Efficacy of Educational Interventions Targeting Primary Care Providers' Practice Behaviors: an Overview of Published Systematic Reviews

Objectives : Primary care providers (e.g., family physicians, pediatricians, registered nurses, physician assistants, and nurse practitioners) could play a pivotal role in the provision of preventive services, especially for very young children (younger than 3 years old) and population groups with limited access to dental care. Given the current problems with access to dental care among low-income Americans, we contend there is a need to involve nondental primary health care providers in screening for and preventing oral health problems. The objective of this overview is to present findings from systematic reviews on the efficacy of continuing medical education, printed educational material, academic outreach, reminders, and local opinion leaders on the adoption of new knowledge and practices by primary care providers. Methods : A search was conducted using the Cochrane Library and MEDLINE. The search aimed to locate systematic reviews published between January 1988 and March 2003. Two researchers independently extracted data and assessed study quality using a modified version of the QUOROM statement. Results : Eleven systematic reviews were included in this overview. The evidence from the included systematic reviews showed that formal continuing medical education (CME) and distributing educational materials did not effectively change primary care providers' behaviors. There are effective interventions available to increase knowledge and change behaviors of primary care providers, such as small group discussion, interactive workshops, educational outreach visits, and reminders. Conclusion : There is a limited knowledge base on the efficacy of the selected interventions on oral health screening by primary care providers. Considering the potential role of primary care providers in improving oral health of underserved populations, this research area should receive more attention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65255/1/j.1752-7325.2004.tb02747.x.pd

Recruitment, Development, and Retention of Dental Faculty in a Changing Environment

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153771/1/jddj002203372011751tb05026x.pd

Spatial Clustering based Meteorological Fields Construction for Regional Vulnerability Assessment

Chemical accidents have affected the social-environmental system. For the regional vulnerability assessment, which is the baseline work to assess the impact on the environment, a meteorological field is needed to determine how chemicals from multiple adjacent companies are propagated. In this study, we present the method of meteorological field based on the spatial cluster which is the main component of vulnerability assessment on regional chemical accident scenario. To integrate spatially dense chemical companies into a cluster, we adopt spatial clustering algorithms. Experiment result shows that DBSCAN-based approach reduces 80.5% total area of the meteorological field against brute-force algorithm, and shows good performance on the average of the overlap ratio, and utility ratio for clustering results

Risk indicators for dental caries using the International Caries Detection and Assessment System (ICDAS)

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73802/1/j.1600-0528.2006.00369.x.pd

Depot Medroxyprogesterone Acetate Use and Periodontal Health in 15‐ to 44‐Year‐Old US Females

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141038/1/jper1008.pd

Barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools: a systematic review

Background Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools. Methods Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines. Results A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers. Conclusion The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives

Obesity and Sugar‐sweetened Beverages in African‐American Preschool Children: A Longitudinal Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93655/1/oby.2008.656.pd

Fluid consumption and fluoride intake among children in the United States: Implications for water fluoridation *policy.

Current standards for water fluoridation in the U.S. have stood since 1962. Research on which current public policy is based was conducted in the 1940s and 50s. Since the 1980s, declines in dental caries and an increase in dental fluorosis have been observed. The literature indicates that children today are ingesting more fluoride than in the past. This dissertation aimed to evaluate assumptions pertaining to water fluoridation, with a focus on the fluid consumption among children in the U.S. Specific aims are: (1) to evaluate the relationship between fluid consumption among children and local climate, (2) to investigate the relationship of fluid consumption patterns and sociodemographic factors, (3) to estimate fluoride intake and to identify population groups with a risk of high fluoride intake, based on the fluid consumption patterns. A secondary analysis of data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988--1994) was conducted. Fluid consumption data was from a 24-hour dietary recall survey. Data for local climate from the US National Climatic Data Center was incorporated. Cluster analysis was conducted using SAS to determine fluid consumption patterns. Fluoride intake was estimated using assumptions of fluoride concentrations in drinking water and beverages. SUDAAN was used to adjust standard errors for the complex sampling design. This dissertation found that; (1) there is no evidence that fluid consumption is significantly related to local climate in modern conditions, (2) age, sex, race/ethnicity, and SES are significantly associated with children's fluid consumption patterns, (3) the amount of fluoride intake may vary greatly depending on fluid consumption patterns and sociodemographic characteristics. From the results, it is suggested that; (1) the current national temperature-related guidelines for fluoride concentration in drinking water may be due for re-evaluation, (2) fluid consumption patterns and sociodemographic factors should be considered in future research and public policy making for fluoride use, (3) the possibility of additional risk of fluorosis with supplement use should be recognized, and (4) a regulation to require the labeling of the fluoride content in beverages would help parents and health care providers to make informed decisions on their children's risk of fluorosis.Dr.P.H.DentistryHealth and Environmental SciencesPublic administrationPublic healthSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studies, School of Public Healthhttp://deepblue.lib.umich.edu/bitstream/2027.42/132523/2/9974997.pd

Factors Affecting Masticatory Performance of Older Adults Are Sex-Dependent: A Cross-Sectional Study

This cross-sectional study assessed the oral and physical factors contributing to improvement of the masticatory performance of community-dwelling older adults in South Korea. We enrolled 84 healthy older adults (38 men, 46 women; age, 71.40 ± 5.15 years) and assessed their skeletal muscle mass index (SMI), functional tooth units (FTUs), and mixing ability index (MAI). Associations between variables were analyzed using Spearman’s correlation coefficient, and the effects of SMI and FTUs on the MAI were evaluated through linear multiple regression. FTUs were positively associated with the MAI in men and women (r = 0.339, p = 0.038 and r = 0.461, p = 0.001, respectively). SMI and FTUs were moderately associated in men (r = 0.459, p = 0.004). MAI showed an approximately 4.4 times increase for each FTU in men (B = 4.442, p = 0.037); however, after the SMI was added, this effect was no longer significant. In women, the MAI increased by about 6.7 times with each FTU (B = 6.685, p = 0.004). FTUs had a significant effect on the MAI only in women with low muscle mass. While there was no significant effect of the SMI on the MAI, its influence should not be overlooked

Resilience to Urban Poverty: Theoretical and Empirical Considerations for Population Health

Objectives. To better understand the trajectory that propels people from poverty to poor health, we investigated health resilience longitudinally among African American families with incomes below 250% of the federal poverty level