Oral Health Workforce and American Indian and Alaska Native Communities: a Systematic Review.

OBJECTIVE: Understanding the oral health workforce representing and serving American Indian and Alaska Native (AI/AN) communities is vital to improving community dental health outcomes. No systematic review of recent published literature on the oral health workforce among this population has been completed. METHODS: We conducted a systematic review of published literature examining the oral health workforce representing and serving AI/AN communities in the USA. We analyzed 12 articles according to the PRISMA Statement. RESULTS: The studies suggested that AI/AN identity is an important aspect of routine and accessible oral healthcare. There are unique barriers and motivations that personnel in the oral health workforce face, let alone the distinctiveness of serving AI/AN communities. CONCLUSIONS: This review provides evidence that expanded oral health positions aid in community members receiving more routine and preventative care and is an upstream public health approach that has diversified the dental workforce.

Native American Community Perspectives on Oral Health Access: Understanding the Impact of Rurality.

PURPOSE: Oral health disparities related to access persist for American Indian/Alaska Native (AI/AN) communities compared to the general population, especially in rural areas of the United States. The objective of this study was to better understand community perspectives of oral health, how rurality impacts access to care, and attitudes towards the implementation of dental therapists in Oklahoma, particularly among the AI/AN population. METHODS: A descriptive, observational study design was utilized. An exploratory survey was conducted online and comprised of qualitative and quantitative data. The total frequencies and percentages were evaluated for the quantitative questions. The qualitative data was analyzed using thematic analysis. Utilizing descriptive and qualitative research methods, the focus was to describe the experiences of the respondents and their characteristics related to oral health in Oklahoma. RESULTS: A total of 201 responses were obtained, where 65% (n = 131) identified as an enrolled member or employee of a tribe represented in Oklahoma. Key qualitative themes included community access to care, community concerns, and community motivated solutions. CONCLUSIONS: AI/AN communities are an underserved group in healthcare. Although communities in rural areas face major barriers to oral health services, evidence-based solutions can be implemented.

Oral Health Policy and Improvement Strategies in Oklahoma.

Oklahoma an ethnically, financially and geographically diverse population has unique oral health care challenges. These challenges include poor overall oral health, inadequate oral health coverage, significant physical access to care barriers and a shortage of oral health care workers. Just as the oral health care barriers are diverse, so are the potential solutions. Potential solutions include efforts at all levels of government, innovations of health care delivery and recognition of the unique needs of Oklahoma American Indian population. Potential strategies address each of these opportunities and recognize both the short and long term needs of Oklahoma oral health.

Early Care and Education Teacher's Role in Obesity Prevention and Healthy Development of Young American Indian Children.

INTRODUCTION: The purpose of this study was to develop an understanding of how stakeholders, specifically early care and education (ECE) teachers, perceive their role in the development of young American Indian children, and envision working with health care providers and parents in order to enhance children's health. METHODOLOGY: Twenty tribally affiliated ECE teachers from Oklahoma participated in interviews. Thematic analysis was conducted, and three main themes, each with two to three subthemes, emerged. RESULTS: Teachers felt that nutrition and physical activity were important to children's health. Teachers had little professional interaction with health care providers but desired more. Parental empowerment was conveyed as essential to actualize positive changes in their child's behavior. DISCUSSION: Teachers of tribally affiliated ECE centers are important stakeholders in promoting the health and well-being of young American Indian children. Additional efforts are needed to more effectively integrate teachers and nurses in order to create effective interventions. We propose a stakeholder partnership to guide the development of future interventions.

Health Care Provider's Role in Obesity Prevention and Healthy Development of Young American Indian Children.

INTRODUCTION: Health care providers (HCPs) serving American Indian (AI) populations are critical stakeholders in promoting healthy weight-related behaviors of young AI children. The purpose of this study is to develop an understanding of how HCP perceive their role in the healthy development of young AI children, and how they envision working with early care and education teachers and parents to enhance children's health. METHOD: Twenty HCP that serve young AI children in Oklahoma participated in individual interviews. Thematic analysis was conducted on coded transcripts and three main themes, each with two to four subthemes were identified. RESULTS: HCP had limited contact with teachers, felt family health was equal or more important than child health, and parental empowerment and gradual change was essential for success. CONCLUSION: Creating ways to involve HCP, early care and education teachers, and parents together in multilevel and multisector interventions has the potential to improve the health of young AI children.

Regression comparisons of Tetrahymena pyriformis and Poecilia reticulata toxicity.

The toxicity data of chemicals common to both the Poecilia reticulata mortality assay and the Tetrahymena pyriformis growth impairment assay were evaluated. Two chemicals were not toxic at saturation in the T. pyriformis assay. In addition, due to abiotic transformation, a third chemical was removed from further consideration. Each chemical was a priori assigned a mode of toxic action: neutral non-covalent, polar non-covalent, or electrophilic covalent toxicity. To further investigate comparisons between endpoints, polar and electrophilic chemicals were separated into class-based groups. The polar non-covalent chemicals were separated into phenols and anilines, while the electrophilic chemicals were separated into those reacting via Schiff-base formation (i.e., aldehydes) and those reacting via bimolecular substitution to a nucleophile (i.e., selected nitroaromatics). A comparison of toxic potency as a collective set was statistically described by the relationship; log(LC50(-1)) = 1.05(log(IGC50(-1))) + 0.56, n = 124; r2 = 0.85; s = 0.42; F = 682; Pr > F = 0.0001. The relationship between endpoints was inversely proportional to reactivity associated with the mode of action. While the comparative toxicity for neutral narcotics exhibited an excellent fit (r2 = 0.94), the fits for polar narcotics and electrophiles were poorer, r2 = 0.69 and 0.62, respectively. Investigations into class-based groupings indicated fit of toxic potency data for aldehydes (r2 = 0.85) and phenols (r2 = 0.81) were quite good. However, fits for anilines (r2 = 0.43) and nitroaromatics (r2 = 0.68) revealed that toxicity was not as well related between endpoints for these chemicals.