A Three Delays theoretical framework to describe social determinants as barriers to dental care.

OBJECTIVES: The Three Delays model is a well-established global public health framework for the utilization of obstetric services where each delay represents a series of factors affecting utilization: (1) Delay #1-Deciding to seek care, (2) Delay #2-Reaching an appropriate facility and (3) Delay #3-Receiving adequate care. The aim of this qualitative study was to explore the application of the Three Delays model to dental service utilization and describe factors attributed to delayed utilization within this framework. METHODS: This study utilized a framework analysis, underpinned by the Three Delays model, to examine delays in dental care utilization. A criterion purposive sample of English-speaking adults (18+ years) in Massachusetts and Florida, USA with limited dental care access was recruited. Data were collected via semi-structured interviews conducted in two phases: 17 individual interviews, followed by interviews with a subset of five participants over 3 months (a total of 18 interviews). The analysis involved inductive thematic coding and systematic organization within the framework. RESULTS: Major themes and subthemes were constructed from the participants' narratives, identified and categorized as factors in the Three Delays framework. Each of the delays was interrelated to the other two, and Delay #1 was the most common delay based on the participants' interviews. The themes and subthemes contributing to one or more delays included interpersonal communication, prior dental experience, financial considerations, childcare costs, social connection, technology literacy, time constraints, competing priorities, stressors such as eviction and immigration status and microaggressions including racism and stigma. CONCLUSION: The Three Delays model was applicable to the study of dental care utilization and factors that impact the decision to seek dental care, reaching an appropriate dental facility and receiving adequate dental care in this study context.

The Barocene Era.

This communication defines and describes the Barocene era, as that phase of human development which is characterized by a major impact of overweight and obesity. We use this term to highlight the fact that overweight and obesity need to be prevented and managed on an urgent footing. If not checked, these endocrine diseases will retard our growth and reduce our well being.

Metalloproteinases as Biomarkers and Sociomarkers in Human Health and Disease.

Metalloproteinases (MPs) are zinc-dependent enzymes with proteolytic activity and a variety of functions in the pathophysiology of human diseases. The main objectives of this review are to analyze a specific family of MPs, the matrix metalloproteinases (MMPs), in the most common chronic and complex diseases that affect patients' social lives and to better understand the nature of the associations between MMPs and the psychosocial environment. In accordance with the PRISMA extension for a scoping review, an examination was carried out. A collection of 24 studies was analyzed, focusing on the molecular mechanisms of MMP and their connection to the manifestation of social aspects in human disease. The complexity of the relationship between MMP and social problems is presented via an interdisciplinary approach based on complexity paradigm as a new approach for conceptualizing knowledge in health research. Finally, two implications emerge from the study: first, the psychosocial states of individuals have a profound impact on their overall health and disease conditions, which implies the importance of adopting a holistic perspective on human well-being, encompassing both physical and psychosocial aspects. Second, the use of MPs as biomarkers may provide physicians with valuable tools for a better understanding of disease when used in conjunction with "sociomarkers" to develop mathematical predictive models.

Mental health screening and referral to treatment in dental practices: A scoping review.

OBJECTIVE: The purpose of this study was to conduct a scoping review to examine and summarize the characteristics of research related to mental health (MH) screenings and/or referrals to treatment in dental practices. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews and searched multiple databases for terms connected with dental care, MH concerns, screening, and referral. Included articles: (1) described care provided in a dental practice, (2) described a situation where the patient is experiencing the potential MH problem, (3) did not involve dental anxiety exclusively, and (4) involved some form of MH screening and/or referral to treatment. Article analysis included a summary of key study characteristics, types of evidence, study design, and central concepts and definitions. RESULTS: The search generated 2050 records, with 26 ultimately included. Most studies involved only adults (22, 85%), but only three (12%) reported on rurality (two urban; one mixed) and only two each (8%) reported race or ethnicity. Fifteen (58%) articles were prospective and 11 (42%) were retrospective. The studies varied widely in study designs, from 11 (42%) cross-sectional methodologies to only one (4%) randomized controlled trial. Thirty-four screening tools were used to screen for symptoms of 43 MH conditions, with depression and anxiety screened for most frequently. Few articles discussed making referrals, practice workflows, or follow-up outcomes. CONCLUSIONS: Included studies provide evidence of viable options for dental practitioners regarding MH screening, referring, and conducting follow-up, but lack specificity regarding these processes. Overall, more research is needed to clarify what workflows are most efficient for dental practitioners and efficacious in identifying patients with MH concerns.

Turning a Curve: How People Use Everyday Resources to Negotiate Recovery From Cancer Treatment With Curative Intent.

Many more cancers are treated with intent to cure now than in previous decades, but for most, this involves significant effects from which people need to recover psychologically and socially, as well as physically. This longitudinal photo-elicitation interview study uses grounded theory to explain how people discharged from specialist care made use of everyday social and material resources to manage this process at home. Recovery is presented as a curve in life's pathway requiring gradual reorientation, drawing on social worlds and domestic resources to calibrate this process. Findings are described in three stages: (1) responding to diagnosis and treatment, (2) using social resources for meaning-making, and (3) developing assets for recovery. During treatment, participants drew on past identities to reinforce their sense of self, and personalized health care communication supported this process. In the weeks after treatment, new frameworks of understanding were constructed from perspectives on cancer encountered in the family, workplace, and outpatient clinics. Recovery processes included the negotiation of personal change, the renegotiation of close relationships, and the use of everyday resources to regain three sensations: control, comfort, and continuity. Supportive care would benefit from an individualized exploration of the assets that can help people to negotiate this challenging phase as treatment comes to a close. Possibilities for self-care (the maintenance of health and well-being in the context of everyday life) can be explored and assessed through personalized discussion around the identities, social worlds, and everyday resources available to each individual.

The inter-familiar issues of Greek parents facing childhood cancer.

Cancer as a whole, but especially childhood cancer, creates a number of psychological, social, and family problems as well as practical and financial issues, which every parent is called upon to solve. This study focuses on childhood cancer and aims at a thorough analysis of the physical/organic, psychological, and social problems associated with the parents and relatives of a child with cancer. The special element in pediatric neoplasms is not only the vulnerable population target group, but also the set of secondary effects it has on the environment of the sick child. The research was conducted on a sample of 133 families of children with cancer, and the results were displayed after statistical processing and data analysis with R statistical software. The results of the study confirm with statistically significant data the effect of childhood cancer on the physical, mental, and social health and behavior of the parent. Thus, 53.8% of the respondents stated 5 and above on the 7-point Likert scale for fatigue issues, 55.6% for sleep disorders, 78.1% for stress, and 82.7% for fear. The key findings are characterized by high specificity as it is a unique study that reveals particular aspects of the Greek parent's behavior, mind, and body during the period of their child's illness.   Conclusion: The effects of childhood illnesses, particularly when they are severe, such as neoplasms, present a looming threat, ushering in a multitude of adverse alterations in the daily lives of the affected child's family. What is Known - What is New: • We know the effects that a childhood illness brings not only to the sick child, but also to the entire family circle. The new element in the present research is that these data reflect the situation in Greece, for which the research data in this area is quite limited. Our research is one of the few studies that demonstrate with statistical data the change in the psychosomatic health of the parent who has a child with cancer.

Emotional fluidity in chronic care.

In this exploratory opinion piece, we define emotional fluidity as a state of changing emotions which influence choice of, attitudes and behaviour towards, and response to, chronic health care and therapy. This manifests clinically as changing opinions regarding suitability of modern health care, and as or varying, responses to suggestions and interventions from the health care team. Diabetes distress is an extreme example of emotional fluidity. Emotional fluidity also encompasses the variability of the health care professional's response to emotional and medical needs of persons seeking care. This can be inter-individual or intra-individual, and can be influenced by compassion fatigue. Health care professionals should be aware of emotional fluidity, and should be able to address its negative impact, as well as amplify its positive influence.

Psychovigilance In Diabetes.

Diabetes is associated with a myriad of mental health challenges, ranging from distress and depression to schizophrenia and substance abuse. These conditions are associated with hyperglycaemia, and also interfere with efforts to achieve good glucose control. One way in which this can be handled is by screening, early diagnosis, and timely management of mental health dysfunction and disorders. We term this action as psychovigilance.

Healer's High.

We explore the concept of healer's high, a phenomenon similar to runner's high. We define healer's high as a psycho-endocrine response of intense happiness and bliss, accompanied by a feeling of enhanced energy, experienced by health care professionals when they heal or help someone. We describe the endocrinology that underlies healer's high, and posit that this phenomenon may be used to enhance professional satisfaction, and mitigate compassion fatigue and burnout.

The « patient casting ¼: a key decision in orthognathic surgery / Le « casting du patient ¼: clé de décision en chirurgie orthognathique

Introduction: The surgical orthodontic patient is a patient whose management is specific. The success of this protocol goes beyond of the right indication and the control of the pre-surgical orthodontic preparation of the treatment. The coordination revolves around a multidisciplinary team, namely an orthodontist, a maxillofacial surgeon, a physiotherapist, a speech therapist, a general practitioner, etc. but also with the collaboration of a specialized psychotherapist. Material and Method: Does the ideal « patient ¼ exist in orthognathic surgery? The decision criteria are morphological (occlusal, aesthetic and cephalometric) but also psychosocial. Results: A new classification called « psychological ¼ is proposed in this article. Conclusion: This new classification can be considered as a key decision in the « casting ¼ of the surgical orthodontic patient and represents a first basis for further investigations in this field.

Introduction: Le patient orthodontique chirurgical est un patient dont la prise en charge est spécifique. La réussite de ce protocole va au-delà de la pose de la bonne indication et de la maîtrise de la préparation orthodontique pré-chirurgicale du traitement. La coordination s'articule autour d'une équipe pluridisciplinaire, à savoir un orthodontiste, un chirurgien maxillofacial, un kinésithérapeute, un orthophoniste, un omnipraticien, entre autres, mais également avec la collaboration d'un psychothérapeute spécialisé. Matériel et méthode: Le « patient idéal ¼ existe-t-il en chirurgie orthognathique ? Les critères de décisions sont morphologiques (occlusaux, esthétiques et céphalométriques), mais aussi psycho-sociaux. Résultats: Une nouvelle classification dite « psychologique ¼ est proposée dans cet article. Conclusion: Cette nouvelle classification peut être considérée comme une clé de décision dans le « casting ¼ du patient orthodontique chirurgical et représente une première base pour de plus amples investigations dans ce domaine.

Oral health-related stigma: Describing and defining a ubiquitous phenomenon.

This paper is the fourth of a series of narrative reviews to critically rethink underexplored concepts in oral health research. The series commenced with an initial commissioned framework of Inclusion Oral Health, which spawned further exploration into the social forces that undergird social exclusion and othering. The second review challenged unidimensional interpretations of the causes of inequality by bringing intersectionality theory to oral health. The third exposed how language, specifically labels, can perpetuate and (re)produce vulnerability by eclipsing the agency and power of vulnerabilised populations. In this fourth review, we revisit othering, depicted in the concept of stigma. We specifically define and conceptualize oral health-related stigma, bringing together prior work on stigma to advance the robustness and utility of this theory for oral health research.

Associação entre capital social e padrões alimentares em mulheres do Sul do Brasil / Association between social capital and food patterns in women from Southern Brazil

Resumo O presente estudo objetivou verificar a associação entre aspectos psicossociais (capital social) e padrões alimentares em mulheres adultas. Realizou-se um estudo transversal, de base populacional, com uma amostra representativa de 1.128 mulheres, de 20 a 69 anos de idade, residentes na área urbana do município de São Leopoldo, Rio Grande do Sul, em 2015. Os padrões alimentares foram identificados com base na frequência de consumo alimentar e classificados em: saudável (frutas, vegetais e alimentos integrais), de risco (alimentos ultraprocessados) e brasileiro (arroz e feijão), enquanto o capital social foi avaliado por meio de uma escala de eficácia coletiva. Observou-se que 18,9% da amostra foi classificada com alta eficácia coletiva. Após ajuste para potenciais fatores de confusão, observou-se uma probabilidade 44% maior para adesão ao padrão saudável (RP [razão de prevalência] = 1,44; IC95% [intervalo de confiança de 95%]: 1,01-2,03; p = 0,040) e 71% maior para o padrão brasileiro (RP = 1,71; IC95%: 1,18-2,47; p = 0,004) entre as mulheres com um maior nível de eficácia coletiva, quando comparadas às com baixo nível de eficácia coletiva. Assim, este estudo verificou uma relação significativa entre aspectos psicossociais e consumo alimentar em mulheres.

Abstract The present study aimed to verify the association between psychosocial aspects (social capital) and food patterns in adult women. A cross-sectional, population-based study was conducted with a representative sample of 1,128 women, aged 20 to 69 years, living in the urban area of the municipality of São Leopoldo, Rio Grande do Sul, Brazil, in 2015. The food patterns were identified based on the frequency of food intake and classified as: healthy (fruits, vegetables, and whole foods), at-risk (ultraprocessed foods), and Brazilian (rice and beans), while social capital was evaluated using a collective efficacy scale. It was observed that 18.9% of the sample was classified with high collective efficacy. After adjusting for potential confounding factors, a 44% higher probability was observed for adherence to the healthy pattern (PR [prevalence ratio] = 1.44; 95%CI [95% confidence interval]: 1.01-2.03; p = 0.040) and 71% higher for the Brazilian pattern (PR = 1.71; 95%CI: 1.18-2.47; p= 0.004) among women with a higher level of collective efficacy, when compared to those with a low level of collective efficacy. Thus, this study verified a significant relationship between psychosocial aspects and food intake in women.

Untreated dental caries among Libyan children during and after the war and in internally displaced person camps.

OBJECTIVES: The present study assessed whether living in a conflict zone and in internally displaced person (IDP) camps were associated with the number of untreated caries in primary, permanent and all teeth in Libyan children and whether these associations differed by parents' educational attainment. METHODS: Cross-sectional studies were conducted in Benghazi, Libya, in 2016/2017 during the war and in 2022 after the war including children in schools and in IDP camps in the same setting. Self-administered questionnaires and clinical examinations were used for data collection from primary schoolchildren. The questionnaire collected information on children's date of birth, sex, level of parental education and school type. The children were also asked to report on how often they consumed sugary drinks and whether they brushed their teeth regularly. In addition, untreated caries in primary, permanent and all teeth were assessed according to World Health Organization criteria at the dentine level. Multilevel negative binomial regression models were used to assess the relation between dependent variables (untreated caries in primary, permanent and all teeth) and living environment (during and after the war and living in IDP camps) and parental educational attainment adjusted for oral health behaviours and demographic factors. The modifying effect of parental educational attainment (no, one and both parents university educated) on the association between living environment and the number of decayed teeth was also assessed. RESULTS: Data were available from 2406 Libyan children, 8-12 years old (mean = 10.8, SD = 1.8). The mean (SD) number of untreated decayed primary teeth was 1.20 (2.34), permanent teeth = 0.68 (1.32) and all teeth = 1.88 (2.50). Compared to children living in Benghazi during the war, children living in the city after the war had significantly greater number of decayed primary (adjusted prevalence ratio [APR] = 4.25, p = .01) and permanent teeth (APR = 3.77, p = .03) and children in IDP camps had significantly greater number of primary teeth (APR = 16.23, p = .03). Compared to children whose both parents were university-educated, those with no university-educated parents had a significantly greater number of decayed primary teeth (APR = 1.65, p = .02) and significantly less number of decayed permanent (APR = 0.40, p < .001) and all teeth (APR = 0.47, p < .001). There was a significant interaction between parental education and living environment in the number of all decayed teeth in children who lived in Benghazi during the war: children whose both parents were non-university-educated had significantly less number of all decayed teeth (p = .03) with no interaction effect in those living in Benghazi after the war or in IDP camps (p > .05). CONCLUSION: Children living in Benghazi after the war had more untreated decay in primary and permanent teeth than children during the war. Having parents with no university education was associated with greater or less untreated decay depending on the dentition. These variations were most pronounced among children during the war in all teeth with no significant differences in after-war and IDP camps groups. Further research is required to understand how living in war environment influenced oral health. In addition, children affected by wars and children living in IDP camps should be identified as target groups for oral health promotion programs.

Suicidal behaviour in over-indebted individuals: a cross-sectional study in Sweden.

OBJECTIVE: Associations between debt and suicidal behaviour have been identified, but the research is sparse. Thus, more research is needed to understand the association between economic vulnerability and suicide. The study aimed to generate further knowledge about over-indebted individuals who have attempted suicide at least once. METHOD: Participants were a Swedish sample comprising 641 over-indebted individuals. The inclusion criteria were that the participants should be indebted and have been subjected to debt collection measures and/or seizure orders by the Swedish Enforcement Authority. Participants answered questionnaires regarding socio-demographic variables, debt size, history of suicide attempt, critical life events, and social contacts, and filled the Hospital Anxiety and Depression Scale (HADS). In the statistical analyses, Chi2 test for independence and t-test was used, and binary logistic regression to adjust for the confounding effects of the variables on each other. RESULTS: The analysis revealed that nearly one in five (19.3%, N = 123) had attempted suicide at least once. A larger part of the respondents who had a history of suicide attempts reported that they were living alone (OR 2.30 (95% CI 1.34-3.89, p = .002). Many of those living alone were women (χ2 (1, n = 121) = 4.88, p = 0.03, ɸ = 0.22). CONCLUSIONS: The results of the current study point to the fact that economic vulnerability is an important psychosocial aspect to take into serious consideration concerning mental health and suicide prevention. Longitudinal research is needed to explain, predict and prevent suicide due to over-indebtedness.

Experiences of transition to adulthood and transfer to adult care in young adults with type 1 diabetes: A qualitative study.

AIM: To explore young adults' experiences of living with type 1 diabetes in the transition to adulthood, including experiences of the transfer from paediatric to adult care. DESIGN: A qualitative approach was used. METHOD: Ten young adults, six women and four men, aged 19-29 years, participated. Participants were recruited at their regular diabetes clinic from spring 2021 to spring 2022. Semi-structured interviews were transcribed and analysed using qualitative content analysis. FINDINGS: Dreaming of being nurtured towards self-reliance was the overarching theme. Personal experiences of the transition to adulthood, including the transfer from paediatric to adult care, were described in terms of struggling to find balance in daily life, dealing with feelings of being different, being gradually supported to achieve independence, and wishing to be approached as a unique person in healthcare. CONCLUSION: In healthcare, it is important to emphasize not only diabetes-related factors but also emotional and psychosocial aspects of life connected to the transition to adulthood, including the transfer to adult care. The young adults wished to be seen as unique persons in healthcare during their emerging adulthood and should therefore be supported to achieve self-reliance through personal preparations for new challenges and for the consequences of transitioning to adulthood. Specialist nurses can provide appropriate knowledge and leadership. IMPLICATIONS FOR THE PROFESSION: These findings can guide nurse specialists in support for emerging adults to achieve self-reliance and indicate the importance of person-centred care when experiencing transition and transfer. REPORTING METHOD: The study adhered to EQUATOR guidelines, and the COREQ checklist for qualitative studies was used as the reporting method.

Comparative analysis of the burnout syndrome index between contract and freelance physiotherapists: An observational study.

BACKGROUND: Burnout syndrome has been extensively studied in different health science professions. It has been less studied in physiotherapy than in professions such as medicine. Moreover, it is not known how the working condition influences this syndrome. OBJECTIVE: The main objective of this study was to compare the burnout index between contract and freelance physiotherapists in the private sector in the Community of Madrid, Spain. METHODS: A cross-sectional study was performed with 174 participants divided into 2 groups; one group was composed of contract physiotherapists (n = 87) and the other group was composed of freelance physiotherapists (n = 87). A Mann-Whitney U test was performed for comparison between the groups. Spearman's correlation coefficient was used to analyze the correlations between the burnout syndrome index and the secondary variables. RESULTS: There were statistically significant differences when comparing the groups, with a large effect size for the burnout index with a higher rate among contract physiotherapists (78 [71-84.75]) than in freelance physiotherapists (61.5 [55-72.75]).There were also significant differences in the type of patients treated, number of patients treated per day, time spent per patient, and the annual salary range between the contract and freelance physiotherapists. CONCLUSION: Contract physiotherapists who participated in this study had a significantly higher burnout syndrome index than freelance physiotherapists. Other socio-occupational variables were also found to be related to the burnout syndrome index in freelance physiotherapists and contract physiotherapists. The results of this study could be of interest for new occupational health strategies to reduce the burnout index in contract physiotherapists.

Allostatic Load and Endocrine Disorders.

The building of life stress, well expressed by the concept of allostatic load, plays an important part in all phases of endocrine illness. Allostatic load refers to the cumulative burden of both stressful life events and chronic stress. When environmental challenges exceed the individual ability to cope, allostatic overload ensues. Assessment of allostatic load/overload by clinical measurements including indices and rating scales, in addition to biomarkers, offers a characterization of the person's psychosocial environment that is missing from current formulations. Consideration of allostatic load in endocrinology may shed light on a number of clinical issues: interpretation of abnormal hormone values that lack explanations; coping with the various phases of illness; maladaptive illness behavior; response to treatment; presence of residual symptoms; health-damaging lifestyle habits. Addressing allostatic load calls for innovative models of endocrine outpatients with multidisciplinary organization of care, extended time for the interview, focus on rehabilitation. We provide an overview on the mechanisms of allostatic load, how it can be assessed, its potential role in endocrine disturbances, and how its consideration may lead to a needed innovation in patient care.

Community-Based Service Use After Clozapine Treatment: A Mirror-Image Analysis of Public Claims Data.

Although clozapine demonstrates unique efficacy for treatment-resistant schizophrenia, its impact on community-based services remains largely underexplored. The authors examined changes in use of community-based services after clozapine treatment among a sample of 163 patients with schizophrenia by using public claims data in Allegheny County, Pennsylvania. Mirror-image analyses of service utilization were used to compare the 180-day period before treatment initiation with the 180-day period that began after 6 months of adherent treatment, accounting for age, race, and gender. Across demographic variables, clozapine treatment was associated with increased use of community-based services and decreased use of psychiatric inpatient services (p<0.05, Bonferroni corrected), suggesting that clozapine treatment shifts service needs from emergency care to community-based care and recovery.

Women's critical experiences with the pap smear for the development of cervical cancer screening devices.

Global cervical cancer incidence and mortality have remained a major public health problem. Depending on the quality and coverage of preventive programs, and the capacity of health care systems, different screening tests are used, with the Pap smear being the most widely implemented. Several difficulties have been reported in accessing timely detection, causing late cervical cancer diagnosis. Trying to close these gaps, new screening devices have been developed in recent years; however, there is a lack of knowledge about whether or not women perspective has been included in the design process and technological development of these devices. This scoping review aimed to describe and synthesize scientific literature on women's critical experiences with Pap smears to prospectively contribute to the design, development, and scale-up of cervical cancer screening devices. The electronic databases Web of Science, Scopus, PubMed, PsycINFO and SciELO were searched for relevant studies published between 2012 and 2021; finally, 18 qualitative studies were included. Experiences were classified into four categories: fear and embarrassment, speculum pain and discomfort, outcome distress and health service barriers. Critical experiences before, during, and after the test were analyzed in turn. In particular, during the test, women reported pain associated with the use of the speculum. The acceptability of new screening devices will largely depend on comfort during the test and timely delivery of results. This review provides a useful qualitative synthesis, not only to advance the design of novel devices but also for future implementation research in cervical screening services.