Diagnostic accuracy of parents’ ratings of their child’s oral health-related quality of life

Purpose

Oral health-related quality of life (OHRQoL) in children and adolescents can be assessed with two different approaches: children can directly report their own perceptions or parents can serve as proxies and rate their child’s OHRQoL from their perspectives. It was the aim to investigate whether parents can accurately rate their children’s OHRQoL and to compare agreement between OHRQoL domains and between age groups.

Methods

In this cross-sectional study, a sample of 140 children aged 7–17 years was consecutively recruited at a university-based orthodontic clinic and a public school. OHRQoL was assessed with the 19-item Child Oral Health Impact Profile (COHIP) with one version for the child and one for the parent. Correlation between child and parent ratings and diagnostic accuracy of the parental rating to assess children’s OHRQoL was calculated, and findings were compared between 7–11- and 12–17-year-old children.

Results

COHIP summary score differed only slightly between parents (mean 60.7 ± 9.8 points) and children (mean 61.9 ± 8.9 points). Correlation of summary scores was r = 0.38, corresponding to a moderate agreement. Median of item prevalence of all 19 items was 29.5 % for children and 41.7 % for parents. Median of positive predictive values was 50.9 % and median of negative predictive values 76.7 %, with no substantial differences in age groups.

Conclusions

Parents’ perception of their children’s OHRQoL is not accurate enough to detect oral health problems in an individual child aged between 7 and 17 years, and therefore, proxy OHRQoL assessment for individuals in this age group cannot be recommended.

     

Teenagers’ Explanations of Bullying

The aim of the present study was to explore how teenagers explain why bullying takes place at school, and whether there were any differences in explaining bullying due to gender and prior bullying experiences. One hundred and seventy-six Swedish students in Grade 9 responded to a questionnaire. Mixed methods (qualitative and quantitative methods) were used to analyze data. The grounded theory analysis generated five main categories and 26 sub categories regarding accounts of bullying causes. Results indicated that youth tended to explain bullying in terms of individualistic reasons (bully attributing and victim attributing) than in terms of peer group, school setting, or human nature/society reasons. Girls were more likely to attribute bullying causes to the bully and much less to the victim, compared to boys. Moreover, youth classified as bullies were more likely to attribute the reason for bullying to the victim and much less to the bully, compared to victims, bystanders, and victims/bullies.     

The Enigma of ‘Multiple Causes of Death’

The surface marker classification of non-Hodgkin's lymphomas has demonstrated its value in refining existing morphologic systems of classification and thus in guiding clinical decisions in otherwise ambiguous cases. This accomplishment, in itself significant, may provide the key to the development of effective monospecific therapeutic agents that could be directed at target cells.     

Consumers’ misunderstanding of health insurance

We report results from two surveys of representative samples of Americans with private health insurance. The first examines how well Americans understand, and believe they understand, traditional health insurance coverage. The second examines whether those insured under a simplified all-copay insurance plan will be more likely to engage in cost-reducing behaviors relative to those insured under a traditional plan with deductibles and coinsurance, and measures consumer preferences between the two plans. The surveys provide strong evidence that consumers do not understand traditional plans and would better understand a simplified plan, but weaker evidence that a simplified plan would have strong appeal to consumers or change their healthcare choices.     

Patients’ Understanding of the Regulation of Dietary Supplements

The Dietary Supplement Health and Education Act (DSHEA) permits manufacturers to sell products without providing pre-market evidence of safety or efficacy. One fundamental reason for the passage of the DSHEA was to empower consumers to make their own choices, free from governmental restriction. Yet, little is known about the public’s understanding of the supplement regulatory process. We undertook a study to assess patients’ knowledge regarding governmental oversight of product marketing and advertising. A survey of 300 adult patients from the Baltimore Metropolitan area was administered after showing participants an advertisement for a dietary supplement. Patients were asked questions regarding their understanding of federal regulation of the advertised product. A total of 52% of respondents were unaware that the dietary supplement had not been approved by the government while 63% were unaware that the advertisement for that supplement had not been pre-approved. Factors associated with a lack of understanding of the product approval process included lower education level (OR 2.52; 95% CI 1.52–4.19) and non-Caucasian race (OR 1.99; 95% CI 1.17–3.36). Lower education level was also associated with confusion regarding the advertisement approval process (OR 2.60; 95% CI 1.48–4.57). Based on these results, patients seem unclear about the government’s role in the regulation of dietary supplements. Educational efforts should be geared towards clarifying these issues.     

Qualitative analyses of nursing home residents’ quality of life from multiple stakeholders’ perspectives

Quality of Life Research - Quality of life has been defined in various ways by nursing home stakeholders over the years. As such, analyzing the levels of agreement or disagreement among these...     

Older Teenagers’ Explanations of Bullying

Background

In accordance with the social information processing model, how adolescents attribute cause to a particular social situation (e.g., bullying) they witness or participate in, influences their online social information processing, and hence, how they will act in the situation.

Objective

The aim of the present study was to explore how older teenagers explain why bullying takes place at school, and whether there were any differences in explaining bullying due to gender.

Methods

Two hundred and fifteen Swedish students in upper secondary school responded to a questionnaire. Mixed methods (qualitative and quantitative methods) were used to analyze data.

Results

The qualitative analysis resulted in three main categories and nine subcategories regarding accounts of bullying causes. According to the findings, the youth explained bullying much more often with individualistic explanations (bully attributing and victim attributing) than non-individualistic explanations (social context attributing). Furthermore, girls tended to provide a greater number of bullying explanations and were more likely to attribute bullying causes to the bully and the victim, as compared to boys.

Conclusions

The findings provide insights into older teenagers’ understanding of why bullying occurs in school. The study also identified some gender differences but also some mixed findings regarding gender differences in comparison with previous research with younger participants. The authors concluded that more research has to be done to investigate age and gender differences.     

Correlates of Mothers’ Perception of Their Communities’ Social Capital: A Community-Based Study

Psychosocial issues have been recognized as important factors in children’s health for decades. This study documents the relation among several important psychosocial variables (e.g., mothers’ depressive symptoms) and a new instrument that assesses parents’ perception of their communities’ social capital. Mothers were recruited from their children’s primary care (PC) pediatricians’ offices within the Southwestern Ohio Ambulatory Research Network or from a children’s hospital developmental clinic (DC). Mothers completed a questionnaire that included the Social Capital Scale (SCS), Children with Special Health Care Needs Screener (CSHCNS), Pediatric Quality of Life Inventory, Maternal Social Support Index and the Center for Epidemiologic Studies Depression Scale (CES-D). Mothers were sorted into three subgroups based on site of recruitment (PC or DC) and results of the CSHCNS. The sample (N = 620) was also sorted into terciles based on SCS scores. Mean SCS was about 73 for each of the three subgroups. Compared to mothers in the highest SCS tercile, mothers in the lowest SCS tercile reported lower education, lower income and higher CES-D median scores. The SCS subscale “sense of belonging” had an inverse correlation with CES-D scores (r = ?.248, p < 0.001). Mothers from primary care and sub-specialty clinics had similar perceptions about their communities’ social capital. Compared to mothers in the highest one third of SCS scores, mothers in the lowest one third were more likely to report less education and income as well as more depressive symptoms. A decreased sense of belonging in their communities was also correlated with more depressive symptoms. The SCS is a new useful tool for investigators and clinicians who work with children and their families.     

An empirical analysis of consumers’ attitudes toward pharmacies’ advertising

This study investigates current attitudes and opinions toward pharmacies’ advertising. The purposes of this study were to determine (a) consumers’ attitudes toward advertising by pharmacies and (b) whether age, race, income, marital status, occupation, education, sex, and number of children in household of the consumer accounted for any significant difference in attitudes toward pharmacies that advertise. The intent was to discover information that would be useful to pharmacies in planning marketing strategies and improving the quality of their advertising. The study seems to confirm the belief of many pharmacies that advertising and marketing clearly have a place in the future of pharmacists’ services.     

Quality of life of caregivers in Parkinson’s disease

Objective: To assess the impact of PD on informal caregivers of patients and identify the main factors related to caregiver strain. Patients and methods: Pairs of PD patients and their caregivers. Evaluation by neurologists included the Hoehn and Yahr, Schwab and England, UPDRS (parts 1–3), ISAPD, and Pfeiffers SPMSQ rating scales. Patients completed the Euro-QoL 5D, PDQ-8, and Hospital Anxiety and Depression Scale. The SQLC was used to assess caregivers quality of life (QoL), with caregivers, in turn, applying the Euro-QoL and PDQ-8 to assess patients health-related quality of life (HRQoL). Multiple linear regression models were fitted to ascertain factors linked to the SQLC. Results: Significant correlations were in evidence between the following scores: SQLC and clinical rating scales and SQLC and patients HRQoL. Based on multiple regression analysis, patients functional state (ADL) proved to be the main predictor of caregivers QoL. Self- and caregiver-assessed patients HRQoL also proved to be a relevant factor. Conclusions: (1) Patients functional state was significantly related to caregivers psychosocial burden; (2) patients HRQoL proved to be an additional factor linked to caregiver QoL; (3) improvement of patient disability and HRQoL might alleviate caregiver strain.     

Effects of e-Cigarette Advertisements on Adolescents’ Perceptions of Cigarettes

ABSTRACT

This study examined the effect of exposure to “cigalike” (products resembling cigarettes) e-cigarette advertisements on adolescents’ perceptions of cigarettes. A nationally representative sample of 802 adolescents (13–17 years old) was randomly assigned to watch three e-cigarette or three control advertisements. Never-smokers who saw the e-cigarette advertisements (n = 352) reported significantly lower perceived risks of smoking than those in the control condition (n = 320). Ever-smokers (n = 130) did not show significant differences across the conditions. In subgroup analyses, current smokers (reported smoking in the past 30 days, n = 31) in the e-cigarette condition reported significantly lower perceived benefits of smoking than those in the control condition. E-cigarette advertisements can affect adolescents’ perceptions of cigarettes. Many advertisements, especially the ones promoting “cigalikes,” depict e-cigarettes as being similar to cigarettes (e.g., look, flavor) but also as a solution for cigarettes’ shortcomings (e.g., bad smell). While the advertisements include messages about problems posed by cigarettes, proposing e-cigarettes as a solution may decrease the perceived risks of smoking among never-smokers. It may also not be clear to adolescents whether advertisements are for cigarettes or e-cigarettes. Regulating e-cigarette advertisements to minimize adolescents’ exposure may prevent potential harmful effects on never-smokers’ perception of smoking.     

Occupational therapists’ perception of the concept of occupational balance

Introduction: Occupational balance is one of the concepts used by occupational therapists with no consensus on its definition. Literature demonstrates different perspectives when this concept is applied in practice and in its link to other concepts such as health and well-being. This study aims to explore how the concept of occupational balance is perceived and practised by occupational therapy practitioners.

Method: A qualitative methodology was employed. Fourteen occupational therapists volunteered for the study. Nine occupational therapy practitioners were interviewed individually and five attended a focus group. Thematic analysis was applied to analyze the data.

Results: Six themes were identified as follows: (1) occupational balance: what it is; (2) how occupational balance is formed; (3) occupational balance and well-being (4); subjective and objective representations of occupational balance (5); what disrupts/affects occupational balance; and (6) occupational balance/imbalance and occupational therapy practice.

Conclusions: Both objective and subjective experiences of occupational balance need to be considered in order to make an informed decision in practice. The right occupational balance for each individual should be based on his/her values but with consideration of the principal of no harm to others.     

Restructuring of Care Delivery Focus of AHA's ‘Ameriplan’

Abstract

Patients undergoing surgery for total hip arthroplasty (THA) or total knee arthroplasty (TKA) are at particularly high risk for developing venous thromboembolism (VTE). Despite the existence of effective therapies for VTE prevention, THA/TKA patients remain at risk for developing thrombi. Furthermore, the incidence of VTE is predicted to increase as an aging and increasingly obese population experiences joint damage necessitating THA and TKA. Current guidelines recommend the use of a wide range of antithrombotic agents in patients undergoing THA and TKA. These agents include vitamin K antagonists, low-molecular-weight heparins, fondaparinux, and the new oral anticoagulants. However, adherence to guidelines in clinical practice is disappointingly low. The limitations of traditional anticoagulants present management challenges following orthopedic surgery. Vitamin K antagonists present a number of drawbacks, including a narrow therapeutic window and unpredictable pharmacokinetics and pharmacodynamics. The subcutaneous route of administration of fondaparinux and low-molecular-weight heparins may make them unacceptable to patients in the outpatient setting. The introduction of a new generation of anticoagulants promises to address many of the drawbacks associated with the traditional agents. Clinical studies have shown the new oral anticoagulants to be as effective as traditional thromboprophylaxis, with good tolerability profiles. Clinical knowledge of these new agents will be essential to ensure that patients receive appropriate care following orthopedic surgery. This article will discuss the prevention of VTE after THA and TKA based on current evidence-based practice guidelines, the limitations of conventional anticoagulants, and the promise of new therapeutics.     

The consequences of Ireland’s culture of medical migration

Background

In recent years, Ireland has experienced a large-scale, outward migration of doctors. This presents a challenge for national policy makers and workforce planners seeking to build a self-sufficient medical workforce that trains and retains enough doctors to meet demand. Although, traditionally, medical migration has been considered beneficial to the Irish health system, austerity has brought a greater level of uncertainty to the health system and, with it, a need to reappraise the professional culture of migration and its impact on the Irish health system.

Methods

This paper illustrates how a culture of migration informs career and migration plans. It draws on quantitative data—registration and migration data from source and destination countries—and qualitative data—in-depth interviews with 50 doctors who had undertaken postgraduate medical training in Ireland.

Results

Of 50 respondents, 42 highlighted the importance of migration. The culture of medical migration rests on two assumptions—that international training/experience is beneficial to all doctors and that those who emigrate will return to Ireland with additional skills and experience. This assumption of return is challenged by a new generation of doctors whose professional lives have been shaped by globalisation and by austerity. Global comparisons reveal the comparatively poor working conditions, training and career opportunities in Ireland and the relative attractiveness of a permanent career abroad.

Conclusion

In light of these changes, there is a need to critically appraise the culture of medical migration to determine if and in what circumstances migration is appropriate to the needs of the Irish health system. The paper considers the need to reappraise the culture of medical migration and the widespread emigration that it promotes.

     

Mothers’ Socialization of Emotion Regulation: The Moderating Role of Children’s Negative Emotional Reactivity

During the toddler period, children begin to shift from being primarily dependent on parents to regulate their emotions to managing their emotions independently. The present study considers how children’s propensity towards negative emotional arousal interacts with mothers’ efforts to socialize emotion regulation. Fifty-five low income mothers and their 2-year-old children completed observational assessments measuring mothers’ socialization of emotion regulation, children’s reactivity propensity, and children’s emotion regulation. Children’s propensity towards negative reactivity significantly interacted with mothers’ use of physical soothing. That is, mothers with less reactive children who used more soothing had children who were more likely to use interactive, distraction-based regulatory behaviors during a frustration situation. Theoretical and child care implications of the finding are discussed.     

Australia’s pandemic influenza ‘Protect’ phase: emerging out of the fog of pandemic

Recent sociological analyses of contemporary emergency planning foreground a potential break between preparedness plans animated by the spectre of an imaginary future catastrophe and classical public health efforts that are anchored in close knowledge of populations and efforts to prevent the transmission of disease. Whilst scholarly analysis to date suggests that the distinct rationales of public health governance underpinning these different approaches are likely to be entwined and to work in productive tension with each other, less attention has been paid to how this tension plays out in practice. Using 27 semi-structured interviews with public health experts involved in the development or implementation of Australia’s pandemic influenza plan, this paper examines how preparedness efforts established in anticipation of a catastrophic threat were reconfigured during the Australian 2009 (H1N1) pandemic influenza. Specifically, one Australian state broke with the national plan and rapidly inserted an entirely new pandemic phase – which became known as ‘Protect’ – into their response, thereby providing a critical reorientation in the ‘fog of pandemic’. Our analysis indicates that classical population health efforts interrupted not only the vision of catastrophe embedded within the plans, but the actual plans and their implementation, forcing the public health response in a new direction.