Oral Health Disparities and Unmet Dental Needs among Preschool Children in Chelsea, MA: Exploring Mechanisms, Defining Solutions

Background: Significant disparities exist in children’s receipt of preventive dental care (PDC) in the United States. Many of the children at greatest risk of dental disease do not receive timely PDC; when they do receive dental care, it is often more for relief of dental pain. Chelsea is a low-income, diverse Massachusetts community with high rates of untreated childhood caries. There are various dental resources available in Chelsea, yet many children do not access dental care at levels equivalent to their needs. Objective: Using Chelsea as a case-study, to explore factors contributing to forgone PDC (including the age 1 dental visit) in an in-depth way. Methods: We used a qualitative study design that included semi-structured interviews with parents of preschool children residing in Chelsea, and Chelsea-based providers including pediatricians, dentists, a dental hygienist and early childhood care providers. We examined: a) parents’ dental attitudes and oral health cultural beliefs; b) parents’ and providers’ perspectives on facilitators and barriers to PDC, reasons for unmet needs, and proposed solutions to address the problem. We recorded, transcribed and independently coded all interviews. Using rigorous, iterative qualitative data analyses procedures, we identified emergent themes. Results: Factors perceived to facilitate receipt of PDC included Head-Start oral health policies, strong pediatric primary care/dental linkages, community outreach and advertising, and parents’ own oral health experiences. Most parents and providers perceived there to be an adequate number of accessible dental services and resources in Chelsea, including for Medicaid enrollees. However, several barriers impeded children from receiving timely PDC, the most frequently cited being insurance related problems for children and adults. Other barriers included limited dental services for children <2 years, perceived poor quality of some dental practices, lack of emphasis on prevention-based dental care, poor care-coordination, and insufficient culturally-appropriate care. Important family-level barriers included parental oral health literacy, cultural factors, limited English proficiency and competing priorities. Several solutions were proposed to address identified barriers. Conclusion: Even in a community with a considerable number of dental resources, various factors may preclude access to these services by preschool-aged children. Opportunities exist to address modifiable factors through strategic oral health policies, community outreach and improved care coordination between physicians, dentists and early childhood care providers

Family-Centered Care: Current Applications and Future Directions in Pediatric Health Care

Family-centered care (FCC) is a partnership approach to health care decision-making between the family and health care provider. FCC is considered the standard of pediatric health care by many clinical practices, hospitals, and health care groups. Despite widespread endorsement, FCC continues to be insufficiently implemented into clinical practice. In this paper we enumerate the core principles of FCC in pediatric health care, describe recent advances applying FCC principles to clinical practice, and propose an agenda for practitioners, hospitals, and health care groups to translate FCC into improved health outcomes, health care delivery, and health care system transformation

Sleep problems for children with autism and caregiver spillover effects

Sleep problems in children with autism spectrum disorders (ASD) are under-recognized and under-treated. Identifying treatment value accounting for health effects on family members (spillovers) could improve the perceived cost-effectiveness of interventions to improve child sleep habits. A prospective cohort study (N = 224) was conducted with registry and postal survey data completed by the primary caregiver.Wecalculated quality of life outcomes for the child and the primary caregiver associated with treatments to improve sleep in the child based on prior clinical trials. Predicted treatment effects for melatonin and behavioral interventions were similar in magnitude for the child and for the caregiver. Accounting for caregiver spillover effects associated with treatments for the child with ASD increases treatment benefits and improves cost-effectiveness profiles

Facilitating Pupil Thinking About Information Literacy

Whilst information literacy is frequently taught through the imposition on learners of an established framework, this paper suggests a different approach by taking a lead from James Herring’s ideas. Specifically, it provides guidance to school-based information professionals who would like to encourage their pupils to devise their own flexible, information literacy models which are unique to them. Drawing on existing material in information science and wider thought, it proposes areas for coverage and considers how information professionals may support the dynamic process of model construction. It is recommended that those who are intent on facilitating the creation of personal information literacy models help pupils to identify the roles they take on in their lives, to reflect on the information needs that result, to ascertain the information they require in particular situations, to explore their information-seeking activities, to consider means by which information can be captured and to give thought as to how the information they have accessed may be used. This framework is, however, by no means rigid and readers are, of course, free to make their own adjustments

Gender differences in health and medical care: Thailand.

This dissertation examines the determinants of the gender difference in reported morbidity and the use of medical care in Thailand to examine why women are more likely to report illness than men but live longer. Health status was measured by self reports of illness in the past month for persons aged 15 and older using the 1985 Mortality and Morbidity Survey. Use of medical care was measured by self reports of using non-traditional practitioners. A gender difference of about two percentage points was found. Several explanations for the higher rates of illness among women were examined. An indirect measure of whether the respondent answered the illness questions him or herself versus having a proxy report had the strongest influence on the gender difference in reported morbidity, causing gender to loose its predictive power. Educational and occupational status partially explained the gender difference, although it appears that with respect to occupational status, the main mechanism influencing the gender difference in reported morbidity is the selection of ill men out of the labor force. Holding constant marital status and being a woman of reproductive age did not influence the gender difference in reported morbidity. There were no important gender differences in the reporting of life-threatening versus non-life-threatening illnesses. The severity of the condition does not help to explain why women are more likely to report illness but live longer than men. Among those who were identified as ill in the past month, women reported more use of medical care than men. Thus, women might be more inclined to get their health conditions treated and therefore, may be less likely to experience mortality. Several recommendations are made to reduce the influence of reporting behavior and selection effects in future studies of gender differences in health. In particular, assuring that studies ask men and women directly about their health status is critical. Accurate measures of the mechanisms that are thought to influence health differently for men and women are also important to collect. Finally, it is important to collect information that will facilitate making conclusions about causality.Ph.D.SociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/105931/1/9226943.pdfDescription of 9226943.pdf : Restricted to UM users only

Child Health Status and Parental Employment

Objective: To understand the relationship between several measures of child health status and the employment of parents. Design: A cross-sectional study using 1994 National Health Interview Survey on Disability data. Participants: A nationally representative sample of children and their parents. Outcome Measures: Maternal and paternal employment (measured separately). Intervention: We use a series of logistic regression models with maternal and paternal employment as the dependent variables and the health status of the child with the poorest health status in the family as the primary independent variable. Models additionally include sociodemographic correlates of employment. Results: Having a child with poor health status, as measured by general reported health, hospitalizations, activity limitations, and chronic condition or disability status, is associated with reduced employment of mothers and fathers. For example, the odds ratios of being employed for having a child with an activity limitation are 0.75 for mothers (95% confidence interval, 0.67-0.85) and 0.66 for fathers (95% confidence interval, 0.53-0.82). Conclusions: Having a child with poor health status is associated with reduced maternal and paternal employment. Further studies are needed to determine whether poor child health status causes reductions in parental labor force participation. If such a causal relationship exists, it has important implications for social policy, employment policy, and clinical anticipatory guidance

Caregiver strain among North American parents of children from the Autism Treatment Network Registry Call-Back Study.

Caregiver strain is the adverse impact that parents of children with emotional and behavioral issues including autism often experience (e.g. negative consequences of caregiving such as financial strain and social isolation; negative feelings that are internal to the caregiver such as worry and guilt; and negative feelings directed toward the child such as anger or resentment). This study showed that on average caregiver strain did not significantly change in North American parents of children with autism during a 2-year period. Improved caregiver strain was linked to improved child functioning and behavior. Routine assessment of caregiver strain and referral to evidence-based programming and supports may help alleviate some of the burden that families of children with autism commonly experience