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Gerardo Maupome
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Oral health disparities in the Latino community are often linked to lifestyle, socio-economic position, and structural barriers in healthcare systems. However, it is increasingly recognized that individuals rely on professional and informal social networks to understand and address their health problems. Social norms inherent within these networks can shape oral health-related decision-making. Network members can offer support, recommend or provide services, influence health behaviors, and encourage or discourage adherence to treatment regimes. To address this gap in knowledge, Dr. Gerardo Maupomé examines the link between oral health disparities and social networks.
Building on prior and formative research, Dr. Maupomé and colleagues are using network methods to gain an insight into the complex and dynamic mechanisms underlying oral health disparities. First, they identify customs, attitudes, and behaviors around dental care and oral health. Second, they apply this information to characterize the relationships between the diverse strands of interpersonal networks and behaviors. The research will produce innovative methodological knowledge about quantifying how personal networks change over time, and how such evolution support or undermine positive oral health traits in an at-risk population. The ultimate goal is to devise actionable strategies and identify entry points into networks that lead to positive changes.
Dr. Maupomé’s work to reduce disparities in oral health is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.
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Item Enamel defects, cavities in primary dentition, fluoride sources and their relationship to cavitiesin permanent teeth defect Enamels, cavities in primary dentition and fluoride sources: relationship with caries in permanent teeth(Elsevier, 2007-05) Vallejos-Sánchez, Ana Alicia; Medina-Solís, Carlo Eduardo; Casanova-Rosado, Juan Fernando; Maupomé, Gerardo; Casanova-Rosado, Alejandro José; Minaya-Sánchez, Mirna; Oral Pathology, Medicine and Radiology, School of DentistryOBJECTIVE:To examine the relationship between the presence of enamel defects, dental caries in primary teeth, and exposure to various fluoride technologies and the presence of dental caries in permanent teeth in children with mixed dentition. MATERIALS AND METHODS:A cross-sectional study was conducted in 713 children aged 6-9 years old in 4 elementary schools in Campeche, Mexico through the use of a questionnaire for the mothers and an oral examination in the children. The dependent variable was the prevalence of caries in permanent dentition. RESULTS:The mean number of decay, missing or filling teeth in primary dentition (dmft) and in permanent dentition (DMFT) was 2.48 (2.82) (deft > 0 = 58.9%) and 0.40 (0.98) (DMFT > 0 = 18.2%), respectively. The significant caries index (SiC), which is calculated in deciduous dentition, was 5.85 for 6 year-olds. Multivariate logistic regression adjusted for variables related to fluoride exposure revealed that older age (OR = 2.99), a deft of > 0 (OR = 5.46), and lower maternal educational level (OR = 1.57) were significantly associated with a higher number of dental caries in permanent teeth. An interaction between sex and enamel defects was also found. CONCLUSIONS:The number of dental caries in both primary and permanent dentitions was relatively smaller than that found in prior studies performed in Mexican populations. The results confirm that the presence of caries in primary dentition is strongly associated with caries in permanent dentition. No significant relationship was found between fluoride exposure and dental caries in permanent dentition.Item PILOT APPRAISAL OF VARIABLES AMONG MEXICAN-AMERICANS FOR SOCIAL NETWORKS ANALYSIS(Office of the Vice Chancellor for Research, 2010-04-09) Maupome, Gerardo; Wright, E.; Martinez-Mier, E.A.; Medina-Solis, C.E.Hispanics in the USA often suffer poor oral health. More appropriate solutions may be designed if we move beyond the simplistic interpretation of poor oral outcomes being associated with 1-2 variables, e.g., language; such an approach has failed to provide consistent interpretations, and offers no points for intervention. We propose to examine a constellation of variables interwoven into multilevel strategies under a new(er) paradigm, social network theories (http://cmol.nbi.dk/models/infoflow/infoflow.html). Objectives: To qualitatively identify domains of variables modulating oral health outcomes among 1st-2nd generation MexicanAmerican immigrants. Methods: Through key informant interviews, we ascertained KAB variables in immigrant families originating in Jalisco, Mexico. This community has had a strong, revolving presence for decades in a well-delimited location in Indianapolis, IN, around St. Patrick’s parish. We did not conduct clinical exams but used questions from American national surveys to document health perceptions, availability of dental services/insurance, presence of dental pain and impaired function in adults and children, and family structure and sociodemographic profiles during a Catholic festival (no incentives, no appointments). Data were content-analyzed. Results: Data were collected from 22 parent-child dyads (15 female adults, 7 male; mean age 24±6.3yrs; data from the oldest child and the interviewee). Frequencies of dental emergencies and acute problems varied markedly, with recurrence patterns. A minority exhibited consistent dental attendance, often enabled by public/private dental insurance. Time in the USA varied considerably, with 1st and 2nd generation immigrant parents and children sharing the household. Occupations ranged from manual to clerical, and education from elementary to college among adults. Conclusion: Interviews were feasible and acceptable, and the experience informed future fieldwork considerations. We are using the variables to design a social networks study to characterize the evolution of patterns between families in Indianapolis and among peers living in Jalisco, aiming to measure impacts ascribable to immigration along acculturation spectra.Item The Binational/Crosscultural Health Enhancement Center(Office of the Vice Chancellor for Research, 2010-04-09) Bergman, Alicia April; Bigatti, Silvia M.; Clark Jr., Charles M.; Everetts, David R.; Kahn, Hilary E.; Lorant, Diane Estella; Maupome, Gerardo; Mays, Rose M.; Riner, Mary E.; Snodgrass, Michael David; Soto, Armando; Stelzner, Sarah M.; Whitehead, Dawn Michele; Wilson, Gregory A.; Yoder, Karen M.The Binational/Cross-Cultural Health Enhancement Center (BiCCHEC) fosters multidisciplinary research collaborations that address the biological, cultural, historical, legal, behavioral and demographic issues that impact the health status of communities where Latinos are born and where they live in Indiana. Since its inception, BiCCHEC projects have been multidisciplinary, 80% of the projects involve two or more IUPUI schools. BiCCHEC projects are also collaborative, 70% of the projects have one or more community partners. BiCCHEC researchers have also established a strong commitment to teaching and service, actively involving students in research (25% of current projects are student led) and servicelearning activities, developing exchange programs through our partnerships and providing direct health services in community organized events. Signature center funds have been utilized to fund internal pilot projects. The current poster will highlight four of those projects that have received pilot funding from signature center funds and have resulted in external grant applications or have already received funding, or have resulted in peer reviewed-publications. These projects are considered representative of BiCCHEC’s activities, because of their collaborative, multidisciplinary and community-based nature and include: • Study on oral health disparities using community-based participatory research • Study on the attitudes regarding children with disabilities, beliefs regarding death, coping skills and supports used during bereavement in communities in Indiana and rural Mexico • Building of a bi-national research partnership for healthful eating and diabetes prevention among Mexican and Mexican-American children • Study on emigration and return migration in 20th Century Mexico: Across the border and back again • Study on the effects of migrants' acculturation on oral health and diet in Indianapolis and Tala, Jaliscco using social network theoryItem Diagnostic thinking and information used in clinical decision-making: a qualitative study of expert and student dental clinicians(BMC, 2010-05-13) Maupomé, Gerardo; Schrader, Stuart; Mannan, Saurabh; Garetto, Lawrence; Eggertsson, Hafsteinn; Cariology, Operative Dentistry and Dental Public Health, School of DentistryBackground It is uncertain whether the range and frequency of Diagnostic Thinking Processes (DTP) and pieces of information (concepts) involved in dental restorative treatment planning are different between students and expert clinicians. Methods We video-recorded dental visits with one standardized patient. Clinicians were subsequently interviewed and their cognitive strategies explored using guide questions; interviews were also recorded. Both visit and interview were content-analyzed, following the Gale and Marsden model for clinical decision-making. Limited tests used to contrast data were t, χ2, and Fisher's. Scott's π was used to determine inter-coder reliability. Results Fifteen dentists and 17 senior dental students participated in visits lasting 32.0 minutes (± 12.9) among experts, and 29.9 ± 7.1 among students; contact time with patient was 26.4 ± 13.9 minutes (experts), and 22.2 ± 7.5 (students). The time elapsed between the first and the last instances of the clinician looking in the mouth was similar between experts and students. Ninety eight types of pieces of information were used in combinations with 12 DTPs. The main differences found in DTP utilization had dentists conducting diagnostic interpretations of findings with sufficient certainty to be considered definitive twice as often as students. Students resorted more often to more general or clarifying enquiry in their search for information than dentists. Conclusions Differences in diagnostic strategies and concepts existed within clearly delimited types of cognitive processes; such processes were largely compatible with the analytic and (in particular) non-analytic approaches to clinical decision-making identified in the medical field. Because we were focused on a clinical presentation primarily made up of non-emergency treatment needs, use of other DTPs and concepts might occur when clinicians evaluate emergency treatment needs, complex rehabilitative cases, and/or medically compromised patients.Item Confirmation of symmetrical distributions of clinical attachment loss and tooth loss in a homogeneous Mexican adult male population(Elsevier, 2010-09) Minaya-Sánchez, Mirna; Vallejos-Sánchez, Ana A.; Casanova-Rosado, Alejandro J.; Casanova-Rosado, Juan F.; Medina-Solís, Carlo E.; Maupomé, Gerardo; Márquez-Corona, María de L.; Islas-Granillo, Horacio; Social and Behavioral Sciences, School of Public HealthBackground/purpose To ascertain whether or not clinical attachment loss and tooth loss are present with similar severity and prevalence across the two sides of the mouth in a homogeneous sample of urban male adults. Materials and methods A cross-sectional study was carried out on 161 policemen (a largely homogeneous group in terms of ethnic background, socioeconomic status, sex, occupation, and medical/dental insurance) in Campeche, Mexico. Periodontal examinations were undertaken using the Florida Probe System in a dental chair by one trained and standardized examiner (kappa ≥ 0.60) to determine clinical attachment loss and tooth loss. We examined six sites in all teeth present in the mouth (a maximum of 168 sites, no third molars). Because of correlated data between observations, McNemar (for tooth loss) and Wilcoxon (for attachment loss) signed-rank tests were used to compare right and left sites within the same patient. Results The mean age was 38.4 ± 11.0 years. The mean number of teeth present was 24.4 ± 4.6; the mean number of periodontal sites/person was 146.7 ± 27.8. All P values were ≥ 0.05 (except for attachment loss in the upper first premolars), suggesting that there were no statistically significant differences between the right and left sides for the frequency of presentation of these two conditions. Conclusion Tooth loss and attachment loss measurements largely resemble each other on both sides of the mouth.Item Design of the Prevention of Adult Caries Study (PACS): A randomized clinical trial assessing the effect of a chlorhexidine dental coating for the prevention of adult caries(BMC, 2010-10-05) Vollmer, William M.; Papas, Athena S.; Bader, James D.; Maupomé, Gerardo; Gullion, Christina M.; Hollis, Jack F.; Snyder, John J.; Fellows, Jeffrey L. Fellows; Laws, Reesa L.; White, B. Alexander; PACS Collaborative Research Group; Social and Behavioral Sciences, School of Public HealthBackground Dental caries is one of the primary causes of tooth loss among adults. It is estimated to affect a majority of Americans aged 55 and older, with a disproportionately higher burden in disadvantaged populations. Although a number of treatments are currently in use for caries prevention in adults, evidence for their efficacy and effectiveness is limited. Methods/Design The Prevention of Adult Caries Study (PACS) is a multicenter, placebo-controlled, double-blind, randomized clinical trial of the efficacy of a chlorhexidine (10% w/v) dental coating in preventing adult caries. Participants (n = 983) were recruited from four different dental delivery systems serving four diverse communities, including one American Indian population, and were randomized to receive either chlorhexidine or a placebo treatment. The primary outcome is the net caries increment (including non-cavitated lesions) from baseline to 13 months of follow-up. A cost-effectiveness analysis also will be considered. Discussion This new dental treatment, if efficacious and approved for use by the Food and Drug Administration (FDA), would become a new in-office, anti-microbial agent for the prevention of adult caries in the United States.Item The relationship between the ABO discrepancy index and treatment duration in a graduate orthodontic clinic(Allen Press, 2011) Parrish, Laura D.; Roberts, W. Eugene; Maupome, Gerardo; Stewart, Kelton T.; Bandy, Robert W.; Kula, Katherine S.; Orthodontics and Oral Facial Genetics, School of DentistryObjective: To test the hypothesis that there is no relationship between the components of the American Board of Orthodontics (ABO) discrepancy index (DI) and duration of orthodontic treatment. Materials and methods: A retrospective review of 732 patient records with permanent dentition was performed. Pretreatment radiographs and casts were used to determine the DI score. Other data collected were total treatment duration, age, sex, ethnicity, and the date fixed appliances were removed. Reliability tests showed substantial agreement between examiners (Cohen's kappa 0.68-0.94). Pearson and Spearman correlation coefficients were used to assess the association between the DI scores and length of treatment. A multiple variable regression analysis was used to determine which variables predict treatment duration (P < .05 significant). Results: There was a significant association between the DI and treatment duration. There was a significant multivariate association for DI components (occlusions, crowding, overjet, cephalometrics, overbite, lateral open bite, and tooth transposition) and treatment duration. Conclusions: The hypothesis was rejected. This retrospective study of university clinical records showed that the average increase in treatment duration was about 11 days for each point increase in total DI score. Treatment duration was differentially increased by various components of the DI: approximately 6.5 months for tooth transposition; approximately 1 month for crowding, overjet, or overbite; approximately 3 weeks for occlusion discrepancies; approximately 2 weeks for lateral open bite; and approximately 5 days for cephalometric discrepancies.Item Gingival recession and associated factors in a homogeneous Mexican adult male population: A cross-sectional study(2012) Minaya-Sánchez, Mirna; Medina-Solís, Carlo-Eduardo; Vallejos-Sánchez, Ana-Alicia; de Lourdes Marquez-Corona, Maria; Pontigo-Loyola, América-Patricia; Islas-Granillo, Horacio; Maupomé, GerardoBackground: Diverse variables are implicated in the pathogenesis of gingival recession; more detailed knowledge about the relationship between the clinical presentation of gingival recession and assorted risk indicators may lead to improved patient monitoring, early intervention, and subsequent prevention. The objective was to evaluate clinically gingival recession in a homogeneous Mexican adult male population and to determine the strength of association with related factors. Method: A cross-sectional study was carried out in a largely homogeneous group in terms of ethnic background, socioeconomic status, gender, occupation, and medical/dental insurance, in Campeche, Mexico. Periodontal examinations were undertaken to determine diverse clinical dental variables. All periodontal clinical examinations were assessed using the Florida Probe System, a dental chair and one examiner. Questionnaires were used to collect diverse risk indicators. Statistical analyses were undertaken with negative binomial regression models. Results: The mean number of sites with gingival recession per subject was 6.73±5.81; the prevalence was 87.6%. In the negative binomial regression model we observed that for (i) each year of age, and (ii) each percentage unit of increase in sites with plaque, and (iii) with suppuration, mean sites with gingival recession increased 2.9%, 1.0% and 13.0%, respectively. Having a spouse was associated with gingival recession. Conclusions: We observed association between gingival recession, and sociodemographic and clinical parameters. Patients need to be educated about risk indicators for gingival recession as well as the preventive maneuvers that may be implemented to minimize its occurrence. The potential of improved oral self-care to prevent a largely benign condition such as gingival recession is important, given the associated disorders that may ensue root exposure, such as root caries and root hypersensitivity.Item Letter from America: UK and US state-funded dental provision(2012) Currie, R.B.; Pretty, I.A.; Tickle, M.; Maupomé, GerardoObjectives: Current UK and US economic conditions have re-focussed attention on the need to deliver dental care with limited finance and resources. This raises hard questions determining which services will be offered and what they should achieve to satisfy public demands and needs. We consider impending dental health reforms in the US and UK within the context of contemporary experiences to identify issues and delivery goals for the two nations. Background: The paper provides a brief history and background of the development of social dental care models in the UK and US, highlighting some differences in state-funded delivery of dental care. Shifting Demand: From the 1950s, demand for dental treatment has increased and acquired a more complex composition growing from predominantly surgical and restorative treatment to encompass preventive care and cosmetic services. Prioritising care according to need: Despite improvements in general health and technology, inequalities in access and utilisation of dental care are still experienced, primarily by groups with low socio-economic status. Delivery: balancing resources, demand and need: In developing and delivering reform agendas, much can be learned from previous policy interventions. Pressures of cost, coverage, and capacity, besides demand versus need must be carefully considered and balanced to deliver quality service and value for users and taxpayers. Conclusions: Ethical and moral consideration should be given to making services needs-driven to address high treatment requirements rather than the high care demands of the worried well. This challenge brings the additional political pressure of convincing many of the voters (and subsequent complainers) that their demands may be less important than the needs of others.Item A Community-Based Intervention to Prevent Obesity Beginning at Birth among American Indian Children: Study Design and Rationale for the PTOTS study(2012) Karanja, Njeri; Aickin, Mikel; Lutz, Tam; Mist, Scott; Jobe, Jared B.; Maupomé, Gerardo; Ritenbaugh, CherylEating and physical activity behaviors associated with adult obesity have early antecedents, yet few studies have focused on obesity prevention interventions targeting very young children. Efforts to prevent obesity beginning at birth seem particularly important in populations at risk for early-onset obesity. National estimates indicate that American Indian (AI) children have higher rates of overweight and obesity than children of other races/ethnicities. The Prevention of Toddler Obesity and Teeth Health Study (PTOTS) is a community-partnered randomized controlled trial designed to prevent obesity beginning at birth in AI children. PTOTS was developed to test the effectiveness of a multi-component intervention designed to: promote breastfeeding, reduce sugar-sweetened beverage consumption, appropriately time the introduction of healthy solid foods, and counsel parents to reduce sedentary lifestyles in their children. A birth cohort of 577 children from five AI tribes is randomized by tribe to either the intervention (three tribes) or the comparison condition (two tribes). The strengths and weaknesses of PTOTS include a focus on a critical growth phase, placement in the community, and intervention at many levels, using a variety of approaches.