Do baby teeth really matter? Changing parental perception and increasing dental care utilization for young children

IntroductionParent/caregivers' inability to recognize the importance of baby teeth has been associated with inadequate self-management of children's oral health (i.e. lower likelihood of preventive dental visits) which may result in dental caries and the need for more expensive caries-related restorative treatment under general anesthesia. Health behavior theories aid researchers in understanding the impact and effectiveness of interventions on changing health behaviors and health outcomes. One example is the Common-Sense Model of Self-Regulation (CSM) which focuses on understanding an individual's illness perception (i.e. illness and treatment representations), and subsequently has been used to develop behavioral interventions to change inaccurate perceptions and describe the processes involved in behavior change.MethodsWe present two examples of randomized clinical trials that are currently testing oral health behavioral interventions to change parental illness perception and increase dental utilization for young children disproportionately impacted by dental caries in elementary schools and pediatric primary care settings. Additionally, we compared empiric data regarding parent/caregiver perception of the chronic nature of dental caries (captured by the illness perception questionnaire revised for dental: IPQ-RD constructs: identity, consequences, control, timeline, illness coherence, emotional representations) between parent/caregivers who did and did not believe baby teeth were important.ResultsCaregivers who believed that baby teeth don't matter had significantly (P < 0.05) less accurate perception in the majority of the IPQ-RD constructs (except timeline construct) compared to caregivers who believed baby teeth do matter.ConclusionThese findings support our CSM-based behavioral interventions to modify caregiver caries perception, and improve dental utilization for young children.     

Do patients with traumatic brain injury benefit from physiotherapy? A review of the evidence

Physiotherapy is an integral component of the management of patients with traumatic brain injury. This paper reviews the evidence that physiotherapy is effective in the management of these patients. The three specific areas addressed here are the effect of physiotherapy on: (1) range of movement, abnormal muscle tone, quality of movement, balance and conscious level; (2) the ability to perform functional tasks; and (3) outcome in areas such as independence in daily living, vocational and social domains. There is evidence that techniques such as casting or splinting may be effective in improving restricted range of movement after traumatic brain injury. However, there is either no research or such limited data that it is not possible to draw any firm conclusions regarding the effect of physiotherapy on quality of movement, balance, conscious level, the ability to perform functional tasks or outcome of this patient group. The need for research into all aspects of physiotherapy management for traumatically brain-injured patients is highlighted.     

Best evidence topic report. Do we need to give steroids in children with Bell's palsy?

Report by Chetan Sandeep Ashtekar, Specialist Registrar
Checked by Manohara Joishy, Specialist Registrar, and Rohit Joshi, Clinical Observer     

Do obesity and low levels of physical activity increase the risk for developing type 2 diabetes mellitus among women with prior gestational diabetes in rural China?

Moderate-to-vigorous intensity physical activity (MVPA) and obesity play important roles in the development of type 2 diabetes mellitus (T2DM) among women with prior gestational diabetes mellitus (GDM). Yet, how MVPA affects the risk of developing T2DM among women with prior GDM across the different categories of obesity indicators is unclear. This study aimed to describe the levels of postpartum abnormal glucose tolerance (AGT), obesity indicators (body mass index [BMI] and waist circumference [WC]), and MVPA and to explore the independent effect and joint effect of MVPA and obesity indicators (BMI and WC) on the risk for developing AGT among women with prior GDM in rural China. A total of 425 women with prior GDM were recruited from two county-level hospitals in Western and Eastern Hunan, China. Data were collected with self-reported measurements on sociodemographics and clinical factors as well as postpartum weight-related behaviors (physical activity and dietary intake). The 75-g oral glucose tolerance test, weight, height, and WC were measured on site. Binary logistic regression models and multiplitive interaction models were used to explore the independent and joint associations of BMI and MVPA as well as WC and MVPA on AGT, respectively. One-fifth (20.9%) of the sample women had AGT. The obesity indicators were significantly associated with an increased risk of postpartum AGT, but MVPA was not. In joint effect analyses, larger WC and insufficient MVPA were not significantly associated with increased risk of AGT compared with normal WC and sufficient MVPA (mutually adjusted odds ratio [OR], 1.43; 95% confidence interval [CI], 0.46–4.43; p > .05). In joint effect analyses of MVPA and BMI, the mutually adjusted OR for developing AGT in women who were obese and had insufficient MVPA was 4.49 (95% CI, 1.35–14.92; p < .05) compared with normal weight and sufficient MVPA. Adequate weight management and increased MVPA are warranted for Chinese women with prior GDM to prevent T2DM.     

Smoking behaviour in young families: Do parents take practical measures to prevent passive smoking by the children?

Objective - To investigate smoking behaviour in young families.

Design - Cross-sectional study.

Setting - Mother and child health centres in Oslo, Norway.

Subjects - the families of 1046 children attending the health centres for 6-weeks-, 2- or 4- year well child visits.

Main outcome measures - Daily smoking, smoking quantity and practical measures taken by the parents to prevent passive smoking among the children as assessed by parental reports.

Results - in 48% of the families at least one adult was smoking. 33% of the smoking parents smoked more than ten cigarettes per day. 47% of the smoking families reported that they did not smoke indoors.

Conclusions - the parents were less likely to smoke if they were more than 35 years of age, had a child aged less than one year, had' a spouse/co-habitee or had a long education. Smoking parents smoked less if they had a spouse/co-habitee, had a child aged less than one year or had few children. Smoking parents were more often careful and did not smoke indoors if they had a child aged less than one year, had a spouse/co-habitee, did not have a smoking spouse/co-habitee or smoked a low number of cigarettes per day.     

Do community-based rehabilitation programmes promote the participation of persons with disabilities? A case control study from Mandya District,in India

Abstract

Purpose: In this paper, we measure the effectiveness of Community-Based Rehabilitation (CBR) programmes in promoting the well-being of people with disabilities and removing the barriers to their participation in family and community decision-making processes. Method: To evaluate the impact of the CBR programme, we use data from a large-scale control study in Karnataka, India. Propensity score matching is used to evaluate the impacts on disabled persons after 2, 4 and 7 years of entering the CBR. The theoretical framework for the analysis is based on the CBR guidelines, which are combined with the International Classification of Functionings (ICF), the United Nations Convention on the Rights of People with Disabilities (UN CRPD) and Amartya Sen’s capability approach. Results: CBR has a positive impact on the well-being of persons with disabilities participating in the programme and particularly on their participation within the family and the society at large. Conclusions: CBR programmes have a multidimensional and positive impact on individual and collective capabilities; on individual, agency and social empowerment.

• Implications for Rehabilitation

• Community-Based Rehabilitation (CBR) can make a lasting difference in the life of persons with disabilities.

• CBR improves participation and inclusion of persons with disabilities in the family and in the community.

     

Do IFN-γ-release assays predict the risk of TB? New evidence from a study on patients with silicosis

IFN-γ-release assays (IGRAs) are new tools for the diagnosis of latent TB infection which, until recently, relied only on the use of the tuberculin skin test (TST). However, while the positive predictive value of a positive TST for active TB is well established, little evidence on this issue is available for IGRAs. In a study conducted on silicosis patients in Hong Kong, China, Leung et al. found that a positive response to an IGRA, the T-SPOT.TB, was associated with a larger than fourfold increase in the risk of developing TB compared with those who tested negative, while a smaller than twofold increase was observed for TST-positives compared with negatives. This study provides further support to the guidelines from public health agencies recommending the use of IGRAs in place of or in addition to TST. Several issues regarding their optimal use, however, remain open to debate.     

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: does the 'seatbelt sign' predict intra-abdominal injury after motor vehicle trauma in children?

A short cut review was carried out to establish whether the seat belt sign was a significant predictor of intra-abdominal injury in children involved in motor vehicle collisions. 51 papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that seatbelt sign appears to be associated with an increased risk of intra-abdominal injuries, especially gastrointestinal and pancreatic injuries.     

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Bet 4: is intranasal fentanyl better than parenteral morphine for managing acute severe pain in children?

A short cut review was carried out to establish whether intranasal fentanyl is better than parenteral morphine for managing acute severe pain in children. 51 papers were found using the reported searches, of which 4 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that intranasal fentanyl is an effective and safe alternative to IV or IM morphine for managing acute pain in children presenting to the Emergency Department.