Geography matters: state-level variation in children's oral health care access and oral health status.

OBJECTIVES: To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences. STUDY DESIGN: Observational study using cross-sectional surveys. METHODS: Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation. RESULTS: Unadjusted rates of no preventive dental care ranged 9.0-26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ∼» of the state variation in no preventive visit and ∼½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation. CONCLUSION: Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health.

MATCH: a maternal and child health information network.

The Maternal and Child Health Information Network--MATCH--was begun in 1984 as a demonstration project with support from the Division of Maternal and Child Health of the Health Resources and Services Administration, Public Health Service. The primary purpose of the project was the development of a system to manage data related to prenatal, child health, family planning, and genetic services that are delivered with State support in clinics in the State of Ohio. The design of MATCH enables the same data base to be used at both the State and local levels. Because it allows all participants, central and district, to manipulate the raw data, it is called an end-user--as opposed to a batch retrieval--system. Data recorded on individual forms during each client's visit to local service clinics are collected and entered into a microcomputer whose software package is a commercial data base. The clinic can then use the data for its purposes: program planning, management, evaluation, client referrals, appointment followup, quality control, and billing. The same data are also uploaded by central office staff to the State's DEC mainframe from data-filled disks mailed in by the clinics. Personnel who staff local projects can access their own data on the mainframe computer to generate reports for local use and send and receive messages electronically. That is, the system is "interactive." The intent is to first link data generated by the primary care and preventive programs of maternal and child health (MCH) in an information system,then link that system to other health data arriving at the State health department (for example, birth and death certificates), and, finally, to use the system as the basis for a State level MCH primary care data system in Ohio for surveillance, planning,management, quality control, accountability,and research purposes.

Dysarthria of adult cerebral palsy: I. Intelligibility and articulatory impairment.

The speech intelligibility and articulatory impairment of 32 spastic and 18 athetoid males, aged 17-55, were examined. Selection was based on a definite diagnosis of cerebral palsy, and adequate intelligence, hearing, and ability to perform the required tasks. Two estimates of speech intelligibility were obtained from naive listeners: single words correctly recognized and prose intelligibility rating. Diadochokinetic (DDK) syllable rates and percent correct articulation of selected phonemes were employed as indices of articulatory impairment. The 50 subjects were, on average, judged to be 50% intelligible on both intelligibility estimates. Group mean DDK rate was 2.9 syllables per second and 78% of phonemes were transcribed as correctly articulated. :The mean scores of the spastic subjects were superior to the athetoids on all speech measures, significantly so for single-word intelligibility and DDK rate even when group inequalities for physical disability and I.Q. were adjusted. In this sample, spastics were less physically disabled and had lower I.Q.'s than athetoids. Specific phonemic features characteristic of the dysarthria in cerebral-palsied subjects were: (1) anterior lingual place inaccuracy; (2) reduced precision of fricative and affricate manners; and (3) inability to achieve the extreme positions in the vowel articulatory space. A comparison of these results with those reported for children with cerebral palsy suggests that the consonantal place and manner problems are fairly stable features of cerebral palsy dysarthria.

Dysarthria of adult cerebral palsy: II. Phonemic analysis of articulation errors.

The articulation errors of 32 spastic and 18 athetoid males, aged 17-55 years, were analyzed using a confusion matrix paradigm. The subjects had a diagnosis of congenital cerebral palsy, and adequate intelligence, hearing, and ability to perform the speech task. Phonetic transcriptions were made of single-word utterances which contained 49 selected phonemes: 22 word-initial consonants, 18 word-final consonants and nine vowels. Errors of substitution, omission and distortion were categorized on confusion matrices such that patterns could be observed. It was found that within-manner errors (place or voicing errors or both) exceeded between-manner errors by a substantial amount, more so on final consonants. The predominant within-manner errors occurred on fricative phonemes for both initial and final positions. Affricate within-manner errors, all of devoicing, were also frequent in final position. The predominant between-manner initial position errors involved liquid-to-glide and affricate-to-stop changes, and for final position, affricate-to-fricative. Phoneme omission occurred three times more frequently on final than on initial consonants. The error data of individual subjects were found to correspond with the identified overall group patterns. Those with markedly reduced speech intelligibility demonstrated the same patterns of error as the overall group. The implications for treatment are discussed.

Cerebellar stimulation in the management of cerebral palsy: clinical and physiological studies.

Cerebellar stimulators were inserted into seven children who had cerebral palsy and in whom extensive investigation, including computerized tomography, had revealed no structural brain abnormality. A team including physiotherapists, occupational therapists, speech pathologists, and respiratory physiologists assessed the children pre- and postoperatively; their somatosensory evoked potentials were also measured. The mean age at implantation was 8.6 yearsl follow-up has ranged from 8 to 23 months (mean, 17.3 months). No adverse effects of the cerebellar stimulation have been noted. Detailed case histories obtained from the parents, together with formal assessment scores, indicate good improvement in six patients and mild but significant improvement in the seventh. Clinically, there has been gradual improvement in all seven patients. The charge density range associated with clinical improvement was 0.8 to 2.1 muCi/cm2/phase. The stimulation equipment must be monitored very carefully to ensure that any variation from the desired output is acceptably small because it is probable that sizable deviation is a determining factor in lack of response to this therapy.

Division of posterior cricoid plate in young children with subglottic stenosis.

Subglottic stenosis was corrected surgically in three young children. The key surgical maneuver is the anterior and posterior division of the cricoid cartilage. Endoscopic, xerographic and speech assessments have been done at intervals since decannulation. The anterior commissure is widened and the endolarynx deformed in two children examined. Radiographic studies indicated that increased airway diameters have been maintained to date. Speech has been adversely affected to some degree in all three patients.