Disparities in Access to Oral Health Care Northridge, Mary E; Kumar, Anjali; Kaur, Raghbir
Annual review of public health,
04/2020, Letnik:
41, Številka:
1
Journal Article
Recenzirano
Odprti dostop
In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and or members of racial ethnic minority, immigrant, or rural populations who have suboptimal ...access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.
Meta‐analyses of interventions such as parenting, stimulation, and early childhood education have reported consistent medium‐to‐high effect sizes on early childhood development (ECD) and early ...learning outcomes. However, few effective interventions promoting ECD have achieved scale. In order to increase the access to effective or high‐quality services, greater focus on implementation research of interventions promoting ECD is necessary. In this paper, we describe the development of reporting guidelines for implementation research of nurturing care interventions designed to promote ECD following an expert consensus‐building process. The goal of these guidelines is to support a transparent and standard reporting of implementation evidence on nurturing care interventions designed to promote early childhood development.
We describe the development of reporting guidelines for implementation research of nurturing care interventions designed to promote early childhood development following an expert consensus‐building process. The goal of these guidelines is to support a transparent and standard reporting of implementation evidence on nurturing care interventions designed to promote early childhood development.
Prevalence of pediatric neurodevelopmental and mental health disorders (ND/MHD) is increasing in the United States and globally. ND/MHD are associated with higher risk of poor dietary, physical ...activity (PA), screen, and sleep habits in youth, contributing to elevated lifetime chronic disease risk. ND/MHD symptoms can present unique challenges to parenting, create competing parenting priorities, and may decrease parental capacity to instill healthy habits. Unfortunately, literature characterizing parenting of health habits in youth with ND/MHD is sparse. The objective of this study was to describe barriers to, facilitators of, and practical strategies for parenting healthy lifestyle habits in children and teens with ND/MHD.
We conducted semi-structured interviews with parents whose children with diagnosed ND/MHD were attending a Boston-area therapeutic day school serving K-10th grade. Interviews allowed parents to focus on parenting PA, diet, sleep, and/or screen habits as context for questions. Interviews were transcribed, double-coded using constant comparative methods, and summarized into themes using NVivo 11.
We interviewed 24 parents; average age of their child with ND/MHD was 11.2 years (range: 8-15). Most had a son (75%) with multiple ND/MHD (88%); diagnoses included autism spectrum disorder (50%), attention deficit-hyperactivity disorder (67%), anxiety (67%), and other mood disorders (58%). Major barriers to parenting all types of health habits included depleted parent resources, child dysregulation, lack of supportive programming available to children with ND/MHD, and medication side effects. Major facilitators included participation in specialized therapeutic options, adaptive community programs and schools, as well as parents' social capital. Effective parenting strategies included setting clear, often structural boundaries, using positive reinforcement, allowing agency by presenting healthy choices, and use of role modeling to promote healthy habits. Almost one third of parents extensively discussed the role of pets or therapy animals as key to establishing and maintaining healthy routines, particularly PA and screen-time management.
Parenting healthy habits in children with ND/MHD is difficult and is undermined by competing demands on parenting resources. To reduce chronic disease disparities and promote health in this population, future research must better adapt existing health promotion materials and programs to more practically support parents in multiple settings including home, schools and community organizations.
IntroductionChildren’s early development is affected by caregiving experiences, with lifelong health and well-being implications. Governments and civil societies need population-based measures to ...monitor children’s early development and ensure that children receive the care needed to thrive. To this end, the WHO developed the Global Scales for Early Development (GSED) to measure children’s early development up to 3 years of age. The GSED includes three measures for population and programmatic level measurement: (1) short form (SF) (caregiver report), (2) long form (LF) (direct administration) and (3) psychosocial form (PF) (caregiver report). The primary aim of this protocol is to validate the GSED SF and LF. Secondary aims are to create preliminary reference scores for the GSED SF and LF, validate an adaptive testing algorithm and assess the feasibility and preliminary validity of the GSED PF.Methods and analysisWe will conduct the validation in seven countries (Bangladesh, Brazil, Côte d’Ivoire, Pakistan, The Netherlands, People's Republic of China, United Republic of Tanzania), varying in geography, language, culture and income through a 1-year prospective design, combining cross-sectional and longitudinal methods with 1248 children per site, stratified by age and sex. The GSED generates an innovative common metric (Developmental Score: D-score) using the Rasch model and a Development for Age Z-score (DAZ). We will evaluate six psychometric properties of the GSED SF and LF: concurrent validity, predictive validity at 6 months, convergent and discriminant validity, and test–retest and inter-rater reliability. We will evaluate measurement invariance by comparing differential item functioning and differential test functioning across sites.Ethics and disseminationThis study has received ethical approval from the WHO (protocol GSED validation 004583 20.04.2020) and approval in each site. Study results will be disseminated through webinars and publications from WHO, international organisations, academic journals and conference proceedings.Registration detailsOpen Science Framework https://osf.io/ on 19 November 2021 (DOI 10.17605/OSF.IO/KX5T7; identifier: osf-registrations-kx5t7-v1).
IntroductionWith the ratification of the Sustainable Development Goals, there is an increased emphasis on early childhood development (ECD) and well-being. The WHO led Global Scales for Early ...Development (GSED) project aims to provide population and programmatic level measures of ECD for 0–3 years that are valid, reliable and have psychometrically stable performance across geographical, cultural and language contexts. This paper reports on the creation of two measures: (1) the GSED Short Form (GSED-SF)—a caregiver reported measure for population-evaluation—self-administered with no training required and (2) the GSED Long Form (GSED-LF)—a directly administered/observed measure for programmatic evaluation—administered by a trained professional.MethodsWe selected 807 psychometrically best-performing items using a Rasch measurement model from an ECD measurement databank which comprised 66 075 children assessed on 2211 items from 18 ECD measures in 32 countries. From 766 of these items, in-depth subject matter expert judgements were gathered to inform final item selection. Specifically collected were data on (1) conceptual matches between pairs of items originating from different measures, (2) developmental domain(s) measured by each item and (3) perceptions of feasibility of administration of each item in diverse contexts. Prototypes were finalised through a combination of psychometric performance evaluation and expert consensus to optimally identify items.ResultsWe created the GSED-SF (139 items) and GSED-LF (157 items) for tablet-based and paper-based assessments, with an optimal set of items that fit the Rasch model, met subject matter expert criteria, avoided conceptual overlap, covered multiple domains of child development and were feasible to implement across diverse settings.ConclusionsState-of-the-art quantitative and qualitative procedures were used to select of theoretically relevant and globally feasible items representing child development for children aged 0–3 years. GSED-SF and GSED-LF will be piloted and validated in children across diverse cultural, demographic, social and language contexts for global use.
The social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. Lack of SDOH training of dental providers on SDOH may result in suboptimal care ...provided to pediatric dental patients and their families. The purpose of this pilot study is to report the feasibility and acceptability of SDOH screening and referral by pediatric dentistry residents and faculty in the dental clinics of Family Health Centers at NYU Langone (FHC), a Federally Qualified Health Center (FQHC) network in Brooklyn, NY, USA.
Guided by the Implementation Outcomes Framework, 15 pediatric dentists and 40 pediatric dental patient-parent/guardian dyads who visited FHC in 2020-2021 for recall or treatment appointments participated in this study. The a priori feasibility and acceptability criteria for these outcomes were that after completing the Parent Adversity Scale (a validated SDOH screening tool), ≥ 80% of the participating parents/guardians would feel comfortable completing SDOH screening and referral at the dental clinic (acceptable), and ≥ 80% of the participating parents/guardians who endorsed SDOH needs would be successfully referred to an assigned counselor at the Family Support Center (feasible).
The most prevalent SDOH needs endorsed were worried within the past year that food would run out before had money to buy more (45.0%) and would like classes to learn English, read better, or obtain a high school degree (45.0%). Post-intervention, 83.9% of the participating parents/guardians who expressed an SDOH need were successfully referred to an assigned counselor at the Family Support Center for follow-up, and 95.0% of the participating parents/guardians felt comfortable completing the questionnaire at the dental clinic, surpassing the a priori feasibility and acceptability criteria, respectively. Furthermore, while most (80.0%) of the participating dental providers reported being trained in SDOH, only one-third (33.3%) usually or always assess SDOH for their pediatric dental patients, and most (53.8%) felt minimally comfortable discussing challenges faced by pediatric dental patient families and referring patients to resources in the community.
This study provides novel evidence of the feasibility and acceptability of SDOH screening and referral by dentists in the pediatric dental clinics of an FQHC network.
Research in early childhood development (ECD) has established the need for scaling‐up multisectoral interventions for nurturing care to promote ECD, for improved socioeconomic outcomes for ...sustainable societies. However, key elements and processes for implementation and scale‐up of such interventions are not well understood. This special series on implementation research and practice for ECD brings together evidence to inform effectiveness, quality, and scale in nurturing care programs; identifies knowledge gaps; and proposes further directions for research and practice. This paper frames the dimensions and components fundamental to the understanding of implementation processes for nurturing care interventions, factors for improving implementation of interventions, and strategies to scale by embedding interventions in delivery systems. We discuss emerging issues in implementation research for ECD, including (1) the role of context in adaptation and implementation, (2) standardized reporting of implementation research, (3) the importance of feasibility studies to inform scale‐up and capacity building, (4) fidelity and program quality improvement, and (5) intervention integration into existing systems. Effective implementation of nurturing care interventions is at the heart of achieving positive developmental outcomes for young children. It is pivotal to adapt and implement these interventions based on evidence for high impact, especially in low‐resource settings.
Context:
Treatment of X-linked hypophosphatemia (XLH) with active vitamin D metabolites and phosphate can partially correct skeletal deformities. It is unclear whether therapy influences the ...occurrence of two major long-term morbidities in XLH: enthesopathy and dental disease.
Objective:
The objective of the study was to investigate the relationship between treatment and enthesopathy and dental disease in adult XLH patients.
Design:
The study was designed as observational and cross-sectional.
Setting:
The study was conducted at an academic medical center's hospital research unit.
Participants:
Fifty-two XLH patients aged 18 years or older at the time of the study participated in the study.
Interventions:
There were no interventions.
Main Outcome Measures:
The number of enthesopathy sites identified by radiographic skeletal survey and dental disease severity (more than five or five or fewer dental abscesses), identified historically, were measured.
Methods:
Associations between proportion of adult life and total life with treatment and number of enthesopathy sites were assessed using multiple linear regression, whereas associations between these exposure variables and dental disease severity were assessed using multiple logistic regression. All models were adjusted for confounding factors.
Results:
Neither proportion of adult nor total life with treatment was a significant predictor of extent of enthesopathy. In contrast, both of these treatment variables were significant predictors of dental disease severity (multivariate-adjusted global P = .0080 and P = .0010, respectively). Participants treated 0% of adulthood were more likely to have severe dental disease than those treated 100% of adulthood (adjusted odds ratio 25 95% confidence interval 1.2–520). As the proportion of adult life with treatment increased, the odds of having severe dental disease decreased (multivariate-adjusted P for trend = .015).
Conclusions:
Treatment in adulthood may not promote or prevent enthesopathy; however, it may be associated with a lower risk of experiencing severe dental disease.
Children constitute an important target market segment and merit attention from a marketing perspective. The role that children play in making decisions concerning the entire family unit has prompted ...researchers to direct attention to the study of influence of children. The amount of influence exerted by children varies by product category and stage of the decision making process. For some products, they are active initiators, information seekers, and buyers; whereas for other product categories, they influence purchases made by the parents. The purchasing act is governed by how they have been socialized to act as consumers. Family, peers, and media are key socializing agents for children wherein family-specific characteristics such as parental style, family's Sex Role Orientation (SRO), and patterns of communication play key roles. More so, changes taking place in the socio-cultural environment in India (such as emergence of dual-career, single parent families) entail that dimensions of children's influence in family purchase decision making be investigated in a specific context. Indian society vastly differs from the West in terms of family composition and structure, values, norms, and behavior, which affect the role that children play in purchase decision making in families. Hence, the aim of this paper is not only to explore the dimensions already investigated by previous researchers in India and Western countries but also to identify directions for future research.
► RIPs are capable of depurinating both prokaryotic and eukaryotic ribosomes. ► RIPs have been shown to inhibit HIV replication and integration; however its usage as drugs is still in its relative ...infancy. ► Biomedical application of RIPs in viral diseases prevention are discussed in this review. ► Promising structural data on RIPs will lead to development of small HIV-inhibiting molecules.
Ribosome-inactivating proteins (RIPs) are mainly present in plants and function to inhibit protein synthesis through the removal of adenine residues from eukaryotic ribosomal RNA (rRNA). They are broadly classified into two groups: type I and type II. Type I RIPs are a diverse family of proteins comprising a single polypeptide chain, whereas type II RIPs are heterodimeric glycoproteins comprising an A-chain (functionally equivalent to a type I RIP) linked via a disulphide bond to a B chain, mediating cell entry. In this review, we describe common type I and type II RIPs, their diverse biological functions, mechanism of cell entry, stability in plasma and antigenicity. We end with a discussion of promising applications for RIPs in biomedicine.
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