Browsing by Author "Østbye, Truls"

Background: Global aging poses various challenges for both developing and developed countries. The proportion of older adults in developed countries is currently much higher than in developing countries. Health authorities are now confronting increasing public health problems, including a growing burden of oral diseases among older people. Although the percentage of older adults who have retained their natural teeth has increased steadily during the past decades, the number of natural teeth might still contribute vastly to older people’s quality of life. As little research has been conducted in the Southeast Asia area, this study aims to 1) investigate the association of number of natural teeth and oral pain with oral health-related quality of life; 2) discover ethnic disparities in regards to number of natural teeth and oral health-related quality of life; and 3) examine factors related to number of natural teeth retained among elderly Singaporeans.

Methods: The study was carried out in a dental clinic conducting a questionnaire survey on patients who visited the clinic. Geriatric Oral Health Assessment Index (GOHAI) was used and the GOHAI total score (ranged from 12 - 60) was measured to describe participants’ oral health-related quality of life from three perspectives: physical, social, and mental health components. Participants’ dental records were linked to the questionnaire survey and data on their dental parameters were also collected. Linear regression analysis was conducted as the main method towards all the three study aims, whereas logistic regression analysis was performed as supplementary evidence especially for Aim 1. Non-parametric statistical tests were also used in cased of normality assumption requirements throughout the analytical process.

Results: The mean GOHAI total score of the study subjects was 47.72 (SD = 7.45). The mean number of natural teeth was 18.27 (SD = 8.15). A positive association between number of natural teeth and GOHAI total score was found by the linear regression analysis (Coefficient = 0.20, 95%CI: 0.17, 0.44) and a Spearman correlation test (rho=0.22, P < 0.01). A negative association between oral pain and GOHAI total score was detected by the linear regression (Coefficient = -5.88, 95%CI: -7.86, -3.91) and a Spearman correlation test (rho = -0.40, p < 0.001) as well. In terms of factors associated with number of natural teeth, older people with more number natural teeth were found to be associated with younger age, higher educational level, and flossing at least once a day. Ethnic disparities were observed with Malays exhibited the lowest number of natural teeth and GOHAI total score, compared to Chinese and Indians.

Conclusions: The oral health-related quality of life of the investigated population was generally fair. Ethnic disparities existed in oral health-related quality of life and number of natural teeth among older adults in Singapore that Malays had adverse oral health status compared to Chinese and Indians. With more number of natural teeth retained and less oral pain, a person was more likely to have better oral health-related quality of life. Flossing at least once a day might contribute to the retention of more natural teeth.

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Migration is a fundamental demographic process that has been linked to cognitive function among the immigrant populations in developed countries. However, there is limited understanding of how migration and cognitive function are related among internal migrants in developing countries. The purpose of this dissertation is to provide some of the first evidence of the association between rural-urban migration and cognitive function among middle aged and older adults in China and India. We also examined whether the association between migration and cognitive function can be explained by a variety of factors such as sociodemographic background, health behaviors, and physical health status.

We first conducted a comprehensive review of the literature on the association between migration and cognition among middle-aged and older adults. Based on the current evidence, we developed a general conceptual framework to understand the factors contributing to the association. We identified five potential mechanisms from the literature: 1) socioeconomic status, 2) psychosocial factors, 3) behavioral factors, 4) physical and psychological health status, and 5) environmental factors. We also included several underlying factors in this conceptual framework such as early-life conditions, gender, and genetic factors. Overall, we found that factors linking migration and cognitive function are multidimensional and complex. We encouraged future studies to further test these mechanisms and refine this framework using empirical data.

To examine the association between migration and cognitive function among the internal migrant populations in China and India, we conducted a cross-national comparison study using the 2007-2010 World Health Organization Study on global AGEing and adult health (SAGE) data. We included 12,937 adults aged 50 or over from China and another 6,244 from India. We categorized migration status into six groups: urban residents, rural residents, urban-to-urban migrants, rural-to-urban migrants, rural-to-rural migrants, and urban-to-rural migrants. We generated a global cognitive function score by combing the following five cognitive tests: immediate and delayed recall tests, digit span tests (forward and backward), and verbal fluency test. We also assessed a variety of covariates in the analyses that included sociodemographic characteristics, psychosocial factors, health behaviors, and physical health status.

In the Chinese sample, we found that urban residents and urban-to-urban migrants had the highest level of cognitive function; whereas rural residents and rural-to-rural migrants had the poorest cognitive function. Our findings also showed that people who migrated to/within rural areas before age 20 had poorer cognitive function than those who migrated later in their adulthood. We found similar association in the Indian sample that urban residents and urban-to-urban migrants had the highest levels of cognition; while rural residents and people who migrated to (or within) rural areas had the poorest cognitive function. In both countries, we found that these patterns remain largely unchanged after adjusting for multiple study covariates.

In this dissertation, we also assessed gender differences in the association between migration and cognitive function. While doing a cross-country comparison, we observed a consistent female disadvantage in cognitive function in both countries. We found that female rural residents and female rural-to-rural migrants had the poorest cognitive function in both the Chinese and Indian samples. Among Chinese men, we found that rural residents had poorer cognitive function than urban residents, while urban-to-urban migrants had the highest level of cognition; however, for male counterparts in India, rural-to-rural migrants had the lowest level of cognitive function.

In sum, we found that cognitive function among middle aged and older adults in China and India differ significantly according to their migration status. The association between migration and cognitive function is complex and differs by gender and country.

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Background: The interrelatedness between social determinants of health impedes researchers to identify important social factors for health. Older populations have highly diverse social backgrounds, and a new approach is needed to quantify the aggregate effect of social factors and develop person-centered social interventions. We aim to create a polysocial score index to comprehensively assess the social and physical environments as well as their combined effect on health among older adults.Methods: We included a total of 7,383 adults, consisted of 3,651 participants in 2006 and 3,732 participants in 2008, who were at least 65 years and completed an additional psychosocial questionnaire in the Health and Retirement Study (HRS), a longitudinal study of a nationally representative sample of non-institutionalized residents in the United States. We searched the entire HRS data set and selected 24 social determinants of health encompassing five social domains: (1) economic stability, (2) neighborhood and physical environment, (3) education, (4) community and social context, and (5) health care system. The outcome was five-year mortality. We used a forward stepwise logistic regression model with a threshold of P-value equal to 0.1 to screen for important social factors; those having a 2-sided P value < 0.1 were retained in the final model. We assigned the polysocial score to each participant by summing the score for each social variable based on the raw coefficients of the regression model. The score of each variable was calculated as the absolute value of the raw coefficient times 10. Both continuous and categorical polysocial scores (low: 0-29, intermediate: 30-39, and high: 40+) were constructed. Participants with higher scores had a better social environment. Logistic regressions were used to assess the unadjusted and adjusted associations between polysocial score and five-year mortality. Demographic (age, gender, and race/ethnicity), lifestyles (body mass index, smoking status, and alcohol use), and health conditions (disability in activities of daily living, hypertension, diabetes, cancer, lung disease, heart disease, stroke, psychiatric disease, arthritis, and self-reported health) were included in the adjusted models. Interaction analyses were conducted in additive scales and multiplicative scales to evaluate whether the association between polysocial score and death was different by sex and race/ethnicity. Results: Polysocial score was created using 15 social determinants of health selected from 24 social determinants of health: total household income, total wealth, out-of-pocket medical expenditure, education level, employment status, marital status, type of house, regions of residence, used language, long-term care insurance coverage, life insurance coverage, social engagement, discrimination, stress level, and neighborhood social cohesion. The total score ranged from 7 to 59; the mean (SD) was 35.5 (7.5). Of the 7,383 participants, 491 (30.8%), 599 (17.2%), and 166 (7.8%) deaths occurred over five years among participants with a low (0-29), intermediate (30-39), and high (40+) polysocial score, respectively. In the fully adjusted logistic regression model in which polysocial score was modeled as a continuous variable, a one-point higher polysocial score was associated with 3% (Odds Ratio [OR]= 0.97; 95% CI, 0.96-0.98) lower odds of death over five years. In the fully adjusted model where polysocial score was modeled as a three-level categorical variable, the odds of death were 24% (Odds Ratio [OR]=0.76; 95% CI, 0.65-0.89) and 54% (OR=0.46; 95% CI, 0.36-0.59) lower among participants with an intermediate or high polysocial score, respectively, than those in the low category. Females had lower odds of mortality than males in the unadjusted logistic regression model. Results of racial/ethnic interaction analyses showed that Hispanic/Latino participants had lower five-year mortality (low: 17.2%; intermediate: 11.9%; high: 6.0%) than non-Hispanic white (low: 34.9%; intermediate: 17.9%; high: 7.3%) and other (low: 25.8%; intermediate: 14.3%; high: 6.3%) racial/ethnic subgroup in the additive scale, while we did not find a significant interaction between polysocial score and race/ethnicity in the multiplicative scale. Conclusions: We created a novel polysocial score including 15 social determinants of health encompassing multiple dimensions: economic stability, physical and neighborhood environment, education, community and social context, and the healthcare system. Higher polysocial score was significantly associated with lower five-year mortality among older adults in the US after adjusting for socio-demographic, lifestyles, and health conditions. The polysocial approach may offer possible solutions to monitor social environments and provide evidence-based suggestions for older adults to improve their social status for specific health outcomes.

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Despite numerous studies demonstrating high rates of discrimination and poor mental health among transgender people in Western countries, little research has been conducted on this population in Sri Lanka. As such, the primary objective of this study was to assess the prevalence of discrimination experienced by transgender people in the workplace, health care, and family settings. Additionally, we investigated the potential association between discrimination and adverse mental health outcomes, including current depression, anxiety disorders, and low self-esteem. In Galle, 100 transgender participants were recruited through snowball sampling and then completed the survey through face-to-face interviews. The survey consisted of five sections: sociodemographic information, mental health scales, and discrimination experience in the workplace, health care, and family settings. We reported the prevalence of discrimination and adverse mental health outcomes. We also estimated the prevalence ratios of current depression and anxiety disorder, which are associated with work inaccessibility and workplace discrimination, adjusting for age, education, and gender identity in separate Poisson regression models. The study found that school harassment (67%), workplace insults (63.5%), and work inaccessibility (47.4%) were the most commonly reported types of discrimination among transgender participants. Among them, the prevalence of current depression, anxiety disorder, and low self-esteem were 44%, 38%, and 81%, respectively. Furthermore, work inaccessibility was associated with a 16% increase in the prevalence of depression. Workplace discrimination, as measured by two categories (1 or 2 types of discrimination, ≥3 types of discrimination) was associated with greater prevalence (41%-56%) of depression and anxiety (22% - 46%) than non-discrimination, although all of those associations were not statistically significant. The high prevalence of discrimination against transgender people presented in the study highlights the urgent need for legislative changes to protect their rights. Future studies should aim to identify coping resources and develop evidence-based interventions to minimize the adverse mental health consequences of discrimination. It is expected that the researchers and transgender voluntary groups who had been involved in the study may transform the study results into meaningful real-world interventions.

In the United States, there has been over 1,000,000 deaths and more than 90 million cases of COVID-19. As of April 19, 2021, all adults aged 16 and older were eligible to receive vaccination. Nevertheless, young adults are being vaccinated at a slower rate than older adults. The current study aimed to identify potential factors associated with young adult vaccine hesitancy through a mixed methods approach comparing vaccinated and unvaccinated through both a quantitative survey and qualitative in-depth interviews. The survey captured 350 responses from young adults aged 20 to 30 living in four states: California, Mississippi, Oregon and Texas. The online survey differentiated between vaccinated and non-vaccinated individuals and analyzed different aspects of vaccine hesitancy from political trust to COVID-19 vaccine beliefs. Sixteen semi-structured in-depth interviews lasting 20 to 30 minutes were performed on Zoom. The main factors associated with vaccine hesitancy in young adults for both the survey and interviews were social drivers, trust in institutions, barriers to vaccination, perceptions of the vaccine, and COVID-19 vaccine information quality. Study findings will increase understanding of COVID-19 vaccination decision-making pathways of young adults with the purpose of informing future interventions and policy for promoting vaccination rates in young adults.

Background: The role of grandparents has changed in response to social, economic and demographic factors, which may operate both in favour of or against the relationship between grandparents and their grandchildren. The potential positive impact of the grandparent-grandchild relationship on the development of adolescent grandchildren has been increasingly recognized, although relatively few studies have directly related this relationship to measures of child well-being. This study aims to examine the association between grandparent-grandchild interactions and socio-emotional and cognitive outcomes among adolescent grandchildren in Sri Lanka. Methods: This cross-sectional study was conducted within schools, temples, homes and community buildings in Galle District. An interviewer-assisted survey was used to collect data about the adolescent participants’ demographics, family and household information, grandparent relationships, empathy, and socio-emotional development. A cognitive test was used to assess the adolescents’ cognitive development. Univariate, bivariate and multivariate analyses were used to examine the association between the grandparent-grandchild relationship and adolescent outcomes. Results: Our results indicate that grandparent-grandchild relationships are significantly associated with adolescent socio-emotional and cognitive development. Conclusions: This study underlines the importance of the grandparent-grandchild relationship.

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