Dental health in rural Victoria: the Crossroads Household Survey

Self-Rated Oral Health as a Valid Measure of Oral Health Status in Adults Living in Rural Australia

It is unclear how well self-rated oral health (SROH) reflects actual oral health status in the rural Australian population. Therefore, this study aimed to compare the clinically assessed oral health status and SROH of adults living in rural Australia. The data were from 574 participants who took part in the Crossroads II cross-sectional study. Three trained and calibrated dentists evaluated the oral health status of participants based on WHO criteria. SROH was assessed with the question 'Overall, how would you rate the health of your teeth and gums?', with a score ranging from excellent = 5 to poor = 1. A logistic regression analysis (LRA) was performed, allowing us to assess factors associated with SROH. The mean age of participants was 59.2 years (SD 16.3), and 55.3% were female. The key results from the LRA show poorer SROH in those with more missing teeth (OR = 1.05; 95% CI; 1.01-1.08), more decayed teeth (OR = 1.28; 95% CI: 1.11-1.46), and more significant clinical attachment loss of periodontal tissue (6mm or more) (OR = 2.63; 95% CI: 1.29-5.38). This study found an association between negative SROH and clinical indicators used to measure poor oral health status, suggesting that self-rated oral health is an indicator of oral health status. When planning dental healthcare programs, self-reported oral health should be considered a proxy measure for oral health status.

Factors patients consider when accessing oral health care

The aim of this cross-sectional study was to understand patients' perceived importance of clinic- and clinician-related factors and contextual characteristics that shape the importance ratings for factors patients consider when accessing oral health care. This study was conducted at Griffith University Dental Clinic, Gold Coast, Australia. Patients answered a self-administered questionnaire on demographics and perceived need for attendance, which constituted the explanatory variables. In the second part of the questionnaire, patients were asked to rate the importance of 17 items related to the provision and quality of oral health services using a five-point scale. Exploratory factor analysis (EFA) was conducted to determine the dimensionality of the questionnaire. The questionnaire was completed by 298 patients. The importance of some of the clinician-related factors, such as 'concern for patients' and 'access to specialist care', were associated with sex, age and employment status. EFA revealed a two-factor structure, which consisted of items related to clinician characteristics and clinic environment characteristics. Female participants had higher importance scores for clinic environment characteristics (mean (±s.d.) 38.00 ± 4.86 vs 35.45 ± 6.30; P < 0.05) and clinician characteristics (32.39 ± 2.85 vs 31.33 ± 3.39; P < 0.05) than male participants. In conclusion, various clinician- and clinic-related aspects were considered important for the provision and quality of oral health services, with the importance of these factors associated with some contextual characteristics. Application of Andersen's behavioural model of health services use provided a framework that offers important insights into patient beliefs and perceptions towards oral health services and can serve as a baseline for future studies in dental clinics across Australia.

Patterns of use of oral health care services in Australian rural adults: the Crossroads-II Dental sub-study

BACKGROUND

As part of a larger study, the Crossroads-II Dental sub-study determined the patterns of, and barriers to, oral health care service utilization in a rural area of Victoria.

METHODS

In this cross-sectional sub-study predisposing, enabling, needs-related, and oral health variables were considered in association with patterns of oral health care utilization. A logistic regression was performed to explain the use of oral health care services.

RESULTS

Overall, 574 adults participated, with 50.9% reporting having visited an oral health care service in the previous 12 months. Age, number of chronic health conditions and holding a health card; were associated with increased visit to a dentist (OR = 1.01; 95% CI: 1.00-1.03; OR = 1.08; 95% CI: 1.01-1.16; OR = 2.06; 95% CI: 1.26-3.36, respectively). Perceived barriers to care and number of missing teeth decreased the odds of using services (OR = 0.46; 95% CI: 0.36-0.58; OR = 0.95; 95% CI: 0.92-0.98, respectively).

CONCLUSIONS

Results suggest that use of oral health care services is associated with a range of financial, educational, health and structural barriers. Increasing the use of oral health care services in rural populations requires additional efforts beyond the reduction of financial barriers.

Hypertriglyceridemic-waist is more predictive of abnormal liver and renal function in an Australian population than a Chinese population

OBJECTIVE

We aimed to compare the association of hypertriglyceridemic-waist (HTGW), with glycaemia, liver and renal function between a Chinese and an Australian population using 3 HTGW definitions.

METHODS

1454 Australian and 5824 Chinese adults, from randomly selected households provided clinical history, glucose, lipids, anthropometric, and blood pressure measurements. Liver and renal functions were assessed using alanine aminotransferase and estimated Glomerular Filtration Rate respectively. The impact of interaction between HTGW and glucose on the liver and renal functions were measured by General Linear Model. Logistic regression was used to estimate the association between this interaction and abnormal liver and renal function.

RESULTS

HTGW was associated with abnormal liver and renal function in both Chinese and Australian populations using all 3 HTGW definitions. The highest sensitivity (93 (95% confidence interval: 87, 97) %) and specificity (81 (80, 84) %) were observed for abnormal renal function in the Australian population. The probability of having abnormal liver or renal function increased with glucose in the presence of HTGW phenotype only in the Australian population. Similar findings were revealed in people without type 2 diabetes.

CONCLUSIONS

In both Chinese and Australian populations, HTGW is associated with abnormal liver and renal function using any of the 3 definitions. HTGW is a potential tool to identify high-risk individuals with impaired renal function especially in the Australian population. HTGW interacted with the fasting glucose in its association with impaired liver and renal function only in the Australian population, suggesting different underlying interactions between environmental and genetic backgrounds.

Longitudinal study of health, disease and access to care in rural Victoria: the Crossroads-II study: methods

Background

High quality, contemporary data regarding patterns of chronic disease is essential for planning by health services, policy makers and local governments, but surprisingly scarce, including in rural Australia. This dearth of data occurs despite the recognition that rural Australians live with high rates of ill health, poor health behaviours and restricted access to health services. Crossroads-II is set in the Goulburn Valley, a rural region of Victoria, Australia 100–300 km north of metropolitan Melbourne. It is primarily an irrigated agricultural area.

The aim of the study is to identify changes in the prevalence of key chronic health conditions including the extent of undiagnosed and undermanaged disease, and association with access to care, over a 15 year period.

Methods/design

This study is a 15 year follow up from the 2000–2003 Crossroads-I study (2376 households participated). Crossroads-II includes a similar face to face household survey of 3600 randomly selected households across four towns of sizes 6300 to 49,800 (50% sampled in the larger town with the remainder sampled equally from the three smaller towns). Self-reported health, health behaviour and health service usage information is verified and supplemented in a nested sub-study of 900 randomly selected adult participants in ‘clinics’ involving a range of additional questionnaires and biophysical measurements. The study is expected to run from October 2016 to December 2018.

Discussion

Besides providing epidemiological and health service utilisation information relating to different diseases and their risk factors in towns of different sizes, the results will be used to develop a composite measure of health service access. The importance of access to health services will be investigated by assessing the correlation of this measure with rates of undiagnosed and undermanaged disease at the mesh block level. Results will be shared with partner organisations to inform service planning and interventions to improve health outcomes for local people.