RESUMEN
Secondary data sources are used to describe the ICS-II USA research locations in terms of external environment, dental care delivery system, and population sociodemographics. The Native American reservations located in Arizona, New Mexico, and South Dakota were rural, while the other research locations were primarily urban. Baltimore, Maryland, and the Native American communities had fluoridated water, but San Antonio did not. Dental services in Baltimore and San Antonio were predominantly financed by private sources, with a small public health component. Dental care services in Native American communities were largely Indian Health Services (IHS) financed by the US Government. Each geographical area exhibited diverse characteristics indicating unique challenges for the delivery of community and clinical dental services.
Asunto(s)
Atención a la Salud , Servicios de Salud Dental/provisión & distribución , Investigación Dental , Investigación sobre Servicios de Salud , Adulto , Negro o Afroamericano/estadística & datos numéricos , Anciano , Baltimore , Atención a la Salud/economía , Servicios de Salud Dental/economía , Accesibilidad a los Servicios de Salud , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Indígenas Norteamericanos/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Factores Socioeconómicos , Sudoeste de Estados Unidos , Texas , Estados Unidos , United States Indian Health Service , Población Blanca/estadística & datos numéricosRESUMEN
Clinically evaluated oral health outcome variables from the ICS-II USA data set were examined in the diverse ethnic groups, for two adult age cohorts (35-44 and 65-74 years). These measures were derived from epidemiological examinations and include the DMFT components, loss of attachment, and an indicator of treatment need--the ratio of decayed teeth over decayed and filled teeth. The ratio of decayed over decayed and filled teeth was used in multivariate analysis, since this measure represents an area where public policy could have an impact if determinants were understood. The most important independent variables were race-ethnicity, educational attainment, no fear of dental visits because of pain, and oral hygiene practices. Having a usual source of dental care and visiting the dentist within the past 12 months did not appear to be as important in predicting unmet needs as these other variables. To bridge the gap between the oral health status of majority and minority populations, health educators in minority communities need to become more accessible, have a pro-active interest in oral health, and also be cognizant of the various socio-cultural issues influencing oral health. The problems regarding Native American adults are more complex and require more careful study.
Asunto(s)
Caries Dental/epidemiología , Necesidades y Demandas de Servicios de Salud , Adulto , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Anciano , Baltimore/epidemiología , Índice CPO , Cuidado Dental para Ancianos , Caries Dental/etnología , Servicios de Salud Dental/estadística & datos numéricos , Escolaridad , Femenino , Política de Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Indígenas Norteamericanos , Masculino , Higiene Bucal/métodos , Higiene Bucal/estadística & datos numéricos , Pérdida de la Inserción Periodontal/epidemiología , Pérdida de la Inserción Periodontal/etnología , Factores Sexuales , South Dakota/epidemiología , Sudoeste de Estados Unidos/epidemiología , Texas/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
Patient satisfaction with dental care is compared across six United States groups: Whites in Baltimore and San Antonio, African-Americans in Baltimore, Hispanics in San Antonio, and Native Americans in the Southwest and the Dakotas. First, differences in patient satisfaction across ethnic groups and between two age groups (65-74 years old and 35-44 years old) are considered. Generally, people from all age and ethnic groups were satisfied with the last dental visit. Second, patient satisfaction is conceptualized as an oral health outcome influenced by characteristics of the dental service utilizer: predisposing sociodemographic characteristics, predisposing oral beliefs, enabling characteristics, oral needs, oral health behaviors, and oral health status. Multivariate analyses by age and ethnic group are used to identify characteristics that influence patient satisfaction. Sociodemographic characteristics were important among the elderly. Strong oral health beliefs influenced patient satisfaction among younger adults. Enabling characteristics were important predictors among the Native American groups. This model explained 15%-30% of the variability in patient satisfaction among the study age and ethnic groups.
Asunto(s)
Atención Odontológica/psicología , Satisfacción del Paciente/etnología , Adulto , Negro o Afroamericano/psicología , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Anciano , Actitud Frente a la Salud/etnología , Baltimore , Estudios de Cohortes , Atención Odontológica/estadística & datos numéricos , Cuidado Dental para Ancianos/psicología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Indígenas Norteamericanos/psicología , Indígenas Norteamericanos/estadística & datos numéricos , Masculino , Satisfacción del Paciente/estadística & datos numéricos , Análisis de Regresión , Factores Sexuales , Factores Socioeconómicos , South Dakota , Sudoeste de Estados Unidos , Encuestas y Cuestionarios , Texas , Estados Unidos , United States Indian Health Service , Población Blanca/psicología , Población Blanca/estadística & datos numéricosRESUMEN
Racial-ethnic group differences are assessed using a standardized set of oral health indicators, as well as various predisposing, enabling and need characteristics collected in the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations. The unique data set contains comparable data on African-American, Native American, Hispanic, primarily Mexican-American, and White adults. Age group differences in oral health indicators are also compared in two adult age cohorts (35-44 and 65-74 years). Since data were collected from geographically diverse regions of the United States, differences in oral health indicators are considered within the context of different dental care delivery systems and external environments. Results indicate that the gap in oral health between Whites and ethnic minority groups is pervasive across research locations and age cohorts. Variation in regional dental care delivery systems and the varying effects of race-ethnicity and age cohort suggest that alternative health promotion strategies will be needed for improving oral health in diverse populations.
Asunto(s)
Etnicidad/estadística & datos numéricos , Salud Bucal , Evaluación de Resultado en la Atención de Salud , Adulto , Negro o Afroamericano , Distribución por Edad , Anciano , Atención a la Salud , Encuestas de Salud Bucal , Femenino , Necesidades y Demandas de Servicios de Salud , Indicadores de Salud , Hispánicos o Latinos , Humanos , Indígenas Norteamericanos , Masculino , Persona de Mediana Edad , Estados Unidos , Población BlancaRESUMEN
This essay examines the encounters between clients and public health nurses hired by the Office of Indian Affairs to work on American Indian reservations during the 1930s. It relies on two different types of sources. The first are the accounts of the nurses, including letters, memoirs, and above all their monthly and annual reports to Washington. The second are oral histories conducted by the authors with elderly residents of two Sioux reservations in South Dakota during August 1993. One of the key missions of the public health nurses was to inculcate Euro-American beliefs. They assumed that American Indians would follow a linear progression from understanding the 'rules of health' to the eradication of all traditional practices. That model left no room for ambiguity or syncretism. The Sioux viewed the nurses as resources to be used strategically and selectively. Those who accepted the nurses' services did so because the services addressed specific needs the Sioux themselves defined as important. Most disregarded the health education programme insofar as it assumed the superiority of Euro-American values.
Asunto(s)
Indígenas Norteamericanos/historia , Educación del Paciente como Asunto/historia , Enfermería en Salud Pública/historia , Enfermería Transcultural/historia , United States Indian Health Service/historia , Agencias Gubernamentales/historia , Historia del Siglo XX , Relaciones Raciales/historia , Estados UnidosRESUMEN
The purpose of this study was to evaluate the oral health status, treatment needs, and dental care utilization patterns of a Native American population aged 65-74 years. A random sample of 688 individuals was chosen and approached regarding participation in the study. Data were gathered through an interviewer-administered questionnaire and an oral examination. A total of 204 individuals completed all aspects of the study. Only one participant had all 28 natural teeth, while 58.3 percent were totally endentulous. Of the 85 dentate participants, almost 53 percent required at least one extraction. The average number of required extractions in the dentate subjects was three. Although 94 percent of the sample stated they had a usual source of dental care, 40.7 percent had not visited a dentist within the last five years. Multiple regression analyses were used to determine the factors associated with total number of teeth present among the dentate participants. Years of education and time since last dental visit were the two significant predictors (P less than .05) of number of teeth present. The higher the level of education, the greater the number of teeth in later life. The number of teeth present was inversely related to years since dental treatment. Compared to the results of the National Survey of Oral Health in US Employed Adults and Seniors, this Native American sample had a higher prevalence of endentulism and utilized dental services less often than a comparable age group in the US population as a whole.