Saudi Cultural Missions Theses & Dissertations
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Item Restricted Is Fatigue Associated with Oral Health Outcomes Among American Adults?(King's College London, 2024-08) Alotaibi, Abdulmajeed; Sabbah, WaelBackground: Fatigue is a frequent problem in the American adult population, affecting every aspect of health, from mental to physical wellbeing. Although the negative effects of fatigue on general health are well documented, little research has been identified that investigated its effect on oral health. Among the adverse consequences of fatigue, bad oral habits like neglecting oral hygiene and regular dental check-ups can lead directly to negative outcomes with individual’s teeth, such as tooth loss, tooth decay and periodontal disease. Fatigue is described as the subjective sense of not being able to accomplish a task efficiently owing to decreased effectiveness. Objective: This study examines the correlation between fatigue and oral health among US population. Method: Data were gathered from the 2015-2018 National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey of adults aged 18 and above. The Patient Health Questionnaire-9 (PHQ-9) was used to assess and examine fatigue using a thoroughly validated assessment based on the Prime-MD diagnostic instrument. In NHANES, it is referred to as the Depression Screener Questionnaire (DPQ). The tooth count was established by clinical exams performed by qualified dentists. Logistic regression models were used to determine the relationship between tooth count and fatigue and adjusted for demographic characteristics, socioeconomic status, dental visits, multimorbidity and smoking status. Results: Of the 11,848 participants (mean age: 47.25 years), 52.94% experienced fatigue. The incidence of tooth loss was greater among individuals who reported being 3 fatigued. However, after accounting for demographic characteristics, socioeconomic status, mean poverty income ratio, and multimorbidity, the link between tooth loss and fatigue maintained its statistical significance (Odds Ratio ‘OR’ = 1.21, 95% Confidence Interval ‘CI’: 1.01-1.43). Model 3 found Participants who hadn't seen a dentist in over a year have more chance to experience fatigue (OR = 1.21, 95% CI: 1.04-1.39, p = 0.014). Conclusion: to conclude, having fewer teeth is linked to fatigue among American adults. To manage fatigue and its broader health effects, a multifaceted approach is needed, including regular dental care, reducing socioeconomic disparities, and assessing both physical and mental health. This integrated strategy can improve overall well-being and address the complex link between fatigue and oral health.14 0Item Restricted Is root caries more likely to occur among older adults with multimorbidity?(KING'S COLLEGE LONDON, 2024) Alyamani, Saif; Sabbah, WaelBackground: Root caries, a prevalent dental condition in the older population, substantially impacts oral health and overall quality of life. It leads to tooth surface loss, pain, and increased risk of periodontal disease, affecting nutrition, psychological well-being, and social interactions. Effective prevention and management are crucial. Multimorbidity, is prevalent in older populations and can influence various health outcomes. The aim of this study is to examine the relationship between multimorbidity and root caries in older American adults. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, this cross-sectional study focused on adults aged 60 years and older. The presence of root caries or root restoration was assessed through clinical dental examinations. Multimorbidity was identified by the existence of nine chronic diseases, namely, diabetes, asthma, cancer, heart attack, stroke, angina, chronic pulmonary disease, kidney diseases, and arthritis. Logistic regression models were used in this study to evaluate the association between multimorbidity and root caries, adjusting for sociodemographic factors, health behaviours, and dental care access. Results: Among the 2486 participants (mean age: 69.3 years), 23% had root caries, while 43% had multimorbidity (two or more conditions). Root caries prevalence was higher in individuals with multimorbidity. However, after adjusting for confounders, multimorbidity’s association with root caries did not show statistically significant results (OR = 1.02, 95% CI: 0.88-1.18). Significant associations were found between root caries and smoking (OR = 4.67 for current smokers vs. never smokers) and income to-poverty ratio, with lower ratios linked to higher root caries prevalence. Conclusion: While multimorbidity alone did not show a significant impact on root caries prevalence, lifestyle factors, particularly smoking and socioeconomic status, played critical roles. Addressing these modifiable risk factors and improving access to dental care are essential for enhancing oral health outcomes in older adults. Additional studies are required to investigate the intricate interactions of factors influencing oral health in this demographic.19 0Item Restricted Discrimination and Multimorbidity among older adults(King's College London, 2024-08) ALFAKHRI, KHALED; Sabbah, WaelAim: This study aims to investigate the relationship between racial discrimination and multimorbidity among American older adults, and whether discrimination mediates the relationship between socioeconomic factors and health outcomes. Methods: Participants in this study who were 65 years of age or older were drawn from the 2022 Behavioural Risk Factors Surveillance System (BRFSS) database. This study included 44,029 participants. Multimorbidity was defined as the presence of two or more chronic conditions, including stroke, heart attack, angina, cancer, asthma, arthritis, depression, chronic pulmonary disease, diabetes, and kidney disease. Racial discrimination was measured through self-reported experiences of being treated differently based on race. Socioeconomic factors (income and education level) and behavioural factors (smoking, alcohol consumption, physical activity) were considered. Negative binomial regression models were used to examine the association between racial discrimination and multimorbidity, adjusting for potential confounders. Results: The analysis revealed a significant association between experience of racial discrimination and multimorbidity (Rate Ratio [RR] = 1.13; 95% Confidence Interval [CI]: 1.05- 1.21). Socioeconomic factors such as lower income and education levels were also significantly associated with higher multimorbidity risk, however no evidence of discrimination experience partially mediating the association. Conclusion: Understanding the impact of racial discrimination on multimorbidity highlights the importance of addressing social determinants of health. This study underscores the need for targeted interventions to mitigate health inequalities among older adults, particularly those facing racial discrimination.30 0Item Restricted Multimorbidity in Diverse Populations: Stratified Analysis of Race/Ethnicity, Age, Obesity, and Healthcare Costs(Saudi Digital Library, 2023) Alshakhs, Manal Jawad; Madlock-Brown, CharisseThis research aims to fill an essential gap in understanding how Body Mass Index (BMI) cutoffs relate to multimorbidity across races in the United States (US). Given the significant and growing rates of obesity and multimorbidity, as well as the known differences in healthy fat distribution among different races, this is an important area of research. BMI is a widely used but imperfect measure of obesity, as it does not account for differences in body composition. However, it is still used as a diagnostic tool. It is vital to ensure that the cutoffs used to define obesity are appropriate for all populations, particularly given the racial disparities in multimorbidity rates. This proposed framework for evaluating BMI cutoffs across races for multimorbidity considered a range of measures, such as, including incidence rates of prevalent diseases, age, gender, type of patient visits, and type of health insurance to arrive at questioning the current World Health Organization (WHO) BMI cutoffs in the US. This research demonstrated that having the exact BMI cutoffs across all races does not serve all populations ideally through three assessments. First, it assessed differences in the prevalence of multimorbidity by race. It identified disease combinations shared by all races/ethnicities, shared by some, and those unique to one group for each age/obesity level. These findings demonstrated that despite controlling for age and obesity, there are differences in multimorbidity prevalence across races. Second, the study developed models to project total charges for the most common multimorbidity combinations in the US and evaluated the accuracy of these models across different racial and ethnic groups and multimorbidity patterns. The relationship between healthcare costs and multimorbidity varied for each racial group and depended on the specific combination of chronic conditions, age, and obesity status. Third, it assessed the relationship between BMI and healthcare burden across race and healthcare utilization among middle-aged patients in the US. It demonstrated that the relationship between BMI and healthcare burden varied across races within the same healthcare care utilization category. This research can improve health outcomes and reduce the risk of chronic diseases associated with obesity and multimorbidity, particularly among vulnerable populations. It will also be essential to consider the potential implications of any new BMI cutoffs on clinical practice and health policies related to obesity and multimorbidity in serving unique clinical needs. More work must be done to understand how multimorbidity, BMI, age, and healthcare burden associate across races.6 0