Carol Cristina Guarnizo-Herreño

Explaining Racial/Ethnic Disparities in Children’s Dental Health: A Decomposition Analysis

OBJECTIVES We measured racial/ethnic inequalities in US childrens dental health and quantified the contribution of conceptually relevant factors. METHODS Using data from the 2007 National Survey of Childrens Health, we investigated racial/ethnic disparities in selected child dental health and preventive care outcomes. We employed a decomposition model to quantify demographic, socioeconomic, maternal health, health insurance, neighborhood, and geographic effects. RESULTS Hispanic children had the poorest dental health and lowest preventive dental care utilization, followed by Black then White children. The model explanatory variables accounted for 58% to 77% of the disparities in dental health and 89% to 100% of the disparities in preventive dental care. Socioeconomic status accounted for 71% of the gap in preventive dental care between Black children and White children and 55% of that between Hispanic children and White children. Maternal health, age, and marital status; neighborhood safety and social capital; and state of residence were relevant factors. CONCLUSIONS Reducing US childrens racial/ethnic dental health disparities-which are mostly socioeconomically driven-requires policies that recognize the multilevel pathways underlying them and the need for household- and neighborhood-level interventions.

Children's dental health, school performance, and psychosocial well-being.

OBJECTIVE To assess the effects of dental health on school performance and psychosocial well-being in a nationally representative sample of children in the US. STUDY DESIGN We analyzed data from the 2007 National Survey of Childrens Health for 40,752-41,988 children. The effects of dental problems and maternal-rated dental health on school performance and psychosocial well-being outcomes were evaluated using regression models adjusting for demographic, socioeconomic, and health characteristics. RESULTS Dental problems were significantly associated with reductions in school performance and psychosocial well-being. Children with dental problems were more likely to have problems at school (OR = 1.52; 95% CI: 1.37-1.72) and to miss school (OR = 1.42; 95% CI: 1.23-1.64) and were less likely to do all required homework (OR = 0.76; 95% CI: 0.68-0.85). Dental problems were associated with shyness, unhappiness, feeling of worthlessness, and reduced friendliness. The effects of dental problems on unhappiness and feeling of worthlessness were largest for adolescents between 15 and 17 years. CONCLUSION Preventing and treating dental problems and improving dental health may benefit child academic achievement and cognitive and psychosocial development.

Equidad de Género en el Acceso a los Servicios de Salud en Colombia

Objective Identifying gender-related inequities in gaining access to health services in the Colombian social health security system. Methods A two-stage evaluation of the National Household Survey was made, before and after the Colombian health system reform was implemented. Socioeconomic,needs, access to health services and financing variables were identified. A descriptive analysis of the variables was made, they were re-codified and new variables created. Bivariate analysis was done, comparing some variables by means of Chi2. Results Needs in health were felt more by women in both surveys. Differences between males and females in consultation for health problems were not significant in 1994; 73 % of the males and 81 % of the females were consulted in 2000 (p<0.0001). Regarding antecedents of having been hospitalised, the percentage of males and females using this service became reduced during 2000. Females used their own resources more as the source of financing services in 2000. People belonging to the 1st and 2nd quintiles used their own resources as financing source in terms of income levels. Conclusions Comparing both periods, total consultations became increased (more rapidly in females). Females had greater access to consultation services in 2000. Gender-related inequities in financing health services have still persisted, even after the reform was implemented.

Dentist Supply and Children’s Oral Health in the United States

OBJECTIVES We evaluated the relationship between dentist supply and childrens oral health and explored heterogeneity by childrens age and urbanicity. METHODS We obtained data from the 2007 National Survey of Childrens Health (>27,000 children aged 1-10 years; >23,000 children aged 11-17 years). We estimated the association between state-level dentist supply and multiple measures of childrens oral health using regression analysis adjusting for several child, family, and population-level characteristics. RESULTS Dentist supply was significantly related to better oral health outcomes among children aged 1 to 10 years. The odds of decay and bleeding gums were lower by more than 50% (odds ratio [OR]=0.46; 95% CI=0.23, 0.95) and 80% (OR=0.18; 95% CI=0.05, 0.76), respectively, with an additional dentist per 1000 population. The odds of a worse maternal rating of childs dental health on a 5-category scale from poor to excellent were lower by about 50% in this age group with an additional dentist per 1000 population (OR=0.51; 95% CI=0.29, 0.91). We observed associations only for children in urban settings. CONCLUSIONS Dentist supply is associated with improved oral health for younger children in urban settings.

Violencia por conflicto armado y prevalencias de trastornos del afecto, ansiedad y problemas mentales en la población adulta colombiana

BACKGROUND Violence in Colombia has a history of over 50 years. Between 1985 and 2012 an estimated of 220,000 Colombians have died and about 6,000,000 have been displaced by violence. OBJECTIVE To describe and compare the prevalence of some problems and mental disorders in the adult population in Colombia, taking into account the characteristics of the municipality, as regards its history of violence or armed conflict. METHODS The results for adults (over 18 years) of some problems and mental disorders were taken from the ENSM-2015. The municipalities were classified according to the presence and intensity of the conflict using the classification proposed by the CERAC. Disorders were measured using CIDI-CAPI, and problems with AUDIT, modified PCL (Post-Traumatic Stress Disorder Checklist). An estimate was also made of psychoactive substances consumption. RESULTS A total of 10,870 people were interviewed, of whom 5,429 had not changed residence. There was had permanent conflict in 21.8% of the municipalities, 65.5% had a discontinued conflict, and only 12.7% had been pacified or had no conflict. The intensity of the conflict was reported as high by 31.8% of the people. Violent municipalities have a higher prevalence of anxiety disorders, depression, possible Post-Traumatic Stress Disorder, and smoking. Alcohol consumption was more common in municipalities with less intense conflict. CONCLUSIONS The municipalities classified as having high levels of violence have a higher prevalence of mental disorders and the majority of the mental problems.

Inequidad en los años de vida potencial perdida, por departamentos en Colombia 1985-2005

Objetivo Describir las diferencias en los anos de vida perdidos en la expectativa de vida al nacer por Departamentos en Colombia, durante el periodo de estudio. Metodos Los datos sobre expectativa de vida al nacer por genero, fueron tomados del Departamento Administrativo Nacional de Estadistica (DANE) para los periodos: 1985-1990, 1995-2000 y 2000-2005. Los datos sobre el pais con la mejor expectativa de vida en el mundo fue tomado de los reportes de la Organizacion Mundial de la Salud. Los anos de vida perdidos en expectativa de vida (AVPP) fueron estimados a partir de las diferencias relativas entre valores regionales y los mejores valores del mundo para los periodos de estudio. Resultados El numero de AVPP tuvo una tendencia a disminuir en ambos generos durante el periodo de estudio. Sin embargo hubo Departamentos en los cuales los AVPP fueron mayores para mujeres que para hombres en los tres periodos. Adicionalmente, el peor quintil de AVPP tuvo un valor medio de 18,98 ±2,36 AVPP para hombres y 18,45+/-2,43 AVPP para mujeres en 1985-1990; 16,99+/-1,7 AVPP para hombres y 16,01+/1,46 para mujeres en 1995-2000; y 15,99+/-1,34 AVPP para hombres y 14,51 +/-0,96 AVPP para mujeres en 2000-2005. Los valores para el mejor quintil de AVPP fueron respectivamente para hombres y mujeres: 7,41+/-0,65; 8,34+/-0,65 en 1985-1990; 7,22+/-0,62 y 8,59+/-0,31 en 1995-2000; y 7,72+/ 0,58 y 8,89+/-0,67 en 2000-2005. Conclusiones Hubo diferencias en la expectativa de vida al nacer entre Departamentos y generos en los tres periodos estudiados. Hubo disparidad en el numero de AVPP, comparando con el mejor pais en el mundo, por Departamentos, durante los periodos de estudio.

Housing index, urbanisation level and lifetime prevalence of depressive and anxiety disorders: a cross-sectional analysis of the Colombian national mental health survey

Objectives To study socioeconomic inequalities in mental health in rural and urban Colombia, a country with a history of internal conflict and large socioeconomic inequalities. Recent survey data are available to study this understudied topic in a middle-income country. Methods Using data from 9656 respondents from the 2015 Colombian Mental Health survey, we investigated the association between lifetime prevalence of depressive and anxiety disorders and quality of dwellings and access to public services housing score (HS). We calculated the relative index of inequality (RII) and slope index of inequality (SII) for HS in urban and rural areas, adjusting for potential confounders and mediating factors. Outcomes The lifetime prevalence of anxiety and depression (combined) was 9.6% in urban versus 6.9% in rural areas (p<0.001). HS was not associated with prevalence of anxiety and depression in urban settings, whereas a higher HS (poorer housing quality) was associated with fewer mental disorders in rural areas in both univariate and multivariate models (multivariate RIIurban0.96 (95% CI 0.51 to 1.81); RIIrural0.11 (95% CI 0.04 to 0.32)). In rural areas, the prevalence of mental health problems was 12% points lower in persons living in the poorest quality dwellings than in those living in high-quality dwellings (SII −0.12 (95% CI −0.18 to −0.06)). Interestingly, within rural areas, persons living in ‘populated centres’ (small towns, villages) had a higher lifetime prevalence of any mental health disorder (9.8% (95% CI 6.9 to 13.6)) compared with those living in more isolated, dispersed areas (6.0% (95% CI 4.6 to 7.7)). Interpretation In rural Colombia, those living in the poorest houses and in dispersed areas had a lower prevalence of mental health problems. Further understanding of this phenomenon of a seemingly inverse association of prevalence of mental disorders with poverty and/or urbanisation in rural areas is needed. Particularly, considering the progressive urbanisation process in Colombia, it is important to monitor mental health in populations migrating to the cities.