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Biomedical subjects

P L Davidson

Publications and source records attributed to P L Davidson.

At least 19 recordsLinked to original sources
PubMed2005

Clinical characteristics of an anatomical hand index measured in patients with rheumatoid arthritis as a potential outcome measure.

OBJECTIVES: To determine the clinical characteristics of an anatomical hand index previously reported as a potential measure of joint deformity and outcome in patients with rheumatoid arthritis. METHODS: The hand index (open hand span - closed hand span/lateral height of the hand) was measured in a cross-sectional study of 145 out-patients with rheumatoid arthritis with disease durations 0-55 yr. Subsets of patients were restudied at mean follow-ups of approximately 9 months and 4 yr. RESULTS: The hand index fell gradually with disease duration. Correlations were demonstrated with the Sharp index (r = - 0.39, P = 0.000) and to a lesser extent with disease activity score (r = - 0.28, P = 0.001). At 260 +/- 115 days the hand index worsened by 0.09 units (P = 0.09, NS). At 51.6 +/- 5.4 months the index showed a fall from 1.96 +/- 0.73 to 1.61 +/- 0.65 (P = 0.000). During the same interval the Sharp index increased from 60 +/- 68 to 80 +/- 71 (P = 0.000). CONCLUSIONS: Measurement of simple hand dimensions can demonstrate worsening of hand deformity with time in patients with rheumatoid arthritis. We suggest that more sophisticated analysis of digital hand images, as used in our original study, might yield additional information and increase the sensitivity of an anatomical hand index as an outcome measure in rheumatoid arthritis.

Anthropometry↗
PubMed2003

Biomechanical analysis of arm fracture in obese boys.

OBJECTIVE: To determine the role of the biomechanical factors of force of impact, bone strength, fall height and surface stiffness on the risk of forearm fracture in obese children compared to non-obese children. METHODOLOGY: Anthropometric and dual-energy X-ray absorptiometry bone density data from 50 boys (25 obese pair-matched with 25 non-obese subjects) aged 4-17 years were entered into a rheological-stochastic simulation model of arm impact. RESULTS: Obese children were shown to be at 1.7 times greater risk of fracture compared to non-obese children. Lower fall heights and softer impact surfaces were found not to reduce the relative risk of fracture between obese and non-obese children. CONCLUSIONS: Environmental modifications are unlikely to lower the risk of arm fracture in obese children to the same levels experienced by non-obese children. The best option available for obese children to reduce fracture risk is to take steps to attain a healthy bodyweight.

Accidental Falls↗
PubMed2000

Perceived effectiveness of teaching methods for heath services administration education.

This article brings to the forefront the challenges of establishing an empirical link between teaching methods and education outcomes in the classroom. In the health administration education field, precious little empirical data exist on the effectiveness of various teaching methods and approaches on achieving education outcomes. Results are reported from the 1998 National Survey of program directors of the AUPHA graduate programs on the perceived effectiveness of a wide range of teaching methods, using a Likert scale, ranging from very effective to not very effective. The authors elaborate on the highest- and lowest-ranked teaching methods, and propose a research agenda for measuring education outcomes in the classroom.

Attitude of Health Personnel↗
PubMed2000

A framework for evaluating the impact of health services management education.

The objectives of this paper are three-fold. The first is to propose a conceptual and analytical framework for planning and evaluating health services management education programs. The framework was developed in response to the health care industry restructuring and the emerging questions and concerns regarding how to strategically redesign the educational programs for the twenty-first century. Additionally, it was used to develop a questionnaire for the 1998 National Survey of Program Directors. The second objective is to suggest variables for operationalizing the framework as the field considers initiatives such as, "Evidence-Based Health Administration Education" (AUPHA Education Outcomes Task Force 1999; Griffith 2000) and other more standardized, quantifiable approaches to assessing program quality. The third objective is to report selected results from the 1998 National Survey of Program Directors focusing on the major changes impacting the health services industry and the implications for management education and development. In the future, ACEHSA and other accrediting commissions will likely consider evidence-based evaluation criteria for assessing and improving education program quality. The framework presented in this paper can be used as a starting point for conceptualizing and developing valid and reliable measures.

Accreditation↗
PubMed2000

Program directors' recommendations for transforming health services management education.

A survey of graduate program directors shows that they recognize major change taking place in the health services industry and the need for programs to respond with curriculum revision. The revisions proposed tend to emphasize more practice involvement and human resources management skills rather than increased quantitative and financial competencies. Is this the right direction for programs to take? Will such revisions produce graduates better able to manage and lead in the emerging health care environment? We need more evidence-based research to answer these questions. In the meantime we have developed an environmental typology suggesting some rather clear distinctions among programs according to their settings. We know that the resulting categories of programs vary according to their national reputations and the kind of students that they serve. Do these different categories of programs prepare their different students well for the changing health care environment? Our current evidence, again, is sparse, indicating the need for further research.

Curriculum↗
PubMed1999

Evaluating the effect of usual source of dental care on access to dental services: comparisons among diverse populations.

Data collected from the International Collaborative Study of Oral Health Outcomes USA (ICS-II) research locations were used to evaluate the relationship between having a usual source of dental care (USDC) and access to dental services. The robustness of the USDC effect after reducing simultaneity bias was tested in the population-based samples using sensitivity analysis. Logistic regression results provided evidence that USDC was the strongest and most consistent predictor of a dental visit in the past 12 months regardless of geographic location, dental care delivery system, or cultural diversity of the population. Even removing cases that had a USDC for less than 1 or 2 years, the effect remained. From a policy perspective, USDC remains critical to understanding and explaining dental are utilization patterns. The findings suggest the need for designing interventions to increase the availability of a regular provider among vulnerable populations.

Adult↗
PubMed1999

Do black and white adults use the same sources of information about AIDS prevention?

Although AIDS prevention campaigns need to target population segments that are at highest risk to be effective, little is known about how various sources of AIDS information vary by race, education, and age. To determine the most common communication channels for AIDS information reported by Blacks and Whites, the authors interviewed 1,769 adults in Baltimore, Maryland, to obtain data on nine common sources of information about AIDS and analyzed their reports by race, age, and education. Television and newspapers were the most common sources but varied little across groups. National and local public health agencies, as well as medical doctors and dentists, were more commonly reported by Blacks than by Whites. Religious organizations were much more commonly reported by Blacks than by Whites. Public health organizations working collaboratively with religious organizations and health care providers might be more effective in developing AIDS prevention strategies than has been considered previously.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Ethnicity, aging, and oral health outcomes: a conceptual framework.

An expanded version of Andersen's Behavioral Model of Health Services Utilization is used as the theoretical and analytical framework for the International Collaborative Study of Oral Health Outcomes (ICS-II). The conceptual framework for understanding determinants of oral health is based on a "systems" perspective. The framework posits that characteristics of the external environment, the dental care delivery system, and the personal characteristics of the population influence oral health behaviors. The expanded behavioral model conceptualizes health behaviors (oral hygiene practices and dental services utilization) as intermediate dependent variables, which in turn influence oral health outcomes (evaluated, perceived, patient satisfaction). The framework is presented with an increased focus on the effects of race-ethnicity and age cohort, the major exogenous variables used in this study for systematic assessment of the differences in the multitude of factors influencing oral health. The framework can be applied by policy analysis and health services managers to help describe, predict, and explain population-based health behaviors and health outcomes.

Adult↗
PubMed1997

ICS-II USA research locations: environmental, dental care delivery system, and population sociodemographic characteristics.

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.

Adult↗
PubMed1997

ICS-II USA research design and methodology.

The purpose of the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II) was to provide policy-markers and researchers with detailed, reliable, and valid data on the oral health situation in their countries or regions, together with comparative data from other dental care delivery systems. ICS-II used a cross-sectional design with no explicit control groups or experimental interventions. A standardized methodology was developed and tested for collecting and analyzing epidemiological, sociocultural, economic, and delivery system data. Respondent information was obtained by household interviews, and clinical examinations were conducted by calibrated oral epidemiologists. Discussed are the sampling design characteristics for the USA research locations, response rates, samples size for interview and oral examination data, weighting procedures, and statistical methods. SUDAAN was used to adjust variance calculations, since complex sampling designs were used.

Adult↗
PubMed1997

Predisposing, enabling, and need for dental treatment characteristics of ICS-II USA ethnically diverse groups.

Personal characteristics (predisposing, enabling, and need) are described for the population-based samples of adults interviewed in the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations. Differences in sample characteristics are compared by ethnic group (African-American, Native American, Hispanic, and White) and age cohort (35-44 and 65-74 years old) by means of Bonferroni multiple-means tests and Student's t tests. Differences in the personal characteristics of these diverse comparison groups abound. Bivariate results indicated that White adults from both age cohorts had higher socioeconomic levels, more positive self-rated health status, and greater proportions of individuals with dental benefits. Lakota adults from both age cohorts reported lower self-rated health status and were most likely to report total tooth loss. Hispanic persons were significantly less likely to report a usual source of dental care or dental benefits. Need for dental treatment (oral pain and oral symptoms index) was generally higher amng Native American and Hispanic groups. It is critical that the differences highlighted between the among these groups be studied in appropriate strategies for improving the oral health of USA adults are to be determined.

Adult↗
PubMed1997

Oral health beliefs in diverse populations.

Using data from population-based samples of adults participating in the ICS-II USA study, and using principal components analysis, we constructed oral health belief measures corresponding to the Health Belief Model (HBM) dimensions. Tests of validity and reliability were performed. Scales measuring perceived benefit of preventive practices and seriousness of oral disease had the highest validity and reliability. We used multiple regression analysis to examine sociodemographic predictors of perceived benefits of preventive practices. Race-ethnicity and age cohort were significant predictors among Baltimore and San Antonio adults. White adults and middle-aged persons in both research locations were more likely to believe in the benefit of preventive practices. Female gender, higher educational attainment, and better self-rated health were significant indicators of more positive oral health beliefs in every research location. Results also characterize persons who place lower value on preventive practices (i.e., males, less-educated persons, and those reporting poorer self-rated health). The design of effective dental public health messages and outreach efforts requires an analysis of the individual's health orientation and the factors influencing oral health beliefs. Oral health education interventions designed to improve health beliefs should contain an evaluation component for assessing the impact of education on health practices and oral health status.

Adult↗
PubMed1997

Socio-behavioral determinants of oral hygiene practices among USA ethnic and age groups.

In this study, socio-behavioral determinants of oral hygiene practices were examined across several dentate ethnic and age groups. Oral hygiene scale scores were constructed from toothbrushing and dental floss frequencies self-reported by population-based samples of middle-aged (35-44 years) and older (65-74 years) dentate adults representing Baltimore African-American and White, San Antonio Hispanic and non-Hispanic White, and Navajo and Lakota Native American persons participating in the WHO International Collaborative Study of Oral Health Outcomes (ICS-II) survey. Female gender, education, certain oral health beliefs, household income, and the presence of a usual source of care were revealed with multivariate analysis to show a significant positive relationship with higher oral hygiene scale scores (indicating better personal oral hygiene practices). Other socio-behavioral variables exhibited a more varied, ethnic-specific pattern of association with oral hygiene scale scores.

Adult↗
PubMed1997

Determinants of dental care utilization for diverse ethnic and age groups.

Dental services utilization in the past 12 months was compared across population-based samples of African-American, Navajo, Lakota, Hispanic, and White adults participating in the WHO International Collaborative Study of Oral Health Outcomes (ICS-II) at USA research locations. Bivariate results revealed that ethnic minority groups in both age cohorts reported significantly fewer dental visits in the past 12 months compared with White adults. When dentate status was controlled for, age cohort differences were not significant in Baltimore (African-American and White) and San Antonio (Hispanic and White) research locations. In contrast, older Native Americans (65-74 years) reported visiting the dentist significantly less often compared with their middle-aged (35-44 years) counterparts. Multivariate results indicated that generalizable variables were associated with dental contact in every ICS-II USA ethnic group (i.e., dentate, usual source of dental care, oral pain). Among the diverse ethnic groups, other determinants presented a varied pattern of risk factors for underutilizing dental care. Information on ethnic-specific risk factors can be used to design culturally appropriate and acceptable oral health promotion programs. Generalizable risk factors across ethnic groups inform oral health policy-makers about changing national priorities for promoting oral health.

Adult↗
PubMed1997

Oral health policy and programmatic implications: lessons from ICS-II.

The conceptual model used in the ICS-II USA Ethnicity and Aging project helps to identify who among the elderly should be targeted for oral health promotion initiatives and the kinds of initiatives most likely to promote positive oral health outcomes. Outcomes have been measured in this study as perceived by the individual and as clinically assessed by the oral epidemiologists. For policy purposes, achieving both types of outcomes is important. A typology of oral health promotion priorities is used to rank the diverse racial-ethnic groups. In the analysis, groups with both low perceived and low evaluated oral health status receive highest priority. By these criteria, the older Native American populations have the highest priority, followed, in order, by Hispanics, African-Americans, and non-Hispanic Whites. Policy implications of the empirical analyses presented in earlier articles are discussed by use of the conceptual model and the typology of oral health promotion priorities. Having a usual source of care and/or regular dental visits appears to be a promising avenue for the promotion of better-perceived oral health status among most older ethnic groups. Improved oral hygiene practices, as represented by both regular toothbrushing and dental floss use, promote better clinically evaluated oral health status among many older ethnic groups.

Adult↗
PubMed1996

Indicators of oral health in diverse ethnic and age groups: findings from the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations.

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.

Adult↗