed as another attack on tribal fishing. The cultural context revealed that it is the fundamental guidance and essential framework associated with all harvesting beliefs, values, and traditional lifeways. These results have implications for advisories. ‘Fish’ and ‘contaminants’ appear differently based on the perceptions and priorities of those who encounter them.

[The deaf patient--information for a barrier-free conversation with patients in dentistry]

There are about 650,000 people with hearing problems in Switzerland, 10,000 of whom use sign language. About 100,000 people are hard of hearing. Deaf patients require special treatment in the dental office as they have specific communication needs. This community, like many other minority groups, has a sign language and a culture of its own. To prevent misunderstandings it is therefore very important to provide solutions for an enhanced communication. However, guidelines for the communication with deaf dental patients are still missing. Successful communication between deaf patients and dentist is essential for effective care. This paper is concerned with providing background information and introducing recommendations for unrestricted dentist-patient communication. The aim of this article is to improve dentists' knowledge of the appropriate communication with this patient group.

The Road to Negative Behavior: Discriminatory Intentions in the German Population

This study analyzes discriminatory intentions shared by members of the German majority against several outgroups in Germany. Patterns of discriminatory intentions against various minority groups were investigated for several indicators, including gender, age, and political orientation, by means of a representative survey (N = 1,778). The relationship between prejudices and discriminatory intentions against different target groups was also analyzed. Prejudice and discriminatory intentions show moderate but consistently positive correlations in relation to one and the same target group. Moreover, it was found that discriminatory intentions against one outgroup are related to hostile attitudes towards other outgroups, too. The results support the hypothesis of a syndrome of group-focused enmity.

Do relocated villages experience more forest cover change? Resettlements, shifting cultivation and forests in the Lao PDR

This study explores the relationships between forest cover change and the village resettlement and land planning policies implemented in Laos, which have led to the relocation of remote and dispersed populations into clustered villages with easier access to state services and market facilities. We used the Global Forest Cover Change (2000–2012) and the most recent Lao Agricultural Census (2011) datasets to assess forest cover change in resettled and non-resettled villages throughout the country. We also reviewed a set of six case studies and performed an original case study in two villages of Luang Prabang province with 55 households, inquiring about relocation, land losses and intensification options. Our results show that resettled villages have greater baseline forest cover and total forest loss than most villages in Laos but not significant forest loss relative to that baseline. Resettled villages are consistently associated with forested areas, minority groups, and intermediate accessibility. The case studies highlight that resettlement coupled with land use planning does not necessarily lead to the abandonment of shifting cultivation or affect forest loss but lead to a re-spatialization of land use. This includes clustering of forest clearings, which might lead to fallow shortening and land degradation while limited intensification options exist in the resettled villages. This study provides a contribution to studying relationships between migration, forest cover change, livelihood strategies, land governance and agricultural practices in tropical forest environments.

Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association) Registry.

BACKGROUND Racial disparities in kidney transplantation in children have been found in the United States, but have not been studied before in Europe. STUDY DESIGN Cohort study. SETTING & PARTICIPANTS Data were derived from the ESPN/ERA-EDTA Registry, an international pediatric renal registry collecting data from 36 European countries. This analysis included 1,134 young patients (aged ≤19 years) from 8 medium- to high-income countries who initiated renal replacement therapy (RRT) in 2006 to 2012. FACTOR Racial background. OUTCOMES & MEASUREMENTS Differences between racial groups in access to kidney transplantation, transplant survival, and overall survival on RRT were examined using Cox regression analysis while adjusting for age at RRT initiation, sex, and country of residence. RESULTS 868 (76.5%) patients were white; 59 (5.2%), black; 116 (10.2%), Asian; and 91 (8.0%), from other racial groups. After a median follow-up of 2.8 (range, 0.1-3.0) years, we found that black (HR, 0.49; 95% CI, 0.34-0.72) and Asian (HR, 0.54; 95% CI, 0.41-0.71) patients were less likely to receive a kidney transplant than white patients. These disparities persisted after adjustment for primary renal disease. Transplant survival rates were similar across racial groups. Asian patients had higher overall mortality risk on RRT compared with white patients (HR, 2.50; 95% CI, 1.14-5.49). Adjustment for primary kidney disease reduced the effect of Asian background, suggesting that part of the association may be explained by differences in the underlying kidney disease between racial groups. LIMITATIONS No data for socioeconomic status, blood group, and HLA profile. CONCLUSIONS We believe this is the first study examining racial differences in access to and outcomes of kidney transplantation in a large European population. We found important differences with less favorable outcomes for black and Asian patients. Further research is required to address the barriers to optimal treatment among racial minority groups.

Analysis of community health worker utilization in El Paso County, Texas

Community health workers (CHWs) are an accepted, viable component of health systems worldwide. Most often they are utilized in developing regions where health care access is limited and/or health care practitioners are scarce. In this way community health workers have been used to extend the reach of primary care delivery to whole nations, and can be used to reduce health disparities in disadvantaged populations or minority groups as well. In the United States, utilization of CHWs is fragmented, and an amalgam of programs exist which are usually only community-specific. These programs are often burdened by financial un-sustainability. The Community Health Worker National Workforce Study (2007) was markedly the first effort to compile a profile of the CHW workforce in all 50 states. El Paso County, as a uniquely bi-national setting, provided a prime locale to assess CHW utilization on a localized scale, and in a distinctively Latino population and medically underserved area. ^ Results gleaned from this study of 45 CHWs and 5 administrators demonstrate commonalities between El Paso County CHWs and the national CHW workforce; differences were found in average education level, wages for experienced CHWs, as well as primary target populace and target health issues. Future research should focus on cost-effectiveness of CHW utilization.^

Crack and powder cocaine federal legislation: A sentencing disparity and potential for policy improvement

Since its introduction into the United States in the 1980s, crack cocaine has been a harsh epidemic that has taken its toll on a countless number of people. This highly addictive, cheap and readily available drug of abuse has permeated many demographic sectors, mostly in low income, lesser educated, and urban communities. This epidemic of crack cocaine use in inner city areas across the Unites States has been described as an expression of economic marginality and “social suffering” coupled with the local and international forces of drug market economies (Agar 2003). As crack cocaine is a derivative of cocaine, it utilizes the psychoactive component of the drug, but delivers it in a much stronger, quicker, and more addictive fashion. This, coupled with its ready availability and cheap price has allowed for users to not only become very addicted very quickly, but to be subject to the stringent and sometimes unequal or inconsistent punishments for possession and distribution of crack-cocaine. ^ There are many public health and social ramifications from the abuse of crack-cocaine, and these epidemics appear to target low income and minority groups. Public health issues relating to the physical, mental, and economic strain will be addressed, as well as the direct and indirect effects of the punishments that come as a result of the disparity in penalties for cocaine and crack-cocaine possession and distribution. ^ Three new policies have recently been introduced into the United Stated Congress that actively address the disparity in sentencing for drug and criminal activities. They are, (1) Powder-Crack Cocaine Penalty Equalization Act of 2009, (HR 18, 111th Cong. 2009), (2) The Drug Sentencing Reform and Cocaine Kingpin Trafficking Act of 2009, (HR 265, 111th Cong. 2009) and (3) The Justice Integrity Act of 2009, (111th Cong. 2009). ^ Although they have only been initiated, if passed, they have potential to not only eliminate the crack-cocaine disparity, but to enact laws that help those affected by this epidemic. The final and overarching goal of this paper is to analyze and ultimately choose the ideal policy that would not only eliminate the cocaine and crack disparity regardless of current or future state statutes, but will provide the best method of rehabilitation, prevention, and justice. ^

U.S. school based sealant programs: Review of their most common characteristics

In the United States, dental caries is the most common chronic illness in children, occurring five to eight times as frequently as asthma. 11 Dental caries is an unmet health need, disproportionately affecting minority groups and individuals with low socio-economic status.15,34,36 School-Based Sealant Programs were developed to target children at risk, to provide dental services in a closer geographic area, to offer low cost preventive dental services, and to educate families about oral health and prevention.1 There is scientific, evidence based literature that shows the effectiveness of dental sealants preventing dental decay. 13^ Currently, there is no central source for cataloging School-Based Sealant Programs (SBSPs). Information is scattered around publications and documents. For instance, the National Health and Nutrition Examination Survey (NHANES) does not have information about all the existing SBSPs. ^ This literature review determined which are the most common characteristics of SBSPs in the U.S. and determined the extent to which these programs provide sealants to children of low socio-economic status. The method utilized was an electronic database search. Pubmed and EBESCO host databases were searched with Mesh terms like “dental school sealant programs”, “community dentistry”, “school based sealant programs” and “oral preventive programs”. Results were organized in terms of location, population served, providers, funding source and data shared. ^ The searches produced 77 studies, from which 40 were included in this work. Only 18 U.S. states were represented in the results; however these findings are very consistent with the Best Practice Approach – School Based Sealant Programs3. Most of the SBSPs provide their services to children from low income families, and utilized the lower labor cost providers permitted by their state regulations. The author intends that this thesis work will become an aide in the development of future programs, and as evidence for the sustainability of these programs.^

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.^

Textos y contextos en narraciones orales de migrantes provincianos

La tesis se centra en el estudio de las narraciones orales de migrantes provincianos, afincados en el conurbano platense, desde 1940. Las narraciones orales se denominan, en esta tesis, de retroalimentación ya que narradores y receptores recrean su origen, sus estrategias de reinserción en una nueva comunidad y de supervivencia de sus tradiciones. Estos textos han sido considerados de acuerdo con su problemática genérica (Bajtin; 1979) como narraciones de ficción (cuentos, chistes, fábulas) y de no-ficción (crónicas personales, anécdotas) y, asimismo, observar procesos de entextualización, cuando una misma narración presenta caracteres de ambas clasificaciones. De este modo, cada texto delimita su género en la situación de narración (Bauman y Briggs: 2003) Dichas narraciones deben ser analizadas por sus contextos de enunciación (Bausinger: 1988, 8-28). Los contextos de enunciación, según Hermann Bausinger, son textual, la conversación en sí misma, situacional, las circunstancias de emisores y receptores, social, del grupo de narración, de su grupo de pertenencia y de los grupos con los que interactúa, y societal, en cuanto a las relaciones con la sociedad mayoritaria son fundamentales al punto de que dos versiones de una misma narración se analizan de acuerdo con contextos de enunciación diferentes, con significaciones sociales disímiles. Dentro de los contextos de enunciación, la tesis propone el análisis del contexto ideológico (Coto: 2008), como signo de la intersubjetividad entre narradores y receptores. El contexto ideológico se analiza a partir de la selección de lexemas relevantes con sus definiciones contextuales, para constituir redes de enunciados, que revelan la ideología de narradores y receptores. La tesis propone establecer una matriz ideológica individual y grupal, observando los lexemas recurrentes en versiones de una misma narración, sus adiciones, supresiones y cambios de significación. Además, los textos puede compararse de acuerdo con sus relaciones intratextuales, intertextuales y extratextuales, en el marco de la genética textual (Palleiro: 2004). Finalmente, la tesis propone una metodología de análisis de las narrativas orales, en el marco de la cultura popular, tradicional y folklórica, con la observación de estrategias narrativas y macrorreglas (Van Dijk: 1983), estilo y (Kerbrat-Orecchioni: 1983) y representatividad sociolingüística. (Van Dijk: 1999 y Magariños: 1993). Estas consideraciones prueban la importancia de esta tesis para los intelectuales dedicados al análisis del discurso y a la interpretación de discursos sociales de grupos minoritarios, es decir, docentes, narradores orales, sociólogos y antropólogos. Asimismo, puede ser muy útil para animadores culturales y comunicadores sociales. La tesis postula continuar estos estudios, observando las relaciones entre narrativas de ficción y de no ficción, como el rumor, la leyenda urbana y la crónica periodística

Textos y contextos en narraciones orales de migrantes provincianos

La tesis se centra en el estudio de las narraciones orales de migrantes provincianos, afincados en el conurbano platense, desde 1940. Las narraciones orales se denominan, en esta tesis, de retroalimentación ya que narradores y receptores recrean su origen, sus estrategias de reinserción en una nueva comunidad y de supervivencia de sus tradiciones. Estos textos han sido considerados de acuerdo con su problemática genérica (Bajtin; 1979) como narraciones de ficción (cuentos, chistes, fábulas) y de no-ficción (crónicas personales, anécdotas) y, asimismo, observar procesos de entextualización, cuando una misma narración presenta caracteres de ambas clasificaciones. De este modo, cada texto delimita su género en la situación de narración (Bauman y Briggs: 2003) Dichas narraciones deben ser analizadas por sus contextos de enunciación (Bausinger: 1988, 8-28). Los contextos de enunciación, según Hermann Bausinger, son textual, la conversación en sí misma, situacional, las circunstancias de emisores y receptores, social, del grupo de narración, de su grupo de pertenencia y de los grupos con los que interactúa, y societal, en cuanto a las relaciones con la sociedad mayoritaria son fundamentales al punto de que dos versiones de una misma narración se analizan de acuerdo con contextos de enunciación diferentes, con significaciones sociales disímiles. Dentro de los contextos de enunciación, la tesis propone el análisis del contexto ideológico (Coto: 2008), como signo de la intersubjetividad entre narradores y receptores. El contexto ideológico se analiza a partir de la selección de lexemas relevantes con sus definiciones contextuales, para constituir redes de enunciados, que revelan la ideología de narradores y receptores. La tesis propone establecer una matriz ideológica individual y grupal, observando los lexemas recurrentes en versiones de una misma narración, sus adiciones, supresiones y cambios de significación. Además, los textos puede compararse de acuerdo con sus relaciones intratextuales, intertextuales y extratextuales, en el marco de la genética textual (Palleiro: 2004). Finalmente, la tesis propone una metodología de análisis de las narrativas orales, en el marco de la cultura popular, tradicional y folklórica, con la observación de estrategias narrativas y macrorreglas (Van Dijk: 1983), estilo y (Kerbrat-Orecchioni: 1983) y representatividad sociolingüística. (Van Dijk: 1999 y Magariños: 1993). Estas consideraciones prueban la importancia de esta tesis para los intelectuales dedicados al análisis del discurso y a la interpretación de discursos sociales de grupos minoritarios, es decir, docentes, narradores orales, sociólogos y antropólogos. Asimismo, puede ser muy útil para animadores culturales y comunicadores sociales. La tesis postula continuar estos estudios, observando las relaciones entre narrativas de ficción y de no ficción, como el rumor, la leyenda urbana y la crónica periodística

Textos y contextos en narraciones orales de migrantes provincianos

La tesis se centra en el estudio de las narraciones orales de migrantes provincianos, afincados en el conurbano platense, desde 1940. Las narraciones orales se denominan, en esta tesis, de retroalimentación ya que narradores y receptores recrean su origen, sus estrategias de reinserción en una nueva comunidad y de supervivencia de sus tradiciones. Estos textos han sido considerados de acuerdo con su problemática genérica (Bajtin; 1979) como narraciones de ficción (cuentos, chistes, fábulas) y de no-ficción (crónicas personales, anécdotas) y, asimismo, observar procesos de entextualización, cuando una misma narración presenta caracteres de ambas clasificaciones. De este modo, cada texto delimita su género en la situación de narración (Bauman y Briggs: 2003) Dichas narraciones deben ser analizadas por sus contextos de enunciación (Bausinger: 1988, 8-28). Los contextos de enunciación, según Hermann Bausinger, son textual, la conversación en sí misma, situacional, las circunstancias de emisores y receptores, social, del grupo de narración, de su grupo de pertenencia y de los grupos con los que interactúa, y societal, en cuanto a las relaciones con la sociedad mayoritaria son fundamentales al punto de que dos versiones de una misma narración se analizan de acuerdo con contextos de enunciación diferentes, con significaciones sociales disímiles. Dentro de los contextos de enunciación, la tesis propone el análisis del contexto ideológico (Coto: 2008), como signo de la intersubjetividad entre narradores y receptores. El contexto ideológico se analiza a partir de la selección de lexemas relevantes con sus definiciones contextuales, para constituir redes de enunciados, que revelan la ideología de narradores y receptores. La tesis propone establecer una matriz ideológica individual y grupal, observando los lexemas recurrentes en versiones de una misma narración, sus adiciones, supresiones y cambios de significación. Además, los textos puede compararse de acuerdo con sus relaciones intratextuales, intertextuales y extratextuales, en el marco de la genética textual (Palleiro: 2004). Finalmente, la tesis propone una metodología de análisis de las narrativas orales, en el marco de la cultura popular, tradicional y folklórica, con la observación de estrategias narrativas y macrorreglas (Van Dijk: 1983), estilo y (Kerbrat-Orecchioni: 1983) y representatividad sociolingüística. (Van Dijk: 1999 y Magariños: 1993). Estas consideraciones prueban la importancia de esta tesis para los intelectuales dedicados al análisis del discurso y a la interpretación de discursos sociales de grupos minoritarios, es decir, docentes, narradores orales, sociólogos y antropólogos. Asimismo, puede ser muy útil para animadores culturales y comunicadores sociales. La tesis postula continuar estos estudios, observando las relaciones entre narrativas de ficción y de no ficción, como el rumor, la leyenda urbana y la crónica periodística

Rural to Urban Migration: A District Level Analysis for India

Based on the recent census data this paper analyses the district level rural to urban migration rates (both intra-state and the inter-state) among males and females separately. Both the rates are closely associated irrespective of whether the migrants originate from the rural areas within the state or outside the state. This would suggest that women usually migrate as accompanists of the males. Though many of the relatively poor and backward states actually show large population mobility, which is primarily in search of a livelihood, the mobility of male population is also seen to be prominent in the relatively advanced states like Maharashtra and Gujarat. Rapid migration of rural females within the boundaries of the states is, however, evident across most of the regions. The social networks, which play an important role in the context of migration are prevalent among the short distance migrants and tend to lose their significance with a rise in the distance between the place of origin and destination though there are some exceptions to this phenomenon. Besides the north-south divide in the Indian context is indeed a significant phenomenon with a few exceptions of metropolitan cities. As regards the effect of factors at the place of destination, prospects for better job opportunities are a major determinant of male migration. Low castes and minority groups tend to pull migration through network effects. Among females also these effects are evident though with the inclusion of the male migration rate they become less significant. Finally the paper brings out the policy implications.