State Medicaid Eligibility Criteria and Unmet Preventive Dental Care Need for CSHCN

Maternal and Child Health Journal - Objective To determine if Medicaid eligibility is associated with unmet preventive dental care need for Medicaid-enrolled CSHCN. Methods We analyzed the...     

Dentists' Perceptions of Barriers to Providing Dental Care to Pregnant Women

PurposeThe purpose of the study was to understand US dentists' attitudes, knowledge, and practices regarding dental care for pregnant women and to determine the impact of recent papers on oral health and pregnancy and guidelines disseminated widely.MethodsIn 2006 and 2007, the investigators conducted a mailed survey of all 1,604 general dentists in Oregon; 55.2% responded). Structural equation modeling was used to estimate associations between dentists' attitudes toward providing care to pregnant women, dentists' knowledge about the safety of dental procedures, and dentists' current practice patterns.ResultsDentist's perceived barriers have the strongest direct effect on current practice and might be the most important factor deterring dentists from providing care to pregnant patients. Five attitudes (perceived barriers) were associated with providing less dental services: time, economic, skills, dental staff resistance, and peer pressure. The final model shows a good fit with a chi-square of 38.286 (p = .12; n = 772; df = 52) and a Bentler-Bonett normed fit index of .98 and a comparative fit index of .993. The root mean square error of approximation is .02.ConclusionFindings suggest that attitudes are significant determinants of accurate knowledge and current practice. Multidimensional approaches are needed to increase access to dental care and protect the oral health of women during pregnancy. Despite current clinical recommendations to deliver all necessary care to pregnant patients during the first, second, and third trimesters, dentists' knowledge of the appropriateness of procedures continues to lag the state of the art in dental science.     

The Effect of Rural Residence on Dental Unmet Need for Children With Special Health Care Needs

BACKGROUND: Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs. OBJECTIVE: To examine the effects of rural residence on unmet dental need for CSHCN. METHODS: We use the nationally representative National Survey of CSHCN Needs. We performed logistic regression to estimate the independent effects of rural residence on the likelihood of having an unmet dental need, using a measure of unmet need based on professional society recommendations and a measure based on parental report. RESULTS: Using either of the measures, a substantial percentage of CSHCN do not receive all needed dental care. Rural CSHCN are more likely to forgo needed dental care than their urban counterparts. Our results suggest that rural CSHCN have unmet needs for dental care due to both difficulty accessing care and because their parents do not recognize a need. CONCLUSION: Traditional access barriers for rural children, such as inadequate provider supply and lack of insurance, may increase unmet needs both directly and indirectly, through their effects on parents' perceptions of need. Reducing unmet needs for dental care in rural children with special needs will require addressing both access issues and parents' understanding of dental care need.     

Unmet Need among Children with Special Health Care Needs in Massachusetts

Objectives We partnered with a Massachusetts family workgroup to analyze state level data that would be most useful to consumers and advocates in Massachusetts. Methods Massachusetts’ and US data from the 2001 National Survey of Children with Special Health Care Needs (NSCSHCN) were analyzed. We examined types of need and prevalence of unmet need for all CSHCN and for more severely affected CSHCN. We also correlated unmet need to child and family characteristics using multivariate logistic regression. Results In Massachusetts, 17% of CSHCN and 37% of children more severely affected did not receive needed care. CSHCN who were uninsured anytime during the previous year were nearly 5 times more likely to experience an unmet need (OR = 4.95, CI: 1.69–14.51). Children with more functional limitations (OR = 3.15; CI: 1.59–6.24) and unstable health care needs (OR = 3.26; CI: 1.33–8.00) were also more likely to experience an unmet need. Receiving coordinated care in a medical home (OR = 0.46; CI: 0.23–0.90) was associated with reduced reports of unmet need. Conclusions With input from families of CSHCN, researchers can direct their analyses to answering the questions and concerns most meaningful to families. We estimate that 1 in 6 CSHCN in Massachusetts did not receive needed care, with more than 1 in 3 CSHCN with a more severe condition experiencing an unmet need. Enabling factors were predictors of unmet need suggesting solutions such as expanding insurance coverage and improving services systems for CSHCN.     

Disparities in Preventive Care by Body Mass Index Categories Among Women

ABSTRACT

Objective: The present analyses examined the relationship of body mass index (BMI) categories to receiving age-appropriate preventive services among women.

Method: Data from the Medical Expenditure Panel Survey (2003, N = 10,954) were analyzed using multiple logistic regressions. Outcomes were: age-appropriate Pap-test, mammography, colorectal, cholesterol and blood pressure screening, and influenza immunization.

Results: Overall, 3% of participants were underweight, and 26.3% were obese. Obese women were less likely to receive Pap-tests (p < .01), and underweight women less likely to receive mammography (p < .001). Dental care was less likely across all BMI groups outside the normal weight range.

Conclusions: The association between BMI categories and preventive services use varied by type of preventive care.     

Health and Health Care Disparities Among Homeless Women

While disparities in health and health care between vulnerable (e.g., minorities, low-income) and majority populations are well documented, less is known about disparities within these special populations that are large and diverse. Such knowledge is essential to determine the neediest within these generally needy populations, and to plan interventions to reduce their health and health care disparities. With data from 1,331 women residing in Los Angeles County California, in one of the largest, most comprehensive studies of the health of homeless women to date, this study examined the health and health care disparities among homeless African American, Latina, and white women. This study further explored if race/ethnicity and other factors that predispose homeless women to poor health, or enable them to obtain better health care, were associated with their unmet need for medical care. The study found that white, non-Latina women were more likely to report unmet need than African Americans and Latinas, and women suffering from drug abuse, violence, or depression were most in need of care. These findings should be considered in targeting and addressing the special needs of homeless women of different racial/ethnic groups.     

Accumulation of Jail Incarceration and Hardship,Health Status,and Unmet Health Care Need Among Women Who Use Drugs

Background

Jail is frequently described as a “revolving door,” which can be profoundly destabilizing to people moving in and out of the system. However, there is a dearth of research attempting to understand the impacts of the accumulation of incarceration events on women who use drugs. We examined the association of the frequency of jail incarceration with hardship, perceived health status, and unmet health care need among women who use drugs.

孕妇常见症状的护理

孕妇在怀孕期间很容易出现各种不适症状,本文主要针对一些主要出现的症状进行总结,以便为孕妇提供一个预防及避免症状的发生的依据.     

Unmet Need,Cost Burden,and Communication Problems in SCHIP by Special Health Care Needs Status

Children with special health care needs (CSHCN) require more health care than other children; hence adequate health insurance is critical. The Maternal and Child Health Bureau defined three components of adequacy: (1) coverage of needed benefits and services; (2) reasonable costs; and (3) ability to see needed providers. This study compares cost burden, access to care, and patient/provider communication within New Jersey’s SCHIP for CSHCN versus those without such needs. We used data from the 2003 NJ FamilyCare (NJFC) Supplement to the New Jersey Family Health Survey on 444 children enrolled in NJFC and 145 children disenrolled from NJFC but covered by other insurance at the time of the survey. The CSHCN Screener was used to identify CSHCN. CSHCN in NJFC had 1.5 times the odds of an unmet need for health care; 2.7 times the odds of a cost burden; and 2.2 times the odds of any coverage or service inadequacy than those without SHCN, even when demographic factors and NJFC plan level (which is based on income) were taken into account. CSHCN enrolled in NJFC have more difficulties in some areas of access to care and cost burden. Patterns of access to care, cost burden, and patient/provider communication were similar for children formerly in NJFC who had other types of insurance at the time of the survey. Future studies should use comprehensive measures of adequacy of coverage, including attitudinal, structural and economic perspectives.     

孕产妇分娩与保健双向转诊调查分析

目的 开展孕产妇分娩与保健双向转诊的实证研究.方法 分析深圳市公明人民医院及其社区康复中心(站)就诊与保健的孕产妇.结果 孕产妇分娩后由医院下转入社区康复中心(站),转诊率为99.99%,孕妇上转到医院分娩和保健的比例为42.40%,孕产妇分娩与保健双向转诊率远高于居民门诊患者和住院患者的转诊率.结论 在目前双向转诊落实难的现实情况下,我们认为当地的孕产妇分娩与保健双向转诊落实得非常好.     

Care From Family Physicians Reported by Pregnant Women in the United States

PURPOSE

We describe the proportion of family physicians providing care of any sort to pregnant women in the United States from 2000 to 2009.

METHODS

We used a repeat, cross-sectional design with data from the nationally representative Integrated Health Interview Series (2000–2009) for respondents who reported being pregnant at the time of the survey (N = 3,204). Using multivariate logistic regression, we modeled changes over time in pregnant women’s reports of care from family physicians. We used interaction terms to test for regional differences in trends.

RESULTS

Approximately one-third of pregnant women reported having seen or talked to a family physician for medical care during the prior year, a percentage that remained stable for the period of 2000 to 2009 (adjusted odds ratio for annual change = 1.006). Most pregnant women reported care from multiple types of clinicians, including family physicians, obstetrician-gynecologists, midwives, nurse practitioners, and physician assistants. There were regional differences in trends in family physician care; pregnant women in the North Central United States increasingly reported care from family physicians, whereas women in the South reported a decline (6.7% annual increase vs 4.7% annual decrease, P ≥.001).

CONCLUSIONS

Trends in family medicine care for pregnant women have remained steady for the nation as a whole, but they differ by region of the United States. Most pregnant women reported care from multiple clinicians, highlighting the importance of care coordination for this patient population.     

80例无痛分娩产妇的护理体会

目的探讨无痛分娩的有效护理方法及其作用。方法对80例产妇的心理护理、生活护理、产程护理及其产后并发症的护理进行总结分析。结果 80例产妇分娩顺利,母子平安,产后并发症轻。结论采用综合护理手段配合无痛分娩技术,可使产妇分娩顺利。     

Disparities in Tdap Vaccination and Vaccine Information Needs Among Pregnant Women in the United States

Maternal and Child Health Journal - Objectives The Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that pregnant...     

四川省孕期妇女孕前保健知识及需求调查

目的了解四川省孕期妇女对孕前保健服务的认知状况及其需求情况,为制定孕前保健服务策略提供科学依据。方法根据四川省经济状况和地理分布,2011—07／12随机抽取四JiJ省8个市（成都、内江、资阳、乐山、南充、眉山、自贡、遂宁）及其相应各1个区县,对在当地妇幼保健机构进行产前检查的孕期妇女及家庭成员进行孕前保健认知情况及需求情况的调查。结果孕期妇女孕前检查率为61．8％,实际孕前体检项目以常规项目为主,血常规检查应答率为70．66％,其次为B超、尿常规、乙肝甲肝等,性激素6项利用最少,应答率为6．97％;了解孕前保健知识最主要的途径是亲朋好友,应答率为75．18％,途径需求调查排首位的是医务人员,应答率为57．45％;对认知水平影响因素分析显示,文化程度、家庭人均月收入、就医便利程度、是否计划怀孕和服务了解途径（报刊书籍、亲朋好友、网络）对孕前保健知识认知水平的影响有统计学意义（P〈0．05）。结论四川省孕前体检率较低,主要为常规项目检查;文化程度、家庭人均月收入、就医便利程度、是否计划怀孕及相关知识获取途径是影响育龄妇女孕前保健认知水平的重要因素。