Comparative evaluation of selected concentrations of sodium hypochlorite on the outcome of endodontic therapy among Ghanaians.

BACKGROUND: Endodontic treatment is one of the main dental treatments to manage inflamed or infected root canal systems of teeth. The success of endodontic treatment principally depends on eradicating microorganisms in the root canal by chemo-mechanical debridement with irrigation solutions like sodium hypochlorite (NaOCl). NaOCl has been used in concentrations ranging from 0.5% to 5.25%. This study determined the antimicrobial effectiveness of selected concentrations (0.5%, 1.0%, 2.6%, and 5.2%) of NaOCl in endodontic treatment. METHODS: The study sites were the University of Ghana Dental School (UGDS) and Noguchi Memorial Institute for Medical Research (NMIMR). Sixty infected single-rooted single-canal teeth were used. Before (S1) and after (S2), root canal samples during the endodontic treatment with the selected concentrations of NaOCl were examined via anaerobic and aerobic cultures. The isolates were identified using Matrix Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (MALDI-TOF MS). RESULTS: All S1 samples were positive for cultivable bacteria. Fifty-three (53) different microbial species belonging to 20 different microbial genera were isolated. Streptococcus viridans was the most frequently isolated microbe. There were zero isolates in the root canals irrigated with 2.6% and 5.2% NaOCl. Two teeth had isolates in the groups irrigated with the lower concentrations (0.5% and 1.0%) of NaOCl. The persistent bacteria were one species each of Streptococcus mitis and Streptococcus oralis, respectively. CONCLUSION: Root canal treatments using chemo-mechanical preparation with the selected concentrations (0.5%, 1.0%, 2.6%, and 5.2%) of NaOCl were effective in significantly reducing the microbial load, and for the 5.2% and 2.6% concentrations, in eliminating all the microorganisms.

Healthcare professionals' perspectives on oral health care in acute stroke patients: a qualitative study.

BACKGROUND: Stroke is a major public health problem, with the disabilities of the patients increasing their risk of poor oral health. Currently, in Ghana and Nigeria, no guideline exists for oral health care in stroke patients, while most of our acute stroke care settings have no documented protocol. AIM: This study sought to understand the perspectives of healthcare professionals in Ghana and Nigeria about oral healthcare in acute stroke patients. METHODS: A qualitative inductive approach was employed to explore healthcare professionals' perspectives. After obtaining informed consent, in-depth interviews were conducted among doctors, nurses, and physiotherapists using semi-structured question guides. Participants' responses were audiotaped for transcription and analysis. Interviews were conducted until data saturation was reached. Data were analyzed thematically to generate themes and sub-themes using an inductive approach. THE RESULTS: Twenty-five (25) health care professionals (HCP) aged 25-60 years with a mean age of 36.2 ± 4.2 years were interviewed. There were 15 (60.0%) males and 10 (40.0%) females. HCP included nurse practitioners 14 (56.0%), medical doctors 7 (28.0%), and physiotherapists 4 (16.0%). The HCP demonstrated adequate knowledge of stroke and considered oral health important for esthetic and clinical reasons. They, however, reported being unable to give it the required attention due to inadequate collaboration between the various professional cadres, insufficient equipment, and a skewed focus on other clinical needs of the acute stroke patients. CONCLUSIONS: The findings indicate that HCPs perceived oral health care as very important among patients with acute stroke. However, they reported a lack of collaboration and integration of oral health care in routine stroke care as a major impediment.

Accuracy of the electronic apex locator, tactile, and radiographic methods in working length determination.

Background: Determination of working length (WL) is necessary for the successful outcome of root canal treatment (RCT). Common methods in WL determination include tactile, radiographic, and electronic apex locators (EAL). Aim: The aim of this study was to compare three methods of WL determination to the actual visualization of the apical constriction (AC). Materials and Methods: Consecutive patients with indications for extraction of single-rooted single canal teeth at the University of Ghana Dental School clinic were randomly assigned to three groups. In-vivo root canal WL was determined by tactile sensation, digital radiography, and a 5th generation EAL (Sendoline S5). Files were cemented in the canals after the in-vivo measurements. The apical 4-5 mm of the roots was trimmed to expose the inserted files and the AC. Actual WL, as determined by visualization of the AC, was done using a digital microscope. Different WLs were then compared for the various groups, and the mean actual canal lengths were reported. Results: EAL accurately predicted the AC in 31 (96.9%) teeth, while the digital radiographic and tactile sensation methods accurately predicted the constriction in 19 (59.4%) and 8 (25%) teeth, respectively, in the study population. The mean working canal lengths for single-rooted teeth showed no observable difference among sexes, age categories, and side of the jaw. Conclusion: The EAL provided more reliable and accurate WL measurements for single-rooted teeth among Ghanaians, compared to digital radiography and tactile methods.

Impacted dentures in the pharynx and esophagus - Implication for advocacy.

Background: Impaction of dentures has potentially significant morbidity and management challenges. This study sought to leverage on the occurrence of swallowed dentures to advance discussions on its management and prevention. Methods: A 5-year retrospective review of patients seen on account of impacted dentures at the Ear, Nose, and Throat Department of the Korle-Bu Teaching Hospital was done. Variables obtained included age, sex, location of impacted denture, treatment done, denture type, number of teeth, and complications. Variables were analyzed, and descriptive summaries were reported. Results: There was a record of 898 cases of impacted foreign bodies which presented to the department. Fifty-five (6.1%) records were on account of impacted dentures. These consisted of 25 (45%) males and 30 (55%) females. Ranging from 23 to 98 years, the mean and median ages were 55.7 (±18.1) years and 56.5 years respectively. There were no complications, and no identifiable predisposing patient conditions. All prostheses were removable acrylic dentures, and some observations included worn-out and loose dentures, while several had their prostheses dislodging in the process of swallowing tablet medications with water. Conclusion: Swallowed dentures are not rare occurrences in Ghana. Denture wearers should, therefore, be encouraged to get professional reviews, especially when prostheses get unretentive, while dental professionals are urged to incorporate measures in their fabrication to reduce the occurrence of swallowed dentures.

Résumé Contexte: L'impaction des prothèses dentaires présente des problèmes de morbidité et de gestion potentiellement importants. Cette étude visait à tirer parti de la survenue de prothèses avalées pour faire avancer les discussions sur sa prise en charge et sa prévention. Méthodes: Une étude rétrospective sur 5 ans des patients vus en raison de prothèses impactées au service des oreilles, du nez et de la gorge de l'hôpital universitaire de Korle Bu a été réalisée. Les variables obtenues comprenaient l'âge, le sexe, l'emplacement de la prothèse incluse, le traitement effectué, le type de prothèse, le nombre de dents et les complications. Les variables ont été analysées et des résumés descriptifs ont été rapportés. Résultats: On dénombre 898 cas de corps étrangers impactés qui se sont présentés au service. Cinquante-cinq (6,1 %) dossiers concernaient des dentiers impactés. Il s'agissait de 25 (45 %) hommes et 30 (55 %) femmes. Allant de 23 à 98 ans, les âges moyen et médian étaient respectivement de 55,7 (±18,1) ans et 56,5 ans. Il n'y a eu aucune complication et aucun état prédisposant identifiable du patient. Toutes les prothèses étaient des prothèses amovibles en acrylique, et certaines observations incluaient des prothèses usées et desserrées, tandis que plusieurs avaient leurs prothèses se délogant en avalant des médicaments en comprimés avec de l'eau. Conclusion: Les dentiers avalés ne sont pas rares au Ghana. Les porteurs de prothèses dentaires devraient donc être encouragés à obtenir des examens professionnels, en particulier lorsque les prothèses deviennent non rétentives, tandis que les professionnels dentaires sont invités à intégrer des mesures dans leur fabrication pour réduire l'apparition de prothèses avalées. Mots-clés: Dentier, Œsophage, Ghana, impacté, avalé.

Assessment of oral health status in a Ghanaian population: rationale, methods, and population characteristics.

BACKGROUND: Oral health surveys aid in estimating the oral health of a population and provide a projection for future oral health care needs. We report the procedures and rationale of a survey carried out to assess the oral health status and risk factors for oral disease among adults in the Greater Accra Region (GAR) of Ghana. The objective was to provide prevalence estimates on dental diseases, oral health behaviour and risk factors, and to establish baseline epidemiological data on the population's oral health for further research. METHODS: This was a population-based cross-sectional study of adults aged 25 years and above. A random, stratified two-stage sampling method was used to select participants from rural and urban communities in three types of districts (Metropolitan, Municipal, Ordinary). A semi- structured questionnaire was used to collect data on socio-demographic characteristics, oral health behaviours and risk factors for oral disease. Anthropometric data and a full-mouth clinical examination was carried out including: soft tissue assessment, tooth count, prosthodontic status, dental caries assessment and periodontal assessment. RESULTS: A total of 729 participants were included in the study with a mean age of 43.9 years (SD 14.6). Majority 425 (61.0%) were females. Though the metropolitan districts had more dental clinics and personnel, along with better health insurance coverage, they had a higher prevalence of missing teeth, retained roots, severe periodontitis and poorer oral health coverage. The findings also show some significant differences in disease prevalence, within the different localities and districts. CONCLUSIONS: Availability and access to oral health services is not the most important determinant of good oral health outcomes in this region. We recommend exploring socio-behavioral and cultural factors as well. This study provides district level data to inform policy and guide further research.

Prevalence of oral conditions and associated factors among schoolchildren in Accra, Ghana: a cross-sectional study.

OBJECTIVE: The impact of oral diseases on children cannot be overemphasized because their effects may go beyond the individual to the household and the community at large. This study aimed to determine the prevalence of common oral conditions in children between the ages of 9 and 16 years in Accra. METHODS: A cross-sectional study was carried out among participants from 16 selected junior high schools in Accra. Their caries experience was assessed using the decayed, missing, and filled teeth (DMFT) index. Other variables recorded were age, sex, previous history of a dental visit, and the presence of other common oral conditions (ie, periodontal disease, traumatised teeth, oral mucosal lesions, neoplasia, cysts, and malocclusion). Summaries and descriptive statistics were generated and reported. The DMFT was compared between subgroups, and the χ2 test was used to compare outcomes of categorical variables. RESULTS: A total of 1118 students participated in the study. This consisted of 37.8% males and 62.2% females. The mean age was 12.8 (standard deviation = 1.7) years. Common oral conditions were found in 49.7% of the participants and the prevalence of caries, periodontal disease, and malocclusion were found to be 13.3%, 30.4%, and 11.3%, respectively. The population's mean DMFT was found to be 0.27 (standard deviation = 0.76). CONCLUSIONS: The prevalence of caries and periodontal disease calls for additionaleffort to reduce the burden of common oral conditions in Ghanaian children.

Periodontitis prevalence and severity in an African population: A cross-sectional study in the Greater Accra Region of Ghana.

BACKGROUND: Periodontitis is a major public health problem affecting many adults, with considerable variation in its prevalence and severity worldwide. There is little data on its prevalence or associated risk factors in Ghana making development of evidence based preventive programs challenging. This study assessed the prevalence, severity, extent, and associated risk factors of periodontitis in an adult Ghanaian population. METHODS: A population based cross-sectional study involving adults aged ≥25 years in the Greater Accra Region (GAR) of Ghana. A random stratified two-stage sampling method was used to select participants from rural and urban communities. Data on sociodemographic and risk factors were collected using a semi-structured questionnaire. A full-mouth periodontal examination was performed to diagnose and describe the severity of periodontitis following the CDC-AAP case definition. RESULTS: A total of 729 participants were included in the study, with a mean age of 43.9 ± 14.6 years and 61% being female. Majority (84.8%) presented with gingivitis, 46.7% had periodontitis with 41.8% having both, and 13.9% had severe periodontitis. The mean clinical attachment loss (AL) was 1.36 ± 0.67 mm and 1.41 ± 0.57 mm for probing depth (PD). Factors associated with periodontitis included, increasing age, smoking, and alcohol use; being Muslim provided lower odds of disease. Older people, former smoking, being underweight and not having health insurance were associated with severe periodontitis. CONCLUSIONS: This study shows a high burden of periodontitis with comparatively more severe disease. Existing sociodemographic disparities in disease burden highlights the need of developing targeted population based preventive programs.

Understanding the causes of breast cancer treatment delays at a teaching hospital in Ghana.

Poor outcomes for breast cancer in Ghana have been attributed to late presentation of symptoms at biomedical facilities. This study explored factors accounting for delays in initiation of breast cancer treatment at the Korle-Bu Teaching Hospital in Accra. Focus group discussions were conducted with 20 women with breast cancer. A theory-driven thematic analysis identified three multilevel factors influencing treatment seeking delays: (1) patient (e.g. misinterpretation of symptoms, fear), (2) healthcare provider (e.g. negative attitudes) and (3) health systems (e.g. shortage of medicines). Addressing treatment delays will require multilevel interventions, including culturally congruent education, psychosocial counselling/support and strengthening health systems.

COVID-19 pandemic and dental practice in Ghana.

With the advent of the COVID-19 pandemic, healthcare systems and their provision of care has globally been challenged, including the delivery of Oral healthcare. In Ghana, it has become imperative that healthcare delivery including the practice of Dentistry and its sub-specialties be re-oriented in our peculiar setting to ensure minimal risk of spread of the infection. This article discusses the impact of COVID-19 on the practice of Dentistry in the country.

Dental Education With the COVID-19 Pandemic: Ghanaian Dental Students' Experience.

Introduction: Due to the COVID-19 pandemic, all Ghanaian tertiary institutions were closed down and resorted to online teaching. This posed a challenge for dental education due to requirements of clinical tutoring and patient handling. This study explored the experiences of dental students with the change in teaching methods during the pandemic with the aim of assessing their effectiveness and explore measures for their improvement. Materials and Methods: This was an online survey involving undergraduate dental students in the two dental schools in Ghana. An e-questionnaire was sent out to all the students, exploring their knowledge of and response to the pandemic and assessing the impact of measures implemented during the pandemic to assist them complete their education. Results: Two hundred out of 412 students participated in the study giving a response rate of 48.5%; however, completed responses were available for 195 students, 123 (63.1%) from the University of Ghana Dental School and 72 (36.9%) from the Kwame Nkrumah University School of Medicine and Dentistry. There were 106 (54.4%) females;108 participants (54.4%) were pre-clinical students. One hundred and sixty-four (84%) respondents believed dental professionals had a higher risk of contagion because of proximity to patients during treatment and 115(59.0%) reported being fearful of performing clinical procedures. The students demonstrated adequate knowledge of the disease and a positive attitude towards the required changes instituted because of the pandemic. They however, highlighted technical obstacles and distraction as some of their challenges. The quality of internet was acceptable, but the volume of data was inadequate to meet their needs. Also, though both Universities had their own recommended learning management systems, Zoom was the preferred online learning platform. Conclusions: Generally, the students demonstrated a positive attitude towards the required changes. A blended educational approach may continue to be ideal for dental education as we adapt to this pandemic. Innovative ways may need to be sought to improve the online experience and the University approved online learning management systems enhanced to make them more user friendly.

Introduction: En raison de la pandémie de COVID-19, tous les établissements d'enseignement supérieur ghanéens ont été fermés et ont eu recours à l'enseignement en ligne. Cela a posé un défi pour l'enseignement dentaire en raison des exigences de tutorat clinique et de traitement des patients. Cette étude a exploré les expériences des étudiants en médecine dentaire avec le changement des méthodes d'enseignement pendant la pandémie dans le but d'évaluer leur efficacité et d'explorer des mesures pour leur amélioration. Méthodes: Il s'agissait d'une enquête en ligne impliquant des étudiants en médecine dentaire de premier cycle dans les deux écoles dentaires du Ghana. Un questionnaire électronique a été envoyé à tous les étudiants, explorant leurs connaissances et leur réponse à la pandémie et évaluant l'impact des mesures mises en oeuvre pendant la pandémie pour les aider à terminer leurs études. Résultats: 200 étudiants sur 412 ont participé à l'étude, ce qui donne un taux de réponse de 48,5%; cependant, des réponses complètes étaient disponibles pour 195 étudiants, 123 (63,1%) de l'École dentaire de l'Université du Ghana et 72 (36,9%) de l'École de médecine et de dentisterie de l'Université Kwame Nkrumah. Il y avait 106 femmes (54,4%); 108 participants (54,4%) étaient des étudiants précliniques. Cent soixante-quatre (84%) répondants pensaient que les professionnels dentaires avaient un risque plus élevé de contagion en raison de la proximité des patients pendant le traitement et 115 (59,0%) ont déclaré avoir peur d'effectuer des procédures cliniques. Les étudiants ont démontré une connaissance adéquate de la maladie et une attitude positive envers les changements requis institués en raison de la pandémie. Ils ont cependant souligné les obstacles techniques et la distraction comme certains de leurs défis. La qualité d'Internet était acceptable, mais le volume de données était insuffisant pour répondre à leurs besoins. De plus, bien que les deux universités aient leurs propres systèmes de gestion de l'apprentissage recommandés, Zoom était la plate-forme d'apprentissage en ligne préférée. Conclusions: En général, les étudiants ont démontré une attitude positive envers les changements requis. Une approche pédagogique mixte peut continuer à être idéale pour l'enseignement dentaire alors que nous nous adaptons à cette pandémie. Des moyens innovants devront peut-être être recherchés pour améliorer l'expérience en ligne et les systèmes de gestion de l'apprentissage en ligne approuvés par l'Université seront améliorés pour les rendre plus conviviaux.

COVID-19 pandemic and dental practice in Ghana

With the advent of the COVID-19 pandemic, healthcare systems and their provision of care has globally been challenged, including the delivery of Oral healthcare. In Ghana, it has become imperative that healthcare delivery including the practice of Dentistry and its sub-specialties be re-oriented in our peculiar setting to ensure minimal risk of spread of the infection. This article discusses the impact of COVID-19 on the practice of Dentistry in the country

Factors Associated With Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana.

Background Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study evaluated duration and factors that influenced waiting time from first presentation to start of definitive treatment. Method We conducted a hospital-based retrospective study of 205 breast cancer patients starting definitive treatment at Korle Bu Teaching Hospital between May and December 2013. We used descriptive statistics to summarize patient characteristics. Mann-Whitney U and Kruskal-Wallis tests and Spearman rank correlation were performed to examine the patients, health system, and health worker factors associated with median waiting time. Poisson regression was used to examine the determinants of waiting time. Results The mean age of the patients was 51.1 ± 11.8 years. The median waiting time was 5 weeks. The determinants of waiting time were level of education, age, income, marital status, ethnicity, disease stage, health insurance status, study sites, time interval between when biopsy was requested and when results were received and receipt of adequate information from health workers. Conclusion A prolonged waiting time to treatment occurs for breast cancer patients in Ghana, particularly for older patients, those with minimal or no education, with lower income, single patients, those with late disease, those who are insured, and who did not receive adequate information from the health workers. Time to obtain biopsy reports should be shortened. Patients and providers need education on timely treatment to improve prognosis.

Gender disparities of chronic musculoskeletal disorder burden in the elderly Ghanaian population: study on global ageing and adult health (SAGE WAVE 1).

BACKGROUND: Traditionally, non-communicable diseases including musculoskeletal disorders have not been a priority in low-and-middle income countries. The main aim of this paper is to assess age and gender specific burden by estimating the current prevalence of musculoskeletal disorders and associated risk factors in the elderly Ghanaian population. METHODS: Between May 2007 and June 2008, the World Health Organization conducted a nationwide study on AGEing (SAGE) and Adult Health in Ghana. The study employed a multistage cluster sampling strategy to identify participants by stratifying the population by age and setting. A structured questionnaire was used for data collection. A Poisson regression model was fitted with robust error variance. Prevalence estimates took into account the complex survey design and sampling weights. Statistical significance was considered at p ≤ 0.05 significance level. Statistical analysis was performed with STATA version 11.2. RESULTS: The prevalence rates of chronic back pain and chronic arthritis/joints pain were higher in women than men. The overall crude prevalence's rates were 28.2 and 10.7% for chronic back pain and chronic arthritis/joints pain respectively. Substantial differences existed between men and women in terms of socio-economic status, education level and occupational status. Women with primary education had a chronic back pain prevalence of 36.2% (95% CI; 29.2, 43.3) and chronic arthritis/joints pain prevalence of 15.8% (95% CI; 11.1, 20.6) while their male counterparts had prevalence rates of 29.0% (95% CI; 23.4, 34.5) and 9.8% (95% CI; 6.4, 13.2) respectively. Residence (rural and urban) did not appear to influence the prevalence of chronic back pain and arthritis/joints pain. CONCLUSION: Our findings suggest the existence of sex differences in chronic back pain and chronic arthritis/joint pain in the elderly population in Ghana after adjustment for demographic and socio-economic factors. It indicates the existence of inequalities in health between elderly men and women with women suffering more from chronic back pain and chronic arthritis/joints pain.

Edentulism and quality of life among older Ghanaian adults.

BACKGROUND: Edentulism affects the quality of life and general health of an individual. But in ageing individuals, it has been observed to have greater impact, manifesting in functional, psychological and social limitations. With an increasing older adult population in Ghana, its burden is likely to increase. This study was thus carried out to explore the association between edentulism and quality of life among older Ghanaian adults. METHODS: Secondary analysis of WHO's Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. Participants included a nationally representative sample of adult's aged 50 years and older living in Ghana. Quality of life was measured using the 8 item WHOQOL measure and a single item measure which was a question "How would you rate your overall quality of life?". To assess the association between edentulism and the independent variables, a bivariate analysis was carried out. A Poisson regression model was then performed, adjusting for age, sex, income, education and the diagnosis of a chronic disease condition. A Spearman's correlation analysis was also carried out between the single and multi item measure of quality of life to assess how well they correlate. RESULTS: Edentulism was observed to be associated with significantly lower levels of SWB among older adults using both the single-item and multiple-item measure (WHOQOL). It, however, showed no association with happiness. Among edentulous respondents, females and those with no formal education reported significantly lower quality of life. The WHOQOL correlated positively and strongly with the single-item measure. CONCLUSION: Edentulism may not be life threatening and yet it has been shown to have a negative effect on the quality of life of older adult Ghanaians. More emphasis may thus need to be placed on the oral health of the aging population in Ghana to avoid it.

Prevalence and geographic distribution of edentulism among older Ghanaians.

OBJECTIVES: Edentulism has important health implications for aging individuals and is used as an indicator of the oral health of a population. Its distribution is unequal within populations, with the greatest burden on disadvantaged and socially marginalized populations. With an increasing older adult population in Ghana, its burden may increase; however, there is no nationwide information on edentulism in Ghana. Focusing on adults 50 years and older, this study assessed the prevalence of edentulism among older Ghanaians and its distribution across the country. METHODS: Secondary analysis of WHO's Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. RESULTS: The overall prevalence was 2.8%, varying by sex (men had lower rates; OR = 0.67, 95% CI = 0.47-0.97); by location, being more prevalent in urban areas (3.6%) and the Western Region (4.7%); by education levels (rates were higher among those with no formal education; OR = 1.626, 95% CI = 1.111-2.380); and by marital status (those living without a partner had higher rates; OR = 1.980, 95% CI =1.366-2.870). On multivariate logistic regression, the variables positively associated with edentulism were older age (OR = 0.945) and urban residence (OR = 0.582). Living in the Brong Ahafo (OR = 3.138), Central (OR = 2.172), Eastern (OR = 2.257), or Volta regions (OR = 3.333) was negatively associated with edentulism. CONCLUSION: Edentulism is unequally distributed across Ghana. Future aged cohorts are likely to follow the same patterns of geographic and social disadvantage if needed interventions are not carried out. This study provides nationwide data to assist service planning.

Prevalence of loss of all teeth (edentulism) and associated factors in older adults in China, Ghana, India, Mexico, Russia and South Africa.

Little information exists about the loss of all one's teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO's) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (N = 13,367), Ghana (N = 4724), India (N = 7150), Mexico (N = 2315), Russian Federation (N = 3938) and South Africa (N = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%-21.7%) than China, Ghana, and South Africa (3.0%-9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.

Tobacco use in older adults in Ghana: sociodemographic characteristics, health risks and subjective wellbeing.

BACKGROUND: Tobacco use over the life-course threatens to increase disease burden in older adulthood, including lower income countries like Ghana. This paper describes demographic, socioeconomic, health risks and life satisfaction indices related to tobacco use among older adults in Ghana. METHODS: This work was based on the World Health Organization's multi-country Study on global AGEing and adult health (SAGE), conducted in six countries including Ghana. Wave one of SAGE in Ghana was conducted in 2007-2008 as collaboration between WHO and the University of Ghana Medical School through the Department of Community Health. A nationally representative sample of 4305 older adults aged 50 years and above were interviewed. Associations between tobacco consumption and sociodemographic, socioeconomic, health risk and life satisfaction were evaluated using chi-square and odds ratio (OR). Logistic regression analyses, adjusted for age, sex and other variables, were conducted to determine predictors of tobacco consumption in older persons. RESULTS: Overall prevalence of current daily smokers among older adults in Ghana was 7.6%. Tobacco use (i.e. ever used tobacco) was associated with older males, (AOR = 1.10, CI 1.05-1.15), older adults residing in rural locations (AOR = 1.37, CI 1.083-1.724), and older adults who used alcohol (AOR = 1.13, CI 0.230-2.418). Tobacco use was also associated (although not statistically significant per p-values) with increased self-reporting of angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, and stroke. Older adults who used tobacco and with increased health risks, tended to be without health insurance (AOR = 1.41, CI 1.111-1.787). Satisfaction with life and daily living was much lower for those who use tobacco. Regional differences existed in tobacco use; the three northern regions (Upper East, Northern and Upper West) had higher proportions of tobacco use among older adults in the country. Quitting tobacco use was higher in the 70+ years age group, in women, among urban residents and in those with at least secondary education. Quitting tobacco use also increased with increasing income levels. CONCLUSIONS: Tobacco use among older adults in Ghana was associated with older men living in rural locations, chronic ill-health and reduced life satisfaction. A high proportion of older adults have stopped using tobacco, demonstrating the possibilities for effective public health interventions. Health risk reduction strategies through targeted anti-smoking health campaigns, improvement in access to health and social protection (such as health insurance) will reduce health risks among older persons who use tobacco.

Bond strength of luting cements to core foundation materials.

PURPOSE: The purpose was to compare the shear bond strength of luting cements to foundation materials and to determine the effect of storage in lactate buffer solution. MATERIALS AND METHODS: Disks that were 8 mm in diameter and 2-mm thick were fabricated from foundation substrates: amalgam, composite resin, resin-modified glass ionomer, and glass ionomer (n = 20). Cylinders that were 2 mm in diameter and 4 mm in length of resin luting cement, resin-modified glass ionomer luting cement, and a glass ionomer luting cement were bonded to the foundation substrate materials. Shear bond strength of each foundation substrate material/cement pair was determined with a universal testing machine after 24 hours. A second set of specimens was tested after storage in a 0.01M lactate buffer solution for 24 hours. A three-way analysis of variance followed by pair-wise comparisons was performed to compare bond strengths (P < .05). RESULTS: The resin cement provided the highest (P < .05) bond strengths to amalgam, composite resin, and resin-modified glass ionomer foundation materials while the glass ionomer cement showed the lowest bond strength (P < .05) to composite resin and glass ionomer foundation restoration materials. After immersion in a 0.01M lactate buffer solution, the shear bond strength of all the material combinations was significantly lower (P < .05) than nonimmersed specimens, except the bonds between composite resin foundation and resin luting cement, which significantly increased (P < .05) in strength. CONCLUSION: The resin cement had the highest bond strength to most foundation substrates investigated. The highest bond was observed between the composite resin foundation and resin cement. This bond was also the most durable on immersion in lactic acid.

Chronic hepatitis C virus and the Hispanic community: cultural factors impacting care.

Hispanics are one of the fastest growing ethnic minorities in the United States. Estimates suggest there are 32.8 million Hispanics in the United States, comprising 12% of the population. Hispanics have a 40% greater chance of being infected with hepatitis C virus than the general population. In fact, chronic liver disease is the seventh highest cause of death in Hispanics, ages 25 to 44, and third highest in the 45 to 64 age group.