Biomedical subjects

R P Duncan

Publications and source records attributed to R P Duncan.

At least 19 recordsLinked to original sources

PubMed1999

Patterns of change in self-reported oral health among dentate adults.

BACKGROUND: Although self-assessments of oral health have become useful tools in dental research, the use of self-reports to study changes in oral health over time has been limited. The aim of this investigation was to describe how oral disease and tissue damage, pain, functional limitation, disadvantage, and self-rated oral health change over time. METHODS: The Florida Dental Care Study (FDCS) (n = 873) is a longitudinal study of oral health among dentate adults (age, > or = 45 years). Incidence rates and transition probabilities were used to describe changes in oral health over a 24-month period. RESULTS: The probability of reporting a specific problem during the 24-month study ranged from 0.52 for perceived need for dental care to 0.07 for avoided eating with others. Only dental sensitivity and perceived need for dental care had transition probabilities >0.20. Decomposition of transition probabilities revealed moderate probabilities of onset coupled with relatively high probabilities of recovery. CONCLUSION: Although oral health status is clearly dynamic, no individual measure exhibited profound fluctuation. Most oral health problems were episodic rather than chronic. Patterns of change in oral health varied across dimensional lines.

Adult↗

PubMed1999

Tooth-specific and person-level predictors of 24-month tooth loss among older adults.

OBJECTIVES: To describe: (1) the 24-month incidence of tooth loss in a diverse sample of dentate adults; and (2) the clinical, attitudinal, behavioral, and sociodemographic correlates of tooth loss incidence. METHODS: The Florida Dental Care Study is a prospective longitudinal cohort study of persons who at baseline had at least one tooth, were 45 years or older, and who resided in north Florida. An in-person interview and clinical examination were conducted at baseline and 24-months after baseline, with 6-monthly telephone interviews between those times. A two-level hierarchical generalized linear regression (logit model) was used to quantify tooth-specific and person-level factors simultaneously. RESULTS: Of the 739 persons who attended for a 24-month examination, 24% lost one or more teeth during follow-up. Tooth loss was more common in persons with dental disease at baseline, incident dental signs or symptoms, those with negative attitudes toward dental care and dental health, those with limited financial resources, older adults, blacks, females, and problem-oriented users of dental care (as distinct from regular attenders). Although disease presence at baseline was a major factor associated with incident tooth loss, most diseased teeth were in fact still present 24 months after baseline. CONCLUSIONS: Other than periodontal attachment loss, severe tooth mobility, and dental caries, no single factor was a dominant predictor of tooth loss; instead, numerous factors made statistically significant but small contributions to variation in tooth loss. Tooth loss apparently is the result of complex interactions among dental disease, incident dental signs and symptoms, tendency to use dental care in response to specific dental problems, dental attitudes, and ability to afford non-extraction treatment alternatives.

Aged↗

PubMed1998

Determinants of dental care use in dentate adults: six-monthly use during a 24-month period in the Florida Dental Care Study.

The objective of this study is to describe for a diverse sample of dentate adults the incidence of dental care use and predisposing, enabling, and need correlates of that use. The Florida Dental Care Study (FDCS) is a prospective longitudinal cohort study of persons who at baseline had at least one natural tooth, were 45 years or older, and who resided in north Florida, U.S.A. An in-person interview and clinical dental examination were conducted at baseline and 24 months after baseline, with 6-monthly telephone interviews between those times. Seventy-seven percent of subjects reported one or more dental visits during the 24 months of follow-up. Six-monthly use ranged from 46% to 55%. Incident perceived need for care and certain incident self-reported oral signs and symptoms were strongly predictive of incident dental care use. Decrements in oral functional limitation, oral disadvantage, and self-rated oral health were predictive of less care bivariately, but were not salient in a multivariate model, with two notable exceptions: two measures related to esthetics. The conclusions are that certain measures of need (perceived need and specific self-reported signs and symptoms) were important predictors of incident dental care. However, persons with need as determined by direct clinical examination and persons with need as determined by self-reported decrements in the more distal measures of oral health (oral functional limitation, oral disadvantage, and self-rated oral health) were actually less likely to seek dental care. The salience of esthetics in predicting use is consistent with cross-sectional findings that dental esthetic cues are important to oral "health". Typical approach to care, dental attitudes, ability to pay for care, race, and sex were also important for understanding incident dental care use.

Dental Care↗

PubMed1998

Satisfaction with chewing ability in a diverse sample of dentate adults.

The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. Two objectives of the FDCS were to: (i) describe satisfaction with chewing ability in a diverse sample of dentate adults; and (ii) quantify the associations between satisfaction with chewing ability and other measures of oral health. Approximately 16% of subjects reported that they were dissatisfied or very dissatisfied with their chewing ability. Bivariate and multivariate results provided consistent evidence of the construct validity of a proposed multi-dimensional model of satisfaction with chewing ability. Multiple regression analysis suggested that dissatisfaction with chewing ability was independently associated with 12 specific clinical and self-reported measures of oral disease/ tissue damage, pain, functional limitation, and disadvantage. The self-reported measures of oral health and the proposed model of satisfaction with chewing ability improve our understanding of this important oral health outcome in diverse population groups.

Aged↗

PubMed1998

Multidimensionality of oral health in dentate adults.

OBJECTIVES: An understanding of the validity and usefulness of self-reported measures (as distinct from clinically determined measures) of oral health is emerging. These self-reported measures include self-rated oral health (SROH). Three objectives were to: (1) describe self-rated oral health in dentate adults, (2) quantify associations between self-rated oral health and other measures of oral health (oral disease and tissue damage, pain and discomfort, functional limitation, and disadvantage), and (3) assess the construct validity of a model of oral health proposed herein. METHODS: The Florida Dental Care Study is a longitudinal study of oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. RESULTS: The prevalence of self-rated oral health decrements was substantial; approximately one fourth of subjects reported their oral health as only fair or poor. Bivariate and multivariate results provided consistent evidence of the construct validity of the proposed model of oral health. Additionally, the salience of one measure of dental appearance suggests that persons may use esthetic cues when rating their oral health. CONCLUSIONS: The proposed multidimensional model of oral health has construct validity. Self-rated oral health is affected by oral disease and tissue damage, oral pain and discomfort, oral functional limitation, and oral disadvantage. These self-reported measures and the proposed model should provide useful information for dental care effectiveness research. General health status has been disaggregated into the "physical" and the "mental;" an additional separation into the "oral" aspects of health seems warranted.

Aged↗

PubMed1998

Evaluation for an observation effect in a prospective cohort study of oral health outcomes.

OBJECTIVES: Evaluation for changes in behavior due to research participants' knowledge that behavior is being observed (also referred to as a Hawthorne effect or reactivity) has received little attention in the dental literature. The Florida Dental Care Study, a prospective, non-randomized, longitudinal study of oral health outcomes, provides some inferential power to evaluate for an effect on dental care use due to participants' knowledge that this behavior was being observed. The purpose of this paper is to document that an observation effect can occur in dental studies, and to estimate its magnitude in four groups that were defined by their typical approach to dental care as stated at baseline: consistent regular attenders (CRAs); inconsistent regular attenders (IRAs); consistent problem-oriented attenders (CPOAs); and inconsistent problem-oriented attenders (IPOAs). METHODS: At baseline, 873 respondents with at least one natural tooth and who were 45 years of age or older participated for an interview and clinical dental examination. Respondents were asked about their dental care use in general and check-up use in particular at 6-month intervals over a period of 24 months. RESULTS: Dental care use in general and check-up use in particular varied across time points and across the four groups of the sample. There was some stimulation in dental care use for the sample overall, but by the 18-to-24-month period, use had returned to baseline levels. In a direction opposite from that hypothesized, results from the CRAs suggested decreased use of dental care over the course of the 24 months of observation. No consistent pattern was evident for the IRAs, CPOAs, or IPOAs. CONCLUSIONS: An observation effect was evident, but was modest in magnitude and differed within and between sub-groups of the sample. While self-selection into dental care user groups is an expected and desirable feature of this design, the size of the user/non-user groups was affected for some subgroups. We conclude that dental care studies with the potential for an observation effect should evaluate for this effect by distinguishing sub-groups of the sample based on their propensity (as stated at baseline) to use dental care. These differential effects across sub-groups should be taken into account as inferences are made.

Chi-Square Distribution↗

PubMed1998

Taking dental self-care to the extreme: 24-month incidence of dental self-extractions in the Florida Dental Care Study.

OBJECTIVE: A common response to health-related symptoms is to treat oneself in lieu of or prior to seeking formal health care. Among the more extreme forms of dental self-care is dental self-extraction. To our knowledge, no study of the incidence of this behavior has been conducted. The objective of this study was to determine if one form of dental self-care, dental self-extraction, is a real phenomenon, and if so, to determine its incidence. METHODS: The Florida Dental Care Study is a longitudinal study of changes in oral health, whose subjects participated for an interview and clinical examination at baseline and 24 months after baseline. RESULTS: Of the 739 persons who participated through 24 months 176 lost one or more teeth. Of these 176 persons, 13 (7%) extracted one or more of their own teeth. The clinical status at baseline of the self-extracted teeth was consistent with the ability to self-extract. CONCLUSION: The phenomenon of dental self-extraction is real and is not limited to residents of developing nations or geographically isolated areas. Because of the potential for prolonged bleeding or bacterial endocarditis in certain population groups, community health clinicians and officials should be cognizant of this behavior.

Age Factors↗

PubMed1998

Oral functional limitation among dentate adults.

OBJECTIVES: The purpose of this study was to measure the prevalence of oral functional limitation in adults and to identify clinical and sociodemographic factors associated with that limitation. METHODS: The Florida Dental Care Study is a longitudinal study of risk factors for changes in oral health. Subjects (n = 873) with at least one tooth who were 45 years old or older participated in a baseline in-person interview and dental examination. Subjects were queried about oral functional limitations. RESULTS: Twenty-three percent of subjects reported difficulty chewing one or more foods using a five-item chewing index, and 10 percent reported difficulty speaking or pronouncing words because of problems with the mouth. The covariates in a multiple logistic regression identified as being significantly associated with chewing difficulty were fewer pairs of occluding anterior teeth, fewer pairs of occluding posterior teeth, more posterior teeth that are root tips, more anterior teeth that are mobile, reporting tooth pain, reporting bad breath, having but not wearing prosthetic appliances, reporting dry mouth, and being female. Having fewer anterior teeth, reporting a sore and/or broken denture, reporting unattractive teeth, and being black were significantly associated with speaking difficulty/difficulty pronouncing words because of problems with the teeth, mouth, or dentures. CONCLUSIONS: The findings in this study suggest a significant prevalence of oral functional limitation in dentate adults. Certain clinical and sociodemographic factors were strongly and independently associated with its presence.

Aged↗

PubMed1997

Differences by race in the decline of health over time.

Previous research on race differences in health, we believe, has failed to take into account the initial state of health of the respondents. Other research has demonstrated that elders in poor health are more likely to experience a change in their health over time. It is unclear if the greater probability of decline in health observed among African Americans is a result of being more likely to begin such observations in health states that are worse than those for Whites. This investigation examines declines in health over a 30-month period in a sample of African American and White elders who began the study in similar "good health." Findings support the supposition that African Americans are more likely to report a decline in their health, regardless of the health measure used. Differences by race in the decline of health appear to be a consequence of economic and educational discrepancies between the two groups.

Black or African American↗

PubMed1997

Isolation and characterization of MPM-2-reactive sperm proteins: homology to components of the outer dense fibers and segmented columns.

Sperm from most mammalian species catalyze the formation of an aster of microtubules in the oocyte after fertilization. One component that may be involved in the regulation of sperm centrosomal activity in the oocyte is a phosphorylated protein complex (MPM-2-reactive sperm protein; MSP) with a molecular mass of 77-85 kDa identified by the MPM-2 antibody. The objective of this study was to compare the MSPs to a previously identified 85-kDa complex (ODF/CP85) that is a component of the outer dense fibers of the sperm midpiece and the segmented columns of the connecting piece. MSPs were isolated from boar sperm using a differential extraction procedure and preparative gel electrophoresis. Three mouse monoclonal and rabbit polyclonal antibodies were made to the isolated complex, and these antibodies labeled similar proteins in rabbit, bull, boar, and mouse sperm. Extraction and solubilization procedures for MSPs and ODF/CP85 required harsh chaotropic and reducing conditions. In addition to migrating at the same molecular mass on gels, proteins from each preparation labeled with MPM-2, an anti-ODF/CP antibody, and the anti-MSP antibody prepared in this study. Amino acid composition was similar to that reported previously for rat and bull ODF/CP85. Furthermore, immunolocalization by both fluorescent and transmission electron microscopy indicated that the MSPs are components of the outer dense fibers and probably the segmented columns of the connecting piece. Taken together, these results indicate that the MSPs are the previously identified 85-kDa complex of the outer dense fibers and connecting piece. Therefore, it is likely that any involvement of these proteins in the regulation of sperm centrosomal activity is through the process of connecting piece disassembly.

Amino Acids↗

PubMed1997

Dental health attitudes among dentate black and white adults.

OBJECTIVES: Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use. METHODS: As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried. RESULTS: Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account. CONCLUSIONS: Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.

Black or African American↗

PubMed1997

Oral disadvantage among dentate adults.

Oral disadvantage can be defined as the avoidance of certain daily activities because of decrements in oral health. These decrements include oral disease and tissue damage, pain, and functional limitation. The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least 1 tooth, were 45 years old or older, and who participated for an interview and clinical examination. Three objectives of the FDCS are: (1) to describe selected psychometric properties of the measurement of oral disadvantage; (2) to describe oral disadvantage in a diverse sample of dentate adults; and (3) to describe the relationship between disadvantage and other aspects of oral health, such as disease/tissue damage, pain, and functional limitation. The prevalence of oral disadvantage within the previous 6 months, using eight self-reported measures, ranged from 5% to 25%, depending upon the measure. Factor analysis suggested that oral disadvantage is best described as three factors: disadvantage due to (1) oral disease/tissue damage, (2) oral pain, and (3) oral functional limitation. Irregular dental attenders, poor persons, and blacks had the highest prevalence of oral disadvantage. Clinical measures of oral disease/tissue damage, self-reported measures of oral disease/tissue damage, oral pain, and oral functional limitation were strongly associated with the presence of oral disadvantage. In multivariate analyses that accounted for differences in clinical measures of disease/tissue damage, self-reported disease/tissue damage, oral pain, and oral functional limitation, females were more likely to report disadvantage due to disease/tissue damage, and middle-aged persons and irregular dental attenders were more likely to report oral disadvantage due to pain. In these same regressions, differences in disadvantage due to race, poverty status, socioeconomic status, and rural/urban area of residence were not evident. These results have implications regarding the use of oral disadvantage to assess the long-term effectiveness of dental care.

Activities of Daily Living↗

PubMed1997

Rural-urban comparisons of age and health at the time of nursing home admission.

This study re-examines the contention that rural elders admitted to nursing homes are younger and healthier than their counterparts who enter urban facilities. The analysis uses interview data gathered in both urban and rural nursing homes. Residents were interviewed at or near the time of admission regarding their health and circumstances immediately prior to entering the nursing home. The findings indicate few and modest differences between urban and rural residents. In those instances where differences are observed, there is ambiguity--some measures indicate lower health status in the case of rural residents, while others suggest that urban residents are more likely to report health impairments. The divergence of these findings from earlier research may be due to differences in the study populations, measurement differences, or, more likely, that policies and processes have changed over time.

Activities of Daily Living↗

PubMed1997

Evaluation of bias and logistics in a survey of adults at increased risk for oral health decrements.

OBJECTIVES: Designing research to include sufficient respondents in groups at highest risk for oral health decrements can present unique challenges. Our purpose was to evaluate bias and logistics in this survey of adults at increased risk for oral health decrements. METHODS: We used a telephone survey methodology that employed both listed numbers and random digit dialing to identify dentate persons 45 years old or older and to oversample blacks, poor persons, and residents of nonmetropolitan counties. At a second stage, a subsample of the respondents to the initial telephone screening was selected for further study, which consisted of a baseline in-person interview and a clinical examination. We assessed bias due to: (1) limiting the sample to households with telephones, (2) using predominantly listed numbers instead of random digit dialing, and (3) nonresponse at two stages of data collection. RESULTS: While this approach apparently created some biases in the sample, they were small in magnitude. Specifically, limiting the sample to households with telephones biased the sample overall toward more females, larger households, and fewer functionally impaired persons. Using predominantly listed numbers led to a modest bias toward selection of persons more likely to be younger, healthier, female, have had a recent dental visit, and reside in smaller households. Blacks who were selected randomly at a second stage were more likely to participate in baseline data gathering than their white counterparts. Comparisons of the data obtained in this survey with those from recent national surveys suggest that this methodology for sampling high-risk groups did not substantively bias the sample with respect to two important dental parameters, prevalence of edentulousness and dental care use, nor were conclusions about multivariate associations with dental care recency substantively affected. CONCLUSIONS: This method of sampling persons at high risk for oral health decrements resulted in only modest bias with respect to the population of interest.

Adult↗

PubMed1997

Validity of self-reported tooth counts during a telephone screening interview.

OBJECTIVES: Telephone screening has become a common method used in health services research to identify efficiently persons in specific populations of interest. In this research, we used a large-scale telephone screening survey to assess: (1) the effectiveness of the telephone method in gathering tooth count information by measuring response rate (cooperation) to specific questions and (2) the validity of subjects' reports of the number of remaining natural teeth. METHODS: We used a telephone screening methodology to identify dentate persons (at least one natural tooth remaining) who were 45 years old or older and resided in one of four counties of north Florida. At a second stage, a sample of the telephone screening participants was selected for further study, which consisted of a baseline in-person interview and a clinical examination. We compared the number of remaining teeth reported during the telephone interview with the number determined at baseline examination. RESULTS: The telephone method was effective at gathering tooth count information, although response rates varied with the level of specificity required. Almost all subjects reported the number of teeth at least at the nominal and ordinal levels, but fewer than three-fourths reported the number at the interval level. When the unit of analysis was the overall sample, self-reported number of teeth was a valid measure of the true number. When the unit of analysis was the individual subject, validity was associated with certain clinical and sociodemographic factors. CONCLUSIONS: When the unit of analysis is the overall sample, these results suggest that self-reported tooth counts during a telephone interview are sufficiently valid to meet all but the most stringent data requirements. When the unit of analysis is the individual subject, these tooth counts may not be valid, depending upon the degree of specificity required and subject characteristics.

Age Factors↗

PubMed1997

Race differences in the health of elders who live alone.

This investigation was initiated to determine whether older African Americans who live alone are in poorer health than their White counterparts who live under the same circumstances. Data on 5 measures of health were collected in telephone interviews with a stratified random sample of community-dwelling elders (n = 1,189). Analysis of weighted data indicate that there were fewer differences in health by race among older persons who lived alone compared to elders who lived with others. Where racial differences in health did exist among older adults who lived alone, the differences could only sometimes be accounted for by population composition factors that are known to influence health.

Activities of Daily Living↗

PubMed1996

Coronal caries, root fragments, and restoration and cusp fractures in US adults.

The Florida Dental Care Study is a longitudinal study of changes in oral health that included at baseline 873 subjects (Ss) who had at least 1 tooth, were 45 years or older, and participated for an interview and examination. Forty-five percent of Ss had active coronal caries; 94% of the coronal carious surfaces were primary decay, and only 6% were secondary/recurrent. Ten percent of Ss had 1 or more root fragments, 16% of Ss had 1 or more teeth with restoration fractures, and 14% of Ss had 1 or more teeth with cusp fractures. Blacks, poor persons, and irregular attenders had more caries, root fragments, and cusp fractures, even though they had significantly fewer teeth. Blacks, poor persons, and irregular attenders were not at increased risk for restoration fractures, probably because fractures were associated with dental care use. These findings regarding caries and restorative treatment needs are consistent with a substantial burden in adult high-risk groups, and are relevant for dental primary health care policy.

Aged↗

PubMed1995

Job satisfaction of nurses employed in rural and urban long-term care facilities.

Previous investigators have identified residential differences in the job satisfaction of hospital nurses. However, the degree to which the greater job satisfaction of rural nurses can be generalized beyond hospitals to other work settings, including nursing homes, is unknown. The purpose of this research was to examine the job satisfaction of nurses (registered and licensed practical) employed in both rural and urban nursing homes. A total of 281 nurses from 26 participating nursing homes completed a mailed questionnaire that measured the personal and job-specific characteristics of the nurses and the contextual properties of the facilities in which they worked. The data indicated no statistically significant differences in the overall job satisfaction, or on any of the five subscales of the instrument, between rural and urban nurses. However, a pooled multivariate model identified five factors that predicted the job satisfaction of nurses employed in long-term care facilities: the employees' race and personal income; the employees' perception that their supervisor was interested in their career aspirations; the length of time that the nurses had intended to stay at the time of their hiring; and their current intent to leave.

Adult↗