An ethnographic study of Latino preschool children's oral health in rural California: Intersections among family, community, provider and regulatory sectors

<p>Abstract</p> <p>Background</p> <p>Latino children experience a higher prevalence of caries than do children in any other racial/ethnic group in the US. This paper examines the intersections among four societal sectors or contexts of care which contribute to oral health disparities for low-income, preschool Latino¹children in rural California.</p> <p>Methods</p> <p>Findings are reported from an ethnographic investigation, conducted in 2005–2006, of family, community, professional/dental and policy/regulatory sectors or contexts of care that play central roles in creating or sustaining low income, rural children's poor oral health status. The study community of around 9,000 people, predominantly of Mexican-American origin, was located in California's agricultural Central Valley. Observations in homes, community facilities, and dental offices within the region were supplemented by in-depth interviews with 30 key informants (such as dental professionals, health educators, child welfare agents, clinic administrators and regulatory agents) and 47 primary caregivers (mothers) of children at least one of whom was under 6 years of age.</p> <p>Results</p> <p>Caregivers did not always recognize visible signs of caries among their children, nor respond quickly unless children also complained of pain. Fluctuating seasonal eligibility for public health insurance intersected with limited community infrastructure and civic amenities, including lack of public transportation, to create difficulties in access to care. The non-fluoridated municipal water supply is not widely consumed because of fears about pesticide pollution. If the dentist brought children into the clinic for multiple visits, this caused the accompanying parent hardship and occasionally resulted in the loss of his or her job. Few general dentists had received specific training in how to handle young patients. Children's dental fear and poor provider-parent communication were exacerbated by a scarcity of dentists willing to serve rural low-income populations. Stringent state fiscal reimbursement policies further complicated the situation.</p> <p>Conclusion</p> <p>Several societal sectors or contexts of care significantly intersected to produce or sustain poor oral health care for children. Parental beliefs and practices, leading for example to delay in seeking care, were compounded by lack of key community or economic resources, and the organization and delivery of professional dental services. In the context of state-mandated policies and procedures, these all worked to militate against children receiving timely care that would considerably reduce oral health disparities among this highly disadvantaged population.</p

Organs at\ua0Risk (OAR) Tolerance in Hypofractionated Radiosurgery

For CyberKnife radiosurgery, the precise interpretation of the normal probability of tissue complications (NTCP) is extremely important due to the reverse planning algorithm and the non-isocentric irradiation geometry adopted by the system, which requires the setting of dose constraints for any organ at risk (OAR). Despite eight decades of practice in radiation therapy, the current understanding of radiobiology remains fairly imprecise, especially the tolerance limits of OAR at hypofractioned schedules. Here, we provide an overview of the radiation tolerance limits of the optic pathway, spinal cord, brain and other central nervous system OARs. Above all, we summarize the basic principles of radiobiology and describe how these can be used to aid decision making for hypofractionated treatments. Basically, we provide radiobiological bases to build models that can be used to safely and effectively extrapolate the doses to be delivered in hypofractioned schedules starting from single fraction clinical data and conventionally fractionated radiotherapy. Although this approach has several limitations, it can provide some practical suggestions and help users to increase confidence with hypofractionated approache