Dental fluorosis and its influence on children’s life

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Are mental health problems and depression associated with bruxism in children?

Renner AC, da Silva AAM, Rodriguez JDM, Simoes VMF, Barbieri MA, Bettiol H, Thomaz EBAF, Saraiva MC. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2011. (C) 2011 John Wiley & Sons A/S Abstract Objectives: Previous studies have found an association between bruxism and emotional and behavioral problems in children, but reported data are inconsistent. The objective of this study was to estimate the prevalence of bruxism, and of its components clenching and grinding, and its associations with mental problems and depression. Methods: Data from two Brazilian birth cohorts were analyzed: one from 869 children in Ribeirao Preto RP (Sao Paulo), a more developed city, and the other from 805 children in Sao Luis SL (Maranhao). Current bruxism evaluated by means of a questionnaire applied to the parents/persons responsible for the children was defined when the habit of tooth clenching during daytime and/or tooth grinding at night still persisted until the time of the assessment. Additionally, the lifetime prevalence of clenching during daytime only and grinding at night only was also evaluated. Mental health problems were investigated using the Strength and Difficulties Questionnaire (SDQ) and depression using the Childrens Depression Inventory (CDI). Analyses were carried out for each city: with the SDQ subscales (emotional symptoms, conduct problems, peer problems, attention/hyperactivity disorder), with the total score (sum of the subscales), and with the CDI. These analyses were performed considering different response variables: bruxism, clenching only, and grinding only. The risks were estimated using a Poisson regression model. Statistical inferences were based on 95% confidence intervals (95% CI). Results: There was a high prevalence of current bruxism: 28.7% in RP and 30.0% in SL. The prevalence of clenching was 20.3% in RP and 18.8% in SL, and grinding was found in 35.7% of the children in RP and 39.1% in SL. Multivariable analysis showed a significant association of bruxism with emotional symptoms and total SDQ score in both cities. When analyzed separately, teeth clenching was associated with emotional symptoms, peer problems, and total SDQ score; grinding was significantly associated with emotional symptoms and total SDQ score in RP and SL. Female sex appeared as a protective factor for bruxism, and for clenching and grinding in RP. Furthermore, maternal employment outside the home and white skin color of children were associated with increased prevalence of teeth clenching in SL. Conclusions: Mental health problems were associated with bruxism, with teeth clenching only and grinding at night only. No association was detected between depression and bruxism, neither clenching nor grinding. But it is necessary to be cautious regarding the inferences from some of our results.

Responsiveness to change for the Brazilian Scale of Oral Health Outcomes for 5-year-old children (SOHO-5)

Abstract Background The responsiveness of oral health-related quality of life (OHRQoL) instruments has become relevant, given the increasing tendency to use OHRQoL measures as outcomes in clinical trials and evaluations studies. The purpose of this study was to assess the responsiveness of the Brazilian Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) to dental treatment. Methods One hundred and fifty-four children and their parents completed the child self- and parental’ reports of the SOHO-5 prior to treatment and 7 to 14 days after the completion of treatment. The post-treatment questionnaire also included a global transition judgment that assessed subject’s perceptions of change in their oral health following treatment. Change scores were calculated by subtracting post-treatment SOHO-5 scores from pre-treatment scores. Longitudinal construct validity was assessed by using one-way analysis of variance to examine the association between change scores and the global transition judgments. Measures of responsiveness included standardized effect sizes (ES) and standardized response mean (SRM). Results The improvement of children’s oral health after treatment are reflected in mean pre- and post-treatment SOHO-5 scores that declined from 2.67 to 0.61 (p < 0.001) for the child-self reports, and 4.04 to 0.71 (p < 0.001) for the parental reports. Mean change scores showed a gradient in the expected direction across categories of the global transition judgment, and there were significant differences in the pre- and post-treatment scores of those who reported improving a little (p < 0.05) and those who reported improving a lot (p < 0.001). For both versions, the ES and SRM based on change scores mean for total scores and for categories of global transitions judgments were moderate to large. Conclusions The Brazilian SOHO-5 is responsive to change and can be used as an outcome indicator in future clinical trials. Both the parental and the child versions presented satisfactory results.

Cross-cultural adaptation and psychometric properties of the Brazilian version of the scale of oral health outcomes for 5-year-old children (SOHO-5)

Abstract Background Most of the instruments available to measure the oral health-related quality of life (OHRQoL) in paediatric populations focus on older children, whereas parental reports are used for very young children. The scale of oral health outcomes for 5-year-old children (SOHO-5) assesses the OHRQoL of very young children through self-reports and parental proxy reports. We aimed to cross-culturally adapt the SOHO-5 to the Brazilian Portuguese language and to assess its reliability and validity. Findings We tested the quality of the cross-cultural adaptation in 2 pilot studies with 40 children aged 5–6 years and their parents. The measurement was tested for reliability and validity on 193 children that attended the paediatric dental screening program at the University of São Paulo. The children were also clinically examined for dental caries. The internal consistency was demonstrated by a Cronbach's alpha coefficient of 0.90 for the children’s self-reports and 0.77 for the parental proxy reports. The test-retest reliability results, which were based on repeated administrations on 159 children, were excellent; the intraclass correlation coefficient was 0.98 for parental and 0.92 for child reports. In general, the construct validity was satisfactory and demonstrated consistent and strong associations between the SOHO-5 and different subjective global ratings of oral health, perceived dental treatment need and overall well-being in both the parental and children’s versions (p < 0.001). The SOHO-5 was also able to clearly discriminate between children with and without a history of dental caries (mean scores: 5.8 and 1.1, respectively; p < 0.001). Conclusion The present study demonstrated that the SOHO-5 exhibits satisfactory psychometric properties and is applicable to 5- to 6-year-old children in Brazil.

Improving children’s cognitive performance – Effect of a memory strategy training in children born very preterm

Aims: To examine the effect of memory strategy training on different aspects of memory in children born very preterm and to determine whether there is a generalization of the training effect to non-trained functions. The influence of individual factors such as age and performance level on the training success will be determined. Methods: In a randomized, controlled and blinded clinical trial, 46 children born very preterm (aged 7-12 years) were allocated to a memory strategy training (MEMO-Training, n=23) or a control group (n=23). Neuropsychological assessment was performed before, immediately after the training and at a 6-month follow-up. In the MEMO-Training, five different memory strategies were introduced and practiced in a one-to-one setting (4 hour-long training sessions over 4 weeks, 20 homework sessions). Results: A significant training-related improvement occurred in trained aspects of memory (verbal and visual learning and recall, verbal working memory) and in non-trained functions (inhibition, mental arithmetic). No performance increase was observed in the control group. At six months follow-up, there was a significant training-related improvement of visual working memory. Age and performance level before the training predicted the training success significantly. Conclusion: Teaching memory strategies is an effective way to improve different aspects of memory but also non-trained functions such as inhibition and mental arithmetic in children born very preterm. Age and performance level influence the success of memory strategy training. These results highlight the importance of teaching children memory strategies to reduce scholastic problems.

Effectiveness of Texas Children's Hospital's Saturday Wellness Program for Children with special health care needs

Children with Special Health Care Needs comprise approximately 13% of children within the state of Texas. In addition to their primary diagnosis, it is estimated that approximately 18% of these children with special health care needs are overweight. Many times parents of children with special health care needs are extremely busy dealing with the daily responsibilities required to care for a child with a chronic illness, and thus, lose connections with their local communities and available resources for health needs such as obesity. Texas Children’s Hospital’s Wellness Program for Children with Special Health Care Needs is a family-centered wellness program to prevent obesity in this population; however, no formal evaluation of the program has been conducted. The purpose of this study was to assess the effectiveness of the Texas Children’s Saturday Wellness Program on weight status, nutrition knowledge, and the frequency of physical activity of children who participated in the program. A secondary data analysis was conducted with 50 children with special health care needs and their families who participated in the program during 2007 and 2008. A pre post-test study design was used with data collected immediately before and after participation in the 4 week program. Data measures included demographics (age, race, etc.), anthropometrics (height and weight), a quality of life survey focusing on nutrition and physical activity behaviors, and a knowledge survey on physical activity and nutrition. Of 50 participants, 33 (66%) completed the program. Children participating in the program showed a significant decrease in BMI (mean=29.83 to mean=29.22, BMI z score p<0.01), as well as frequency of physical activity (p<0.05) and knowledge (p<0.01). Texas Children’s Hospital’s wellness program for children with special health care needs provided a promising structure for a wellness program within a multi-ethnic special needs population; however, long term effect research is needed with a larger sample size and more comprehensive outcomes and process measures. Nonetheless, this program indicates the effectiveness and feasibility of a family-based approach to weight loss in children with special needs.^

Health Knowledge, Attitudes, and Practices among Street Children in LMICs

Background: Worldwide, it is estimated that there are up to 150 million street children. Street children are an understudied, vulnerable population. While many studies have characterized street children’s physical health, few have addressed the circumstances and barriers to their utilization of health services.

Methods: A systematic literature review was conducted to understand the barriers and facilitators that street children face when accessing healthcare in low and middle income countries. Six databases were used to search for peer review literature and one database and Google Search engine were used to find grey literature (theses, dissertations, reports, etc.). There were no exclusions based on study design. Studies were eligible for inclusion if the study population included street children, the study location was a low and middle income country defined by the World Bank, AND whose subject pertained to healthcare.

In addition, a cross-sectional study was conducted between May 2015 and August 2015 with the goal of understanding knowledge, attitudes, and health seeking practices of street children residing in Battambang, Cambodia. Time location and purposive sampling were used to recruit community (control) and street children. Both boys and girls between the ages of 10 and 18 were recruited. Data was collected through a verbally administered survey. The knowledge, attitudes and health seeking practices of community and street children were compared to determine potential differences in healthcare utilization.

Results: Of the 2933 abstracts screened for inclusion in the systematic literature review, eleven articles met all the inclusion criteria and were found to be relevant. Cost and perceived stigma appeared to be the largest barriers street children faced when attempting to seek care. Street children preferred to receive care from a hospital. However, negative experiences and mistreatment by health providers deterred children from going there. Instead, street children would often self treat and/or purchase medicine from a pharmacy or drug vendor. Family and peer support were found to be important for facilitating treatment.

The survey found similar results to the systematic review. Forty one community and thirty four street children were included in the analysis. Both community and street children reported the hospital as their top choice for care. When asked if someone went with them to seek care, both community and street children reported that family members, usually mothers, accompanied them. Community and street children both reported perceived stigma. All children had good knowledge of preventative care.

Conclusions: While most current services lack the proper accommodations for street children, there is a great potential to adapt them to better address street children’s needs. Street children need health services that are sensitive to their situation. Subsidies in health service costs or provision of credit may be ways to reduce constraints street children face when deciding to seek healthcare. Health worker education and interventions to reduce stigma are needed to create a positive environment in which street children are admitted and treated for health concerns.

Professional development programs in health promotion : tools and processes to favor new practices

Developing innovative interventions that are in sync with a health promotion paradigm often represents a challenge for professionals working in local public health organizations. Thus, it is critical to have both professional development programs that favor new practices and tools to examine these practices. In this case study, we analyze the health promotion approach used in a pilot intervention addressing children’s vulnerability that was developed and carried out by participants enrolled in a public health professional development program. More specifically, we use a modified version of Guichard and Ridde’s (Une grille d’analyse des actions pour lutter contre les inégalités sociales de santé. In Potvin, L., Moquet, M.-J. and Jones, C. M. (eds), Réduire les Inégalités Sociales en Santé. INPES, Saint-Denis Cedex, pp. 297– 312, 2010) analytical grid to assess deductively the program participants’ use of health promotion practices in the analysis and planning, implementation, evaluation, sustainability and empowerment phases of the pilot intervention. We also seek evidence of practices involving (empowerment, participation, equity, holism, an ecological approach, intersectorality and sustainability) in the intervention. The results are mixed: our findings reveal evidence of the application of several dimensions of health promotion (equity, holism, an ecological approach, intersectorality and sustainability), but also a lack of integration of two key dimensions; that is, empowerment and participation, during various phases of the pilot intervention. These results show that the professional development program is associated with the adoption of a pilot intervention integrating multiple but not all dimensions of health promotion. We make recommendations to facilitate a more complete integration. This research also shows that the Guichard and Ridde grid proves to be a thorough instrument to document the practices of participants.

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil

EMOND, Alan et al. The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil. Revista Panamericana de Salud Pública/ Pan American Journal of Public Health , v.12, n.2, p.101-110, 2002

Changes in children’s body mass index between 2006/07 and 2013/14 National Child Measurement Programme

This report is the sixth in a series of annual reports which use National Child Measurement Programme (NCMP) data to examine changes in children’s body mass index (BMI) that have taken place since 2006/07. It explores trends in obesity, overweight, excess weight and underweight prevalence, as well as changes in mean BMI over time. Trends within different socioeconomic and ethnic groups are also examined to determine whether existing health inequalities are widening or becoming smaller.

Exploring Children’s Experiences of Participating in a Mindfulness Intervention

In recent years there has been a rapid growth in mindfulness practices being applied to improve the health and wellbeing of those who participate. As a result mindfulness-based interventions (MBI’s) have been applied in medical and educational settings. The purpose of this piece of research is to explore children’s understanding of mindfulness following their involvement in a 12 week mindfulness based intervention. The research provides an in-depth explorative interpretation of both the pupils and the mindfulness practitioner’s experience of mindfulness. Interpretative phenomenological analysis (IPA) was employed as a method of analysis which resulted in 3 master themes being identified. The themes include ‘physiological activities promote mindfulness’, ‘cognitive elements’ and ‘states of being’. Interpretation of the findings considered participants experiences in relation to the 7 attitudinal foundations as proposed by Kabat–Zinn (1990). A number of similarities between the participants were evident, as represented in the 3 master themes. However the degree to which each individual participant expressed their awareness and understating of mindfulness varied. Therefore the findings indicated that the participants were in the process of developing their understanding of mindfulness which differed between them on a conceptual level. This study is considered of relevance for those in the profession of Educational Psychology and those interested in the application of mindfulness-based interventions to improve the health and wellbeing outcomes for children and young people. The research has made a distinctive contribution within the field of mindfulness in light of the findings. Recommendations are made to inform the practices of Educational Psychology Services with reference to the work of Educational Psychologists. Suggestions for further research have also been made to aid the direction of future research.

Patient Characteristics Associated with Differences in Admission Frequency for Diabetic Ketoacidosis in U.S. Children’s Hospitals

Thesis (Master's)--University of Washington, 2016-08

Health, Sickness and Literature for Children

The subjects of health, including sickness, and medicine are developing as new areas of research interest applied to the field of children’s literature really over the past five years. This chapter discusses the ways in which these areas have been, are being, and could be developed and identify reasons why this is so and the importance of such research. The chapter highlights the interdisciplinarity of this work and the ways in which these approaches enable new thinking.

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil

EMOND, Alan et al. The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil. Revista Panamericana de Salud Pública/ Pan American Journal of Public Health , v.12, n.2, p.101-110, 2002