Poverty, Educational Attainment and Health Among America’s Children: Current and Future Effects of Population Diversification and Associated Socioeconomic Change

A complex of interrelated factors including minority status, poverty, education, health status, and other factors determine the general welfare of children in America, particularly in heavily diverse states such as Texas. Although racial/ethnic status is clearly only a concomitant factor in that determination it is a factor for which future projections are available and for which the relationships with the other factors in the complex can be assessed. After examining the nature of the interrelationships between these factors we utilize direct standardization techniques to examine how the future diversification of the United States and Texas will affect the number of children in poverty, the educational status of the householders in households in which children in poverty live and the health status of children in 2040 assuming that the current relationships between minority status and these socioeconomic factors continue into the future. In the results of the analyses, data are compared with the total population of the United States and Texas in 2040 assumed in the first simulation scenario, to have the race/ethnicity characteristics of 2008 and in the second those projected for 2040 by the U.S. Census Bureau for the nation and by the Texas State Data Center for Texas in 2040. The results show that the diversification of the population could increase the number of children in poverty in the United States by nearly 1.8 million more than would occur with the lower levels of diversification evident in 2008. In addition, poverty would become increasingly concentrated among minority children with minority children accounting for 76.2 percent of all children in poverty by 2040 and with Hispanic children accounting for nearly half of the children in poverty by 2040. Results for educational attainment show an increasing concentration of minority children in households with householders with very low levels of education such that by 2040, 85.2 percent of the increase in the number of children in poverty would be in households with a householder with less than a high school level of education. Finally, the results related to several health status factors show that children in poverty will have a higher prevalence of nearly all health conditions. For example, the number of children with untreated dental conditions could increase to more than 4 million in the United States and to nearly 500,000 in Texas. The results clearly show that improving the welfare of children in America will require concerted efforts to change the poverty, educational, and health status characteristics associated with minority status and particularly Hispanic status. Failing to do so will lead to a future in which America’s children are increasingly impoverished, more poorly educated, and less healthy and which, as a result, is an America with a more tentative future.

Psychometric and biohormonal indices of dental anxiety in children. A prospective cohort study.

The stress of dental treatment often elicits negative emotions in children, expressed as dental fear or anxiety. Highly anxious children obstruct treatment and avoid therapy, further amplifying oral health problems. The aim of this study was to examine the neuroendocrine and autonomic nervous system responses to dental treatment and their possible interactions and associations with psychometric indices of anxiety, caries, previous dental experience, anesthesia, age and gender in school children. Upon informed consent, saliva was obtained from 97 children (59% males, mean age ±  SD: 89.73 ± 15 months) in the Clinic of pediatric dentistry before treatment, immediately post-treatment and at the recall visit to determine cortisol and salivary alpha-amylase (sAA) levels. Dental and general anxiety was assessed through specific questionnaires completed by the children. Compared to pre-treatment, cortisol levels were increased following treatment, while sAA levels were higher at the recall. Pre- and post-treatment cortisol and sAA responses were positively correlated. Dental and general anxiety questionnaire scores were also significantly correlated with each other. The integrated autonomic and neuroendocrine responses prior to treatment were correlated with state anxiety and those following treatment with dental anxiety. However, univariable and multivariable linear regression analysis associated post-treatment cortisol, but not sAA, levels with dental anxiety. No associations of cortisol or sAA responses with caries, age, gender, previous dental experience or anesthesia were detected. These data provide some evidence that both sAA and cortisol levels are altered in children in anticipation or during dental treatment, but only cortisol levels are associated to dental anxiety.

Migration background is associated with caries in Viennese school children, even if parents have received a higher education.

BACKGROUND A low level of education and the migration background of parents are associated with the development of caries in children. The aim of this study was to evaluate whether a higher educational level of parents can overcome risks for the development of caries in immigrants in Vienna, Austria. METHODS The educational level of the parents, the school type, and the caries status of 736 randomly selected twelve-year-old children with and without migration background was determined in this cross sectional study. In children attending school in Vienna the decayed, missing, and filled teeth (DMFT) index was determined. For statistical analysis, a mixed negative-binomial-model was used. RESULTS The caries status of the children with migration background was significantly worse compared to that of the native Viennese population. A significant interaction was found between migration background and the educational level of the parents (p = 0.045). No interaction was found between the school type and either the migration background (p = 0.220) or the education level of the parents (p = 0.08). In parents with a higher scholarly education level, migration background (p < 0.01) and school type (p = 0.018) showed an association with DMFT values. In parents with a low education level, however, migration background and school type had no significant association with DMFT values. CONCLUSION These data indicate that children with a migration background are at higher risk to acquire caries than other Viennese children, even when the parents have received a higher education.

Assessment of smoking behaviour in a dental setting: a 1-year follow-up study using self-reported questionnaire data and exhaled carbon monoxide levels.

OBJECTIVES This study analyses the changes in smoking habits over the course of 1 year in a group of patients referred to an oral medicine unit. MATERIALS AND METHODS Smoking history and behaviour were analysed at baseline and after 1 year based on a self-reported questionnaire and on exhaled carbon monoxide levels [in parts per million (ppm)]. During the initial examination, all smokers underwent tobacco use prevention and cessation counselling. RESULTS Of the initial group of 121 patients, 98 were examined at the follow-up visit. At the baseline examination, 33 patients (33.67 %) indicated that they were current smokers. One year later, 14 patients (42.24 % out of the 33 smokers of the initial examination) indicated that they had attempted to stop smoking at least once over the follow-up period and 15.15 % (5 patients) had quit smoking. The mean number of cigarettes smoked per day by current smokers decreased from 13.10 to 12.18 (p = 0.04). The exhaled CO level measurements showed very good correlation with a Spearman's coefficient 0.9880 for the initial visit, and 0.9909 for the follow-up examination. For current smokers, the consumption of one additional cigarette per day elevated the CO measurements by 0.77 ppm (p < 0.0001) at the baseline examination and by 0.84 ppm (p < 0.0001) at the 1-year follow-up. CONCLUSIONS In oral health care, where smoking cessation is an important aspect of the treatment strategy, the measurement of exhaled carbon monoxide shows a very good correlation with a self-reported smoking habit. CLINICAL RELEVANCE Measurement of exhaled carbon monoxide is a non-invasive, simple and objective measurement technique for documenting and monitoring smoking cessation and reduction.

Education for specialization in prosthodontics in Switzerland and the role of EPA.

Advertisement for any dental treatment was rare in Switzerland. Then the use of digital media became popular, particularly in the field of implant- and esthetic-dentistry. In parallel to the dental schools of public universities, private universities and companies built up centers for continuing education that issue specialists diplomas and M.Sc. degrees. Prosthodontics itself is characterized by many sub-disciplines that incorporated their own associations. These also offer graduate training curricula which diminish the significance of specialization in prosthodontics. Specialized prosthodontists do not have a financial benefit in Switzerland where dentistry is not supported by any insurance. In other European countries funding of prosthodontic treatment depends on their healthcare systems. There are four specialties in Dentistry recognized by the European Union (EU). Specialization in prosthodontics was introduced in Sweden already in 1982 and today it is declared in about 20 European countries, while for others no recognized program exists. Thus there are great variations with more recognized specialists in former east European countries. In Switzerland the prosthodontic specialization curriculum was developed and guided by the Swiss Society for Reconstructive Dentistry, and only in 2001 it became fully acknowledged by the Federal Department of Health. The four Swiss Universities offer the 3-year program under the supervision of the society, while the government remains the executive body. In 2003 EPA tried to set up guidelines and quality standards for an EPA recognized specialization. In spite of these attempts and the Bologna Reform in Europe, it appears that the quality standards and the level of education still may differ significantly among European countries.

Impact of dental caries and trauma on quality of life among 5- to 6-year-old children: perceptions of parents and children.

OBJECTIVE To assess the impact of dental caries and traumatic dental injuries (TDI) on the oral health-related quality of life (OHRQoL) of 5- to 6-year-olds according to both self- and parental reports. METHODS A total of 335 pairs of parents and children who sought dental screening at the Dental School, University of São Paulo, completed the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5), which consists of a child self-report and a parental proxy-report version. Three calibrated examiners assessed the experience of caries according to primary teeth that were decayed, indicated for extraction due to caries, or filled (def-t). TDI were classified into uncomplicated and complicated injuries. Poisson regression models were used to associate the different clinical and sociodemographic factors to the outcome. RESULTS Overall, 74.6% of children reported an oral impact, and the corresponding estimate for parental reports was 70.5%. The mean (standard deviation) SOHO-5 scores in child self-report and parental versions were 3.32(3.22) and 5.18(6.28), respectively. In both versions, caries was associated with worse children's OHRQoL, for the total score and all SOHO-5 items (P < 0.001). In contrast, TDI did not have a negative impact on children's OHRQoL, with the exception of two items of the parental version and one item of the child self-report version. In the final multivariate adjusted models, there was a gradient in the association between caries experience and child's OHRQoL with worse SOHO-5 score at each consecutive level with more severe caries experience, for both child and parental perceptions [RR (CI 95%) = 6.37 (4.71, 8.62) and 10.81 (7.65, 15.27)], respectively. A greater family income had a positive impact on the children's OHRQoL for child and parental versions [RR (CI 95%) = 0.68 (0.49, 0.94) and 0.70 (0.54, 0.90)], respectively. CONCLUSIONS Dental caries, but not TDI, is associated with worse OHRQoL of 5- to 6-year-old children in terms of perceptions of both children and their parents. Families with higher income report better OHRQoL at this age, independent of the presence of oral diseases.

Refugees from Myanmar and their health care needs in the US: A qualitative study at a refugee-resettlement agency

In response to the recent rapid influx of refugees from Myanmar, Interfaith Ministries for Greater Houston (IM), a refugee resettlement agency, started to support them in June 2007. The study looked at the refugees' perspectives and identified the gaps in their understanding on US health care system, health seeking behaviors and challenges in utilizing health care in United States. The major issues identified were non-compliance with tuberculosis prevention medication due to barriers in obtaining medication refills, barriers in accessing specialty care services, transportation issues, written and oral language barrier, difficulties in the application for and use of Medicaid and Gold Card, misunderstanding of emergency health services, lack of resources for health education, self-treatment with Western medicine and income too low to buy private health insurance. In order to transform them to healthy citizens able to contribute to the US workforce, several multi-faceted and comprehensive approaches and better coordination among agencies are recommended. ^

Attitudes of dental students to hand hygiene practices at a dental school

Objectives. The purpose of this study was to elucidate behavioral determinants (prevailing attitudes and beliefs) of hand hygiene practices among undergraduate dental students in a dental school. ^ Methods. Statistical modeling using the Integrative Behavioral Model (IBM) prediction was utilized to develop a questionnaire for evaluating behavioral perceptions of hand hygiene practices by dental school students. Self-report questionnaires were given to second, third and fourth year undergraduate dental students. Models representing two distinct hand hygiene practices, termed "elective in-dental school hand hygiene practice" and "inherent in-dental school hand hygiene practice" were tested using linear regression analysis. ^ Results. 58 responses were received (24.5%); the sample mean age was 26.6 years old and females comprised 51%. In our models, elective in-dental school hand hygiene practice and inherent in-dental school hand hygiene practice, explained 40% and 28%, respectively, of the variance in behavioral intention. Translation of community hand hygiene practice to the dental school setting is the predominant driver of elective hand hygiene practice. Intended elective in-school hand hygiene practice is further significantly predicted by students' self-efficacy. Students' attitudes, peer pressure of other dental students and clinic administrators, and role modeling had minimal effects. Inherent hand hygiene intent was strongly predicted by students' beliefs in the benefits of the activity and, to a lesser extent, role modeling. Inherent and elective community behaviors were insignificant. ^ Conclusions. This study provided significant insights into dental student's hand hygiene behavior and can form the basis for an effective behavioral intervention program designed to improve hand hygiene compliance.^

Better together: Addressing maternal and child health outcomes through community health worker continuing education curricula

Background. The incidence of birth defects is a significant public health issue in the United States, adversely affecting the quality of life for parents as well as children born with these defects. Minority populations face a greater burden of birth defects and associated health problems. Prenatal practices can have a large impact on infant health outcomes. Several behaviors during pregnancy, including the intake of folic acid, can greatly influence the likelihood of a child being born with a birth defect. Community Health Workers have been shown to be effective agents at improving prenatal practices, especially when they facilitate support groups that feature pregnant women. ^ Methods. A continuing education curriculum has been created for Community Health Workers that provides content in the area of Maternal and Child Health. Content was selected after conducting a review of relevant literature and theory. Materials for conducting a training for Community Health Workers have been created in addition to materials that were designed for the population with whom the CHWs work. ^ Results. A description of each "key point" of the curriculum and a justification how it relates to the literature of the prevention of birth defects is given here. Additionally, the process of creating the curriculum using the platform delineated in the methods is described. ^ Discussion. Insights for future curriculum development are discussed along with next steps in the process of certifying the curriculum at the state level. A framework for future evaluation of the curriculum is given.^

Systematic review of mobile dental vans

Objectives. To assess the reach and effectiveness of mobile dental vans as a delivery method by providing access to underserved populations. ^ Methods. A literature review was conducted to identify mobile delivery methods whose aims are to address the increasing oral health disparity concern. Forty articles met the inclusion criteria. Of the 40 articles, only 7 analyzed the reach and coverage of the mobile dental clinics. Data was compiled from the literature to compare and assess the different mobile dental care delivery methods. ^ Results. There is a correlation between transportation barriers and lack of access to healthcare. Mobile dentistry helps to delivery dental care to vulnerable populations. ^ Conclusion. Mobile dental clinics are an effective method in improving access to care in underserved populations, as well as increasing overall oral health in these individuals.^

Promoción de salud buco-dental en establecimientos de educación media del Valle de Uco, en la provincia de Mendoza

El presente proyecto pretende fomentar entre la población del Valle de Uco en la provincia de Mendoza, la educación para la salud con el fin de promover pautas de comportamiento individual y comunitario encaminadas a obtener un estado de salud bucodental óptimo. Y además aplicar, utilizando las técnicas adecuadas en cada caso, las medidas preventivas encaminadas a satisfacer las necesidades detectadas en la interpretación de los estudios epidemiológicos llevados a cabo. Además, se contribuirá a reforzar el perfil profesional de nuestros estudiantes, es decir, desarrollar un recurso humano más pertinente a las necesidades de salud de la comunidad al tomar contacto con la realidad actual de nuestra provincia de Mendoza con respecto a lo social, cultural y económico.

Subprograma de salud bucal "El hospital y los chicos" : del diagnóstico del estado dental a la priorización de programas necesarios

Los objetivos de este trabajo fueron determinar el estado dental de la población bajo estudio, detectar subgrupos de riesgo específico para enfermedades bucales y proponer estrategias de intervención apropiadas para la promoción de la salud bucal para ellos. Método: sobre la base de datos del subprograma de salud bucal "El hospital y los chicos" se efectuó un estudio descriptivo del estado dental sobre 277 niños entre 2 meses y 13 años de edad asistentes al CDlF Nº11, Guaymallén, Mendoza. Se registraron: ceod, CPOD, ceos CPOS, índice de Necesidad de tratamiento de caries, índice de Paca de Silness y Loe, ICDAS II, y datos demográficos. Además, como parte del programa, se llevó a cabo la enseñanza de Técnicas de Higiene Bucal adecuada a la edad, dirigidas a madres y niños, y una topicación de flúor profesional siguiendo protocolos específicos según edad del niño. Resultados: la población libre de caries fue del 31,4%, mientras que el 68,6% tuvo experiencia de caries pasada o presente. La media de la sumatoria de ceod+ cpod fue 4,91 = 5, con una carga de enfermedad muy alta denotada por un componente c+C de 4.25=4.55. Presentó un valor para ceos+CPOS de 9,22+11 96 y de c+CS de 6.8918 61. En cuanto a la severidad de las lesiones de caries expresadas con las categorías de ICDAS II del 2 al 6, se observó que las medias mayores corres- , ponden al nivel 6 (x2 Friedman= 20,999, p= 0,000). La media de necesidad de tratamiento de caries fue de 5,74, pero los niveles 8 y más abarcan al 33.2% de la población de estudio Se observó un aumento progresivo de estos indicadores en la primera infancia comenzando en la primera franja etaria con una media de ceod+CPOD de 0.8811,92, de 3, 93t4.65a los tres años, de 6,38+6,36 a los 5 años, y de 8,40+5,47 a los 7 años, siendo esta población la que presentó el mayor valor del indicador (x2 Kruskall Wallis= 104,637, p=O,OO). El índice CPOD fue de 1,35~1,34 a los 7 años y de 4.65+3 99 a los 9 ( x2 Kruskall Wallis =17,609 y p=0,001) Conclusiones~ este grupo de niños de alto riesgo social presentó elevados índices de caries y de necesidad de tratamiento, que requerirán de un sistema de salud que pueda contenerlos. Al observar las medias de ceod+CPOD según las categorías de edad se pone de manifiesto una tendencia a agravarse el estado dentario en la primera infancia, llegando a valores muy por encima de la media general para los 5, 6 ,7 y 8 años El CEOD también tiende a aumentar con la edad, poniendo en evidencia la susceptibilidad de caries de los molares permanentes erupcionados Las tendencias de los indicadores permitieron reconocer dos subgrupos de riesgo para desarrollar programas preventivos' el de niños de O a 3 años, y el de 6 a 12, es decir niños escolares. Se sugieren dos programas prioritarios Materno- infantil y Protección de 1er molar permanente.

Formação pela experiência: Revelando novas faces e rompendo os disfarces da odontologia \'in vitro\'

Os cursos de graduação em odontologia vêm privilegiando uma formação fundamentada na técnica, com práticas curativistas e individualizadas, tornando-se incapazes de formar a força de trabalho necessária à resolução dos problemas de saúde bucal da população. Com a implementação das Diretrizes Curriculares Nacionais (DCN) para os cursos de graduação em odontologia, uma série de mudanças curriculares vêm sendo executadas no sentido de favorecer a formação adequada. Acredita-se que a educação pela experiência configure-se como um conjunto de ferramentas viável e eficaz para garantir a formação adequada e coerente com os princípios do Sistema Único de Saúde (SUS). Cita-se, como uma dessas possibilidades, os Estágios Curriculares Supervisionados (ECS), previstos nas DCN para serem desenvolvidos de forma articulada e com complexidade crescente ao longo do processo de formação. O estudo destina-se a compreender a articulação ensino-trabalho-cidadania por diferentes olhares e, aliado a experiências vivenciais dessa articulação, construir um modelo de Estágio Curricular Supervisionado (ECS) em serviço público de saúde, no âmbito da Atenção Primária em Saúde (APS), para cursos de graduação em odontologia. Trata-se de um estudo qualitativo dividido em duas fases. Na primeira, foi experienciado um modelo de estágio vinculado à um projeto de pesquisa que se propõe à inovar as práticas de saúde bucal no SUS, utilizando-se de uma proposta de clínica ampliada. Nessa etapa, participaram a pesquisadora, estagiários e preceptores que foram entrevistados e/ou escreveram diários de campo. Na segunda fase, alunos de odontologia, profissionais e gestores de serviços de saúde do município de São Paulo manifestaram suas percepções por meio de grupos focais e entrevistas individuais, respectivamente. O material coletado foi analisado por intermédio da hermenêutica dialética e da triangulação de dados. Os dados descortinam a intimidade das clínicas de uma Faculdade de odontologia, revelando o que se denominou de ensino da odontologia \'in vitro\', distante da realidade e limitado no sentido de solucionar os problemas de saúde bucal do público atendido. Em contrapartida, foi evidente os benefícios que as vivências no mundo real, nos mais variados espaços, podem trazer para esses estudantes. Para os estagiários do modelo experienciado, a prática em clínica ampliada permite extrapolar a odontologia \'in vitro\' e se aproximar da realidade. Preceptores e gestores manifestam opiniões convergentes e explicitam, ainda, o poder transformador que a presença de estudantes denota para os serviços além de induzir à educação permanente dos profissionais que atuam como preceptores. Com bases nessas colocações, foi elaborado um modelo de ECS para cursos de odontologia, de modo a permitir que os estudantes experienciem a realidade de saúde e trabalhem na dimensão da clínica do corpo vivo, subjetivado e complexo. Deseja-se oferecer ao estudante a possibilidade de refletir e experienciar os espaços onde as ações em saúde são produzidas, em um processo de ensino-aprendizagem centrado metodologias ativas, com a mediação pedagógica desenvolvida por preceptores e docentes. Acredita-se que suas características, pensadas em função da triangulação dos diferentes olhares que compuseram o estudo, revertem-se de força suficiente para inquietar o instituído e metamorfosear a formação disfarçada da odontologia.

Cenários de prática no Sistema Único de Saúde e as diretrizes curriculares nacionais para o curso de odontologia

A formação dos profissionais de saúde ainda está distante dos princípios e diretrizes do Sistema Único de Saúde (SUS). As propostas publicadas pelas Diretrizes Curriculares Nacionais (DCN) para o curso de odontologia, em 2002, visam preencher essa lacuna por meio da articulação entre as Instituições de Educação Superior (IES) e o SUS. Trata-se de estudo qualitativo, descritivo e exploratório sobre o sentido das atividades realizadas nos cenários de prática do SUS, sob o ponto de vista dos alunos do curso de odontologia de uma IES privada localizada no interior de São Paulo, à luz das DCN e do projeto político pedagógico (PPP) do referido curso. A pesquisa ocorreu no site da rede social do Facebook, em grupos secretos de discussão com 10 discentes, utilizando questões abertas relacionadas à odontologia, ao SUS e à graduação, entre novembro de 2014 e julho de 2015. Durante o processo, descobriu-se que 8 alunos trabalhavam no SUS como auxiliares e técnicos de saúde bucal e uma auxiliar de enfermagem, fato que influenciou na construção e condução das perguntas. As opiniões dos alunos, o PPP da IES estudada e o documento das DCN foram analisados por meio dos Mapas Conceituais (concebidos por Novak e Cañas), e em seguida, validados, respectivamente, pelos discentes, pelo coordenador do curso de odontologia estudado, e pela representante da Associação Brasileira de Ensino Odontológico (ABENO). Para aprofundar a análise das distintas vivências e pontos de vistas, utilizou-se a técnica de análise de conteúdo temática de Bardin. A discussão dos resultados evidenciou que além de ser possível ocorrer práticas pedagógicas nos cenários de prática do SUS, também é provável o aprendizado de competências e habilidades descritas pelas DCN. O potencial transformador desses cenários de prática possibilitou, nessa pesquisa, a proposição de estratégias para a realização de atividades no SUS alinhadas às DCN.