Preconception and interconception health status of women who recently gave birth to a live-born infant--Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004.

MMWR Surveill Summ. 2007 Dec 14;56(10):1-35

Authors: D'Angelo D, Williams L, Morrow B, Cox S, Harris N, Harrison L, Posner SF, Hood JR, Zapata L,

PROBLEM/CONDITION: In 2006, CDC published recommendations to improve health and health care for women before pregnancy and between pregnancies (CDC. Recommendations to improve preconception health and health care--United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006;55[No. RR-6]). The Pregnancy Risk Assessment Monitoring System (PRAMS) provides data concerning maternal behaviors, health conditions, and experiences for women in the United States who have delivered a live birth. REPORTING PERIOD COVERED: 2004. DESCRIPTION OF SYSTEM: PRAMS is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants in selected states and cities in the United States. PRAMS employs a mixed mode data-collection methodology; up to three self-administered questionnaires are mailed to a sample of mothers, and nonresponders are followed up with telephone interviews. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets that can be used to produce statewide estimates of perinatal health behaviors and experiences among women delivering live infants. This report summarizes data from 26 PRAMS reporting areas that collected data during 2004 and that had achieved overall weighted response rates of > or =70% and had weighted data available by the time the analysis was conducted in January 2007. Data are reported on indicators regarding 18 behaviors and conditions that are relevant to preconception (i.e., prepregnancy) health and health care and 10 that are relevant to interconception (i.e., postpartum) health and health care. The number of questions that were administered varied by site; certain questions were not asked for all reporting areas. RESULTS: With respect to preconception maternal behaviors and experiences, mean overall prevalence was 23.2% for tobacco use, 50.1% for alcohol use, 35.1% for multivitamin use at least four times a week, 53.1% for nonuse of contraception among women who were not trying to become pregnant, 77.8% for ever having a dental visit before pregnancy, 30.3% for receiving prepregnancy health counseling, 3.6% for experiencing physical abuse, and 18.5% for experiencing at least four stressors before pregnancy. With respect to preconception maternal health conditions, mean overall prevalence was 13.2% for women being underweight (body mass index [BMI]: <19.8), 13.1% for being overweight (BMI: 26.0-29.0), and 21.9% for being obese (BMI: > or =29.0). Mean overall prevalence was 1.8% for having diabetes, 6.9% for asthma, 2.2% for hypertension, 1.2% for heart problems, and 10.2% for anemia. Among women with a previous live birth, the mean overall prevalence of having a previous low birth weight infant was 11.6% and of having a previous preterm infant was 11.9%. With respect to interconception maternal behaviors and experiences, mean overall prevalence was 17.9% for tobacco use, 85.1% for contraceptive use, 15.7% for having symptoms of depression, and 84.8% for having social support. Mean overall prevalence was 7.5% for the most recent infant being born low birth weight, 10.4% for having a recent preterm infant, 89.3% for having a check-up, 89.0% for receiving contraceptive use counseling, 30.4% for having a dental visit, and 48.6% for receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Results varied by maternal age, race/ethnicity, pregnancy intention, and health insurance status. For certain risk behaviors and health conditions, mean overall prevalence was higher among women aged <20 years, black women, women whose pregnancies were unintended, and women receiving Medicaid; however, no single subgroup was consistently at highest risk for all the indicators examined in this report. INTERPRETATION: PRAMS results varied among reporting areas. The prevalence estimates in the majority of reporting areas and for the majority of indicators suggest that a substantial number of women would benefit from preconception interventions to ensure that they enter pregnancy in optimal health. The results also demonstrate disparities among age and racial/ethnic subpopulations, especially with respect to prepregnancy medical conditions and access to health care both before conception and postpartum. Differences also exist in health behaviors between women who reported intended and unintended pregnancies. PUBLIC HEALTH ACTION: Maternal and child health programs can use PRAMS data to monitor improvements in maternal preconception and interconception behaviors and health status. The data presented in this report, which were collected before publication of CDC's recommendations to improve preconception health and health care in the United States, can be used as a baseline to monitor progress toward improvements in preconception and interconception health following publication of the recommendations. These data also can be used to identify specific groups at high risk that would benefit from targeted interventions and to plan and evaluate programs aimed at promoting positive maternal and infant health behaviors, experiences, and reproductive outcomes. In addition, the data can be used to inform policy decisions that affect the health of women and infants.

PMID: 18075488 [PubMed - indexed for MEDLINE]

Living environment and self assessed morbidity: a questionnaire-based survey.

BMC Public Health. 2007;7:223

Authors: Saha A, Kulkarni P, Saiyed H

BACKGROUND: Health complaints have been reported to be higher among the industrial area residents when compared with reference community. METHODS: Such reports being only a few, a questionnaire survey was conducted in three different areas (Industrial, Residential, Commercial) of Ahmedabad city of India to determine the pattern of morbidity and to do a comparative analysis of different areas within the city. RESULTS: A total of 679 families (243 from commercial, 199 from residential and 237 from industrial area) were included in this study. This study revealed that apart from presence of industry in close proximity to residence (99.2%), industrial area residents are having many other disadvantages from the point of view of public health like waste water stagnation (87.4%), problem of cooking smoke (33.2%) and presence of garbage dumps near residence (72.8%). Consequently, problems like coughing, wheezing, eye irritation, skin irritation, jaundice, asthma, and dental caries have been observed to be more common in industrial area. Comparative risk calculated in terms of odds ratio for different such problems have ranged from 1.83 to 6.2 when industrial area was compared with commercial area. Similarly on comparison of industrial area with residential area, odds ratio for different problems have ranged from 1.82 to 11.5. CONCLUSION: This study has pointed out the need of separate planning and implementation of specific upliftment programs for addressing the environmental as well as public health issues of industrial localities.

PMID: 17760971 [PubMed - indexed for MEDLINE]

Effect of antiasthmatic medication on dental disease: Dental caries and periodontal disease.

J Indian Soc Pedod Prev Dent. 2007 Apr-Jun;25(2):65-8

Authors: Shashikiran ND, Reddy VV, Raju PK

The prevalence of asthma has been increasing since the 1980s. Asthma and tooth decay are the two major causes of school absenteeism. There are few studies present in the literature. The objectives of the present study were to know the severity of dental caries and periodontal problems in children before and after taking antiasthmatic medication. The present study was conducted on 105, six- to fourteen-year-old asthmatic children to determine the condition of their dental caries and their periodontal status before and after taking antiasthmatic medication, for a period of 1 year and these were matched with their controls. The results showed that salbutamol inhaler shows increased caries rate with high significance over other groups, which was followed by salbutamol tablets and beclamethasone inhaler respectively. It has been concluded that antiasthmatic medication has its effects on dental caries and periodontal disease and asthmatic patients are recommended to adopt more precautionary oral hygiene practices and keep their caries activity and periodontal health under constant check.

PMID: 17660639 [PubMed - in process]

Review of the selective COX-2 inhibitors celecoxib and rofecoxib: focus on clinical aspects.

CJEM. 2002 Jul;4(4):268-75

Authors: Loewen PS

The selective cyclooxygenase-2 (COX-2) inhibitors celecoxib and rofecoxib were designed to have similar efficacy but less gastrointestinal toxicity than traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Their efficacy has been demonstrated in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, postoperative dental pain and dysmenorrhea. These agents produce fewer endoscopic ulcers, symptomatic ulcers and gastrointestinal bleeds than traditional NSAIDs; although the absolute benefit is small and the gastropreserving effect is negated by concurrent use of low-dose aspirin for cardiovascular risk reduction. Nephrotoxicity and hyptertension remain concerns with COX-2 inhibitors, as they are with traditional NSAIDs. COX-2 inhibitors may be safe alternatives to traditional NSAIDs for patients with aspirin-sensitive asthma.

PMID: 17608990 [PubMed - in process]

Type I latex allergy: a follow-up study.

J Investig Allergol Clin Immunol. 2007;17(3):164-7

Authors: Garc&#xED;a JA

BACKGROUND: There are several studies that deal with the evolution of patients with occupational rhinitis/asthma as a result of immunoglobulin (Ig) E-mediated allergy to latex. However, none have focused on the course of this illness in non-occupational settings. Objective: To ascertain patient compliance in individuals diagnosed with latex allergy with respect to following avoidance measures, as well as to determine the frequency and type of symptoms that emerged as a result of exposure to latex when receiving healthcare (surgery, gynecology, dentistry), as well as other sources of exposure. METHODS: This is a retrospective study of patients diagnosed with allergy to latex in our department over 11 years. Of the 24 patients, we were able to contact 23 (96%). Twenty were female. Mean age at diagnosis was 36 years (10-67). Mean time of follow-up was 5 years (0.1-11). At the time of diagnosis, patients were informed of the need to avoid contact with latex, with special emphasis given to surgical, gynecological, and dental exposures. RESULTS: Regarding latex exposures in healthcare settings, 5 patients underwent surgery. Four notified of their diagnosis, hence avoiding contact. The patient who failed to inform of his allergy developed laryngeal angioedema. Sixteen patients were exposed via gynecological examinations: Of these, 13 avoided contact with latex gloves and three tolerated them. Twenty patients were exposed to latex during visits to the dentist. Of these, 19 avoided latex and one tolerated it. A further 7 patients (30%) presented allergic syndromes caused by other sources of exposure. These included 4 episodes of contact-induced angioedema due to gloves and balloons and 4 episodes of bronchospasm as a result of being present in atmospheres with high latex contents - hospitals and rooms with balloons. Finally, 4 patients (17%) manifested allergic episodes induced by latex-related foods. CONCLUSIONS: The vast majority of the patients diagnosed with latex allergy informed of their diagnosis when seeking medical care during which they would be exposed. However, 30% of the patients presented some kind of allergic episode due to another type of exposure and 17% presented allergies to related foods.

PMID: 17583103 [PubMed - indexed for MEDLINE]

Wheezing, asthma, hay fever, and atopic eczema in relation to maternal occupations in pregnancy.

Occup Environ Med. 2006 Sep;63(9):640-6

Authors: Magnusson LL, Wennborg H, Bonde JP, Olsen J

OBJECTIVES: To examine whether prenatal occupational exposures, especially to organic solvents, are associated with atopic diseases in childhood. METHODS: The study comprised children born in Odense or Aalborg, Denmark between 1984 and 1987. Occupational job titles were derived from questionnaires filled out by the mothers when attending midwife centres. Assessment of organic solvent exposures was based on job titles selected by occupational specialists. A follow up questionnaire to the parents provided data on medical diagnoses as well as wheezing symptoms for 7844 children aged 14-18. Multivariate logistic regression analyses were performed to estimate the cumulative risk for wheezing (early wheezing not diagnosed as asthma), asthma, hay fever, and atopic eczema during childhood by means of odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Explorative analyses by maternal job titles in pregnancy showed elevated odds ratios concerning different atopic diseases for occupational groups such as "bakers, pastry cooks, and confectionary makers", "dental assistants", "electrical and electronic assemblers", "sewers and embroiders", and "bookbinders and related workers". An excess risk ratio for hay fever (OR 2.8, CI 1.1 to 7.5) was found following maternal gestational exposure to organic solvents. Furthermore, a slightly raised odds ratio for asthma was observed in children of shift workers (OR 1.2, CI 1.0 to 1.5). CONCLUSION: The data suggest links between certain maternal occupations during pregnancy and atopic diseases, which merits further scrutiny. However, no consistent pattern was seen across the different atopic diseases.

PMID: 16757508 [PubMed - indexed for MEDLINE]

Occupational asthma due to acrylates in a graphic arts worker.

Allergol Immunopathol (Madr). 2006 Jan-Feb;34(1):32-6

Authors: Reig Rinc&#xF3;n de Arellano I, Cimarra Alvarez-Lovell M, Robledo Echarren T, Fernández-Nieto M, Quirce Gancedo S, Seaone Plata C, Martínez-Cócera C

BACKGROUND: Acrylates are used in a wide variety of products such as solvents, adhesives, paints, printing ink, soft contact lenses, porcelain nails, and methacrylates (used by dentists and orthopedists). Currently there are various types of acrylic compounds: acrylates, cyanoacrylates (such as tissue adhesives and home glues), and methacrylates (prostheses and dental and orthopedic fillings). The sensitization mechanism is unknown, but the allergy is believed to be due to a non-IgE mediated phenomenon, since a late asthmatic response occurs. Various cases of acrylate-induced asthma have been reported, especially in dentists and persons using glues or paints containing this substance. MATERIAL AND METHODS: We present the case of a 52-year-old man who had been working in graphic arts for the previous 7 years. For the previous 2 years he had experienced persistent cough with a sensation of drowning, dyspnea that increased with moderate exertion, and nasal obstruction despite continuous treatment. The symptoms first appeared after an episode of acute respiratory difficulty associated with weight loss, pulmonary infiltrates, and eosinophilia. Peak expiratory flow (PEF) was measured during work and sick leave, and specific bronchial challenge with acrylates was performed in a bronchial chamber. RESULTS: The PEF improved on weekends and sick leave. The challenge test provoked a late asthmatic response and the non-specific bronchial hyperreactivity increased after the test. As well in the sputum samples there was a increase of eosinophil amount.

PMID: 16540069 [PubMed - indexed for MEDLINE]

Effects of the State Children's Health Insurance Program Expansions on children with chronic health conditions.

Pediatrics. 2005 Jul;116(1):e34-42

Authors: Davidoff A, Kenney G, Dubay L

OBJECTIVE: To estimate the effects of the State Children's Health Insurance Program (SCHIP) expansions on insurance coverage, use of health care services, and access to care for children with chronic health conditions. METHODS: The primary source of data was the National Health Interview Survey. Children with chronic health conditions were identified primarily through reported diagnoses of common chronic conditions (eg, asthma, attention-deficit disorder, mental retardation, Down syndrome, cerebral palsy, muscular dystrophy, sickle cell disease, diabetes, arthritis, heart disease) and on the presence of activity limitations caused by a health problem lasting at least 12 months. We examined changes in a broad array of outcomes for children with chronic health conditions who gained eligibility under SCHIP or who were already eligible for coverage under Medicaid, comparing the periods before and after implementation of the program. Changes for these treatment groups were compared with children with slightly higher incomes, who should not have been affected by the eligibility expansions. Comparisons were made with adjustment for child, family, and other characteristics that might have independent effects on the outcomes of interest. Outcomes included health insurance coverage, use of general and specialty services, access to care, and out-of-pocket spending on health care. Selected analyses were conducted for children not identified as having chronic health conditions. RESULTS: The SCHIP expansions resulted in a 9.8 percentage point increase in the proportion of children with chronic conditions reporting public insurance and a 6.4 percentage point decline in the proportion uninsured. Unmet need for health care decreased by 8 percentage points, with most of the decline found for dental care. Increases in specialist, eye care, and dental visits and decreases in out-of-pocket spending and emergency-department and mental health visits were observed but did not meet standards of statistical significance. Estimated reductions in unmet need were greater for children with chronic conditions than for other children. CONCLUSIONS: Recent expansions in public insurance eligibility under SCHIP have improved coverage for children with chronic conditions, with selected improvements in access to care. However, some eligible children with chronic conditions remain uninsured, and the impact on access to care and service use were limited. Additional progress may require targeted outreach to children with chronic conditions and improvements in Medicaid and SCHIP service-delivery systems. Given the current fiscal environment and the fact that children with chronic conditions have not generally been protected from cutbacks, the recent progress documented in this study may be reversed.

PMID: 15958662 [PubMed - indexed for MEDLINE]

Morbidity profile and its relationship with disability and psychological distress among elderly people in Northern India.

Int J Epidemiol. 2003 Dec;32(6):978-87

Authors: Joshi K, Kumar R, Avasthi A

BACKGROUND: Morbidity among elderly people has an important influence on their physical functioning and psychological well-being. Evaluation of the morbidity profile and its determinants, which have implications for elderly people, are not available. The objective of this study is to assess morbidity, co-morbidity, and patterns of treatment seeking, and to determine relationship of morbidity with disability, psychological distress, and socio-demographic variables among the elderly population in northern India. METHODS: A cross-sectional survey of 200 subjects over 60 years old (100 each from the urban population of Chandigarh City and the rural population of Haryana State of India) was carried out using a cluster sampling technique. The study period was July 1999-April 2000. Various socio-demographic characteristics were recorded at baseline. A clinical diagnosis was made by a physician based on reported illness, clinical examination, and cross-checking of medical records and medications held by the subjects. Psychological distress and disability was assessed using the PGI-Health Questionnaire-N-1 and the Rapid Disability Rating Scale-2, respectively. ANOVA, Kruskal-Wallis H test, correlation coefficient, and multivariate analysis were used to assess the relationship and association of morbidity with other variables. RESULTS: Of the total sample, 88.9% reported illness based on their perception, and of these 43.5% were seeking treatment and actually taking medicines, and 42.5% were diagnosed as having 4-6 morbidities. The mean number of morbidities among elderly people was 6.1 (SD 2.9). A total of 87.5% had minimal to severe disabilities and 66% of elderly people were distressed physically, psychologically, or both. The most prevalent morbidity was anaemia, followed by dental problems, hypertension, chronic obstructive airway disease (COAD), cataract, and osteoarthritis. Morbidities like asthma, COAD, hypertension, osteoarthritis, gastrointestinal disorders, anaemia, and eye and neurological problems were significantly associated with disability and distress. Higher number of morbidities was associated with greater disability and distress. In univariate analysis, socio-demographic variables like age, locality, caste, education, occupation, and income were important determinants of morbidity. Multivariate analysis was undertaken to find out the independent relationship of socio-demographic variables with morbidity. Morbidity was significantly associated with age (b value 0.06, 95% CI: 0.01, 0.12), sex (b value 1.03, 95% CI: 0.02, 2.05), and occupation (b value 0.20, 95% CI: 0.07, 0.33). CONCLUSIONS: A high mean number of morbidities (6.1, SD 2.9) was observed. Elderly subjects with higher morbidity had increasing disability and distress. Age, sex, and occupation were important determinants of morbidity. Assessment of the morbidity profile and its determinants will help in the application of interventions, both medical and social, to improve the health status and thus the quality of life of the elderly in Northern India.

PMID: 14681260 [PubMed - indexed for MEDLINE]

Occupation and asthma: a population-based incident case-control study.

Am J Epidemiol. 2003 Nov 15;158(10):981-7

Authors: Jaakkola JJ, Piipari R, Jaakkola MS

The authors assessed the relations between occupation and risk of developing asthma in adulthood in a 1997-2000 population-based incident case-control study of 521 cases and 932 controls in south Finland. The occupations were classified according to potential exposure to asthma-causing inhalants. Asthma risk was increased consistently for both men and women in the chemical (adjusted odds ratio (OR) = 5.69, 95% confidence interval (CI): 1.08, 29.8), rubber and plastic (OR = 2.61, 95% CI: 0.92, 7.42), and wood and paper (OR = 1.72, 95% CI: 0.71, 4.17) industries. Risk in relation to occupation was increased only for men-for bakers and food processors (OR = 8.62, 95% CI: 0.86, 86.5), textile workers (OR = 4.70, 95% CI: 0.29, 77.1), electrical and electronic production workers (OR = 2.83, 95% CI: 0.82, 6.93), laboratory technicians (OR = 1.66, 95% CI: 0.17, 16.6), and storage workers (OR = 1.57, 95% CI: 0.40, 6.19). Of the predominantly men's occupations, metal (OR = 4.52, 95% CI: 2.35, 8.70) and forestry (OR = 6.00, 95% CI: 0.96, 37.5) work were the strongest determinants of asthma. For women, asthma risk increased for waiters (OR = 3.03, 95% CI: 1.10, 8.31), cleaners (OR = 1.42, 95% CI: 0.81, 2.48), and dental workers (OR = 4.74, 95% CI: 0.48, 46.5). Results suggest an increased asthma risk both in traditional industries and forestry and in several nonindustrial occupations.

PMID: 14607806 [PubMed - indexed for MEDLINE]

Pursuing community-oriented primary care in a Russian closed nuclear city: the Sarov-Los Alamos community health partnership.

Am J Public Health. 2002 Nov;92(11):1740-2

Authors: Rhyne RL, Hertzman PA

The Russian health care system historically has not relied on medical evidence to guide practice, uses centralized management, and is burdened by overspecialization. In 1999, a community health partnership was established between Sarov, Russia, and Los Alamos, NM, 2 cities linked by their nuclear weapons histories. Health problems addressed include asthma and diabetes, pediatric dental caries, low prevalence of breastfeeding, and adolescent drug abuse and sexually transmitted diseases. A community-oriented primary care approach was adopted that includes (1) implementing a "train the trainers" strategy to educate health professionals and lay people, (2) adapting established clinical practice guidelines based on local resources, (3) restricting use of expensive or limited resources, and (4) securing commitments from local government for expendable supplies and medications.

PMID: 12406797 [PubMed - indexed for MEDLINE]

The dental patient with asthma. An update and oral health considerations.

J Am Dent Assoc. 2001 Sep;132(9):1229-39

Authors: Steinbacher DM, Glick M

OVERVIEW: Asthma is a serious global health problem that has steadily increased in prevalence during the past two decades. New classification and treatment guidelines have been published, and dental providers need to be aware of these changes. LITERATURE REVIEWED: The authors searched textbooks and MEDLINE, looking for the most updated medical information on asthma, as well as for previous publications on treatment of asthmatic patients in a dental setting. RESULTS: More than 9,000 articles on asthma were published in English between 1997 and 2000. From 1960 until 2000, approximately 40 articles specifically addressed asthma and dental care. The authors reviewed more than 300 articles from the medical literature and all articles after 1980 that directly focused on oral health issues for importance and relevance. CONCLUSIONS: Recent information regarding the etiology, pathogenesis and treatment of asthma had not been adequately addressed in the dental literature. Dental care of asthmatic patients may necessitate considerations beyond what has previously been published in the dental literature. CLINICAL IMPLICATIONS: In the treatment of asthma, as with treatment of most medical conditions, oral health care providers play a role that is important in terms of both the patient's overall health and the systemic condition's effect on oral health. This article provides dentists with a timely update on asthma and the relationship between asthma and oral health, and it offers suggestions for safe and appropriate dental care.

PMID: 11665347 [PubMed - indexed for MEDLINE]

Incidence and determinants of IgE-mediated sensitization in apprentices. A prospective study.

Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1222-8

Authors: Gautrin D, Ghezzo H, Infante-Rivard C, Malo JL

We investigated prospectively the incidence and determinants of work-related specific skin sensitization in a cohort of 769 apprentices, including 417 in animal health technology, 230 in pastry-making, and 122 in dental-hygiene technology. Subjects were recruited when starting exposure to laboratory animals, flour, or latex. A questionnaire and skin-prick tests with common and work-related allergens were administered on entry and at follow-up visits from 8 to 44 mo; information on number of hours of exposure to specific allergens was obtained. Among 769 apprentices, 698 attended >/= 1 follow-up visit. A total of 111 subjects developed specific sensitization over the study period. The incidence of work-related sensitization (per person-year) was 8.9% (95% CI 7.3 to 11.0%) in the animal-health program, 4.2% (95% CI 1.8 to 8.2%) in the pastry-making program, and 2.5% (95% CI = 0.7 to 4.3%) in the dental-hygiene program. In the animal health group, Cox regression analyses showed that atopy, nasal, and respiratory symptoms in the pollen season, and exposure assessed by the school attended or by duration of exposure to rodents were the most significant predictors of sensitization. In the dental-hygiene program, atopy and asthma were significant determinants. This study shows that: (1) an apprenticeship in animal-health technology carries a greater risk of developing specific sensitization than do apprenticeships in pastry-making and dental-hygiene; (2) atopy, respiratory symptoms in the pollen season, and number of hours in contact with rodents determine the risk of sensitization in apprentices in the animal health program.

PMID: 11029321 [PubMed - indexed for MEDLINE]

[Is it necessary that some patients come to see us so often? Factors associated with primary care use in pediatrics]

Gac Sanit. 2000 May-Jun;14(3):195-202

Authors: Orueta JF, L&#xF3;pez-De-Munain J

OBJECTIVES: To analyze the relationship between pediatric patients morbidity and their level of primary health care services use; and to establish if the patients level of use affects the health promotion and immunization schedule completion. METHODS: All patients assigned to a pediatric practice of the Basque National Health Service in Astrabudua (Bizkaia, Spain) over a 6-year period were categorized into different utilization patterns according to their age and number of primary care visits (whose principal reason for encounter was different from health promotion activities). Bivariate and multivariate analyses were performed comparing three groups of subjects: 116 consistently high users, 115 consistently low users and 123 patients classified as consistently medium or erratic users. Ambulatory care Groups (ACGs) case-mix system was used to manage pathologies. RESULTS: High use patients experienced several morbidity types most frequently than low use ones: asthma (OR = 44.7; 95% CI = 5.5-206.1), diseases likely to recurr (OR = 33.5; 95% CI = 8.5-131.6), specialty unstable chronic conditions (OR = 10.8; 95% CI = 2.2-52.8), psychosocial conditions (OR = 5.7; 95% CI = 2.1-15.2), chronic medical stable conditions (OR = 4.0; 95% CI = 1.9-8.6), eye/dental diseases (OR = 3.5; 95% CI = 1.5-8.1). On the other hand, low users were more likely to be lacking completion of the immunization (OR = 3.0; 95% CI = 1.1-8.8) and the well-child care program visits schedules (OR = 4.3; 95% CI = 2.3-8.0). CONCLUSION: Our data confirm that high utilization, far from being inadequate behavior, is an adequate response to the higher health care needs showed by such patients. Primary care pediatricians should assess preventive care needs of the children who consult them infrequently.

PMID: 10984983 [PubMed - indexed for MEDLINE]

How far have state Medicaid agencies advanced in performance measurement for children?

Arch Pediatr Adolesc Med. 2000 Jul;154(7):665-71

Authors: McManus MA, Graham RR, Fox HB, Mercil CM, Irwin CE

BACKGROUND: While children represent the largest population group enrolled in Medicaid managed care, little is known about the pediatric performance measures used by state Medicaid agencies. OBJECTIVE: To identify Medicaid managed care requirements for using Health Plan Employer Data and Information Set and other performance measures for children (defined as those aged 0-21 years in this study). DESIGN: A structured telephone survey of pediatric performance measures. PARTICIPANTS: Survey respondents were state Medicaid officials responsible for managed care quality oversight in 39 states. MAIN OUTCOME MEASURES: Percentage of states in 1998 with effectiveness-of-care measures on health promotion and disease prevention, early detection and screening, and acute and chronic illness; with use measures on preventive care, ambulatory care, pharmacy, inpatient hospital care, and mental health and chemical dependency services; and with access measures on primary care, low-birth-weight neonates delivered at appropriate facilities, and dental care. RESULTS: In 1998, state Medicaid agencies placed most of their emphasis on monitoring preventive care for children, with immunization rates being the primary focus. Far less attention was directed at assessing the treatment of acute illness. Although more than half of states monitored the treatment of chronic childhood conditions, they focused exclusively on asthma and selected mental health diagnoses. CONCLUSIONS: States are still in the initial phases of designing and implementing quality oversight systems for Medicaid-insured children. Additional quality reporting requirements are clearly needed to assess the treatment of acute and chronic illness among children along with more age-specific reporting requirements.

PMID: 10891017 [PubMed - indexed for MEDLINE]

Individual characteristics and quitting in apprentices exposed to high-molecular-weight agents.

Am J Respir Crit Care Med. 2000 May;161(5):1508-12

Authors: Mons&#xF3; E, Malo JL, Infante-Rivard C, Ghezzo H, Magnan M, L'Archevèque J, Trudeau C, Gautrin D

To determine whether specific immunological sensitization (SIS) and symptoms of allergy are associated with quitting apprenticeships with exposure to high-molecular-weight (HMW) agents. In a cohort study of 769 apprentices starting career programs in animal health technology (AHT), pastry-making (PM), and dental hygiene technology (DHT), health status was assessed at baseline and yearly for up to 44 mo. Subjects who quit the apprenticeship were contacted and offered a last series of measurements as if they pursued. The effect of various factors-at baseline and during the career program-on quitting was examined. Eighty-nine of 769 subjects (11.6%) quit, of whom 74 participated in this study. In multivariate analysis, a history of hay fever (OR = 1.66, 95% CI = 1.0 to 2.75) and attending the pastry-making program (OR = 2.33, 95% CI = 1.11 to 4.91) were significant determinants for quitting. In the subgroup of AHT, SIS to laboratory animals, hay fever, and shortness of breath were significant determinants by univariate analysis; in PM, the only determinant was age; and in DHT, hay fever. Work-related symptoms during training were not associated with quitting. In a multivariate logistic regression analysis in AHT, including characteristics at baseline and at follow-up, baseline SIS (OR = 2.8, 95% CI = 0.94 to 8.38) and symptoms of asthma in general during follow-up (OR = 2.2, 95% CI = 0.94 to 5.38) were the main determinants for quitting, though they were of borderline significance. We conclude that health-related self-selection out of an apprenticeship with exposure to HMW agents is likely to occur and to cause an attrition bias.

PMID: 10806146 [PubMed - indexed for MEDLINE]

Effect of dental treatment on the lung function of children with asthma.

J Am Dent Assoc. 1998 Aug;129(8):1120-8

Authors: Mathew T, Casamassimo PS, Wilson S, Preisch J, Allen E, Hayes JR

In this preliminary study, the authors evaluated whether dental treatment can trigger a reaction in the hyperactive airways of children with asthma, thereby affecting lung function. They also examined the variables, if any, that predict a change in lung function in relation to dental treatment. They tested the lung function of 57 6- to 18-year-old subjects with histories of active asthma, using spirometry before, immediately after and 30 minutes after routine dental treatment. Results revealed a statistically significant decrease (P < .05) in lung function and a clinically significant decrease in lung function in approximately 15 percent of the subjects.

PMID: 9715013 [PubMed - indexed for MEDLINE]

Etiological factors influencing the prevalence of developmental defects of dental enamel in nine-year-old New Zealand children participating in a health and development study.

J Dent Res. 1987 Sep;66(9):1466-9

Authors: Suckling GW, Herbison GP, Brown RH

Over 1000 children, participating in a longitudinal study of health and development, possess documented medical histories based on birth records and regular assessments starting at age 3. A dental examination at age 5 of 923 participants recorded their exposure to fluoride and evidence of trauma to the deciduous teeth. The prevalence of developmental defects of dental enamel in 696 of the children when aged 9 was reported as 56% (Suckling et al., 1985). For the present study, a number of illnesses, accidents, and other experiences were selected from the recorded information as possible etiological factors for any defect, demarcated and diffuse opacities, and hypoplasia. Despite extensive statistical testing, positive and strong associations were few. The prevalence of hypoplasia, seen in 15% of the sample, was higher in those children who had chicken pox before age 3 and, as reported previously, in those children with a history of trauma to their deciduous incisors. This study illustrates the difficulty of establishing the etiology of enamel defects, even when medical and dental histories are available.

PMID: 3476618 [PubMed - indexed for MEDLINE]

Effect of beta 2-adrenoceptor agonists on saliva proteins and dental caries in asthmatic children.

J Dent Res. 1987 Aug;66(8):1404-6

Authors: Ryberg M, M&#xF6;ller C, Ericson T

Twenty-four children, from 10 to 20 years old, with asthma treated with beta 2-adrenoceptor agonists were matched with healthy controls of the same age, sex, and social background. Stimulated whole and parotid saliva was collected, and decayed and filled tooth surfaces as well as oral hygiene habits were recorded. The dietary and sugar intake was carefully checked by a four-day dietary record. The asthmatic children had a 26% lower (p less than 0.05) value for secretion rate of whole saliva. Seventy percent of the children with Streptococcus mutans counts greater than 2 X 10(5) colony-forming units/mL of whole saliva belonged to the asthmatic group (p less than 0.05). The concentrations of total protein and amylase in parotid saliva were significantly lower for the asthmatic children. The concentrations of potassium, salivary peroxidase, bacteria-aggregating glycoproteins, and secretory IgA were not affected, but the secretion rate of parotid saliva was 36% lower in the asthma group (p less than 0.05). Oral hygiene and dietary habits did not differ between the groups. The asthmatic children had higher DFS scores, but these were not significantly different from those of the healthy controls (p = 0.07). We suggest that subjects with asthma treated with beta 2-receptor agonists should receive special prophylactic attention.

PMID: 2887602 [PubMed - indexed for MEDLINE]

Formation of calcium phosphates in saliva and dental plaque.

J Dent Res. 1976 Nov-Dec;55(6):997-1000

Authors: Tannenbaum PJ, Posner AS, Mandel ID

This is an X-ray diffraction study of the mineral phases in saliva and early dental plaque. The salivas studied came from patients with cystic fibrosis (CF), those with asthma, and heavy and light calculus formers. One-week old plaque was studied from individuals who are heavy, moderate, and light calculus formers.

PMID: 1069783 [PubMed - indexed for MEDLINE]

Vasovagal faint in the supine position.

Br Med J. 1970 Nov 7;4(5731):348

Authors: Verrill PJ, Aellig WH

PMID: 4319613 [PubMed - indexed for MEDLINE]

ANESTHESIA FOR AN ASTHMATIC. (A CASE REPORT).

J Am Dent Soc Anesthesiol. 1965 Mar;12:85-6

Authors: WEINSTEIN IR

PMID: 14284659 [PubMed - OLDMEDLINE for Pre1966]