Preventive Dental Care Programs for Children: Parental perceptions and participation barriers.

Purpose: Dental caries is a chronic childhood disease disproportionately affecting children from low socioeconomic backgrounds. Free preventive oral health events sponsored by dental organizations are frequently under enrolled. The purpose of this study was to explore parental perceptions and barriers to participation in preventive dental care programs for their children.Methods: The transtheoretical model and social cognitive theory were used to design this qualitative case study. Open-ended questions were used to interview 20 purposefully sampled participants regarding their perceptions of free preventive dental care programs. Interviews were audio recorded, data were transcribed verbatim, coded, and analyzed thematically until saturation.Results: Two male and 18 female parents ranging in age from 22 to 49 years, with at least one child enrolled in a Title 1 New York City public elementary school, agreed to participate. Nine themes emerged from the data addressing the primary research question on the perceived barriers preventing parents from allowing their children to attend a free preventative dental care program. The themes included too busy, afraid, lack of trust, cultural differences, lack of awareness of the program, cost of care, money, negative childhood experiences and lack of dental insurance.Conclusion: Results from this study demonstrate the need to understand barriers to full enrollment in preventive oral health programs. Particular attention should be given to cultural differences between the program providers and the local residents. Preventative oral health program organizers need to explore multiple communication options to notify parents of upcoming programs.

Automatic office blood pressure measured without doctors or nurses present.

BACKGROUND: We evaluated the agreement between office blood pressure (OBP) measured by a mercury sphygmomanometer (Sphyg) and an automatic (Auto) device without any observers, and compared Auto and Sphyg OBP with ambulatory blood pressure (ABP) and home blood pressure (HBP). METHODS: OBP was measured in 75 hypertensive patients at two sites using an automatic monitor without a doctor or a nurse present and by Sphyg during three clinic visits. Between visits, monitoring of ABP and HBP was also performed. RESULTS: The mean Auto OBP was similar to that of Sphyg OBP and the values were closely correlated (intraclass correlation coefficient=0.84 for systolic OBP and 0.91 for diastolic OBP); however, the difference between Auto and Sphyg systolic OBP (1.6 ± 8.2 mmHg) varied by the first office visit, sex, and the site. Auto systolic OBP was lower than both systolic awake ABP (137.1 ± 14.7 mmHg) and HBP (139.2 ± 15.6 mmHg). Auto systolic OBP and Sphyg OBP were similarly correlated with systolic awake ABP (both r=0.59, P<0.001). The mean Auto diastolic OBP was similar to that of Sphyg OBP (81.1 ± 11.3 vs. 80.3 ± 13.3 mmHg, P=0.20, intraclass correlation coefficient=0.91), and diastolic awake ABP and HBP. Auto diastolic OBP and Sphyg OBP were related to diastolic awake ABP (both r>0.68, P<0.001). In multivariable analyses, neither OBP measure was a significantly stronger predictor of out-of-office blood pressure than the other. CONCLUSION: Auto systolic OBP measured without a doctor or a nurse present was lower than systolic awake ABP and HBP. Auto and rigorously assessed Sphyg OBP had similar means and were similarly related to awake ABP. Auto OBP might be an advantageous alternative to Sphyg measurements in the usual clinic setting.

Computerized self-monitoring and technology-assisted feedback for weight loss with and without an enhanced behavioral component.

OBJECTIVE: The purpose of this study was to develop and evaluate a 12-week weight management intervention involving computerized self-monitoring and technology-assisted feedback with and without an enhanced behavioral component. METHODS: 120 overweight (30.5±2.6kg/m(2)) adults (45.0±10.3 years) were randomized to one of three groups: computerized self-monitoring with Basic feedback (n=45), Enhanced behavioral feedback (n=45), or wait-list control (n=30). Intervention participants used a computer software program to record dietary and physical activity information. Weekly e-mail feedback was based on computer-generated reports, and participants attended monthly measurement visits. RESULTS: The Basic and Enhanced groups experienced significant weight reduction (-2.7±3.3kg and -2.5±3.1kg) in comparison to the Control group (0.3±2.2; p<0.05). Waist circumference and systolic blood pressure also decreased in intervention groups compared to Control (p<0.01). CONCLUSIONS: A program using computerized self-monitoring, technology-assisted feedback, and monthly measurement visits produced significant weight loss after 12 weeks. However, the addition of an enhanced behavioral component did not improve the effectiveness of the program. PRACTICE IMPLICATIONS: This study suggests that healthcare professionals can effectively deliver a weight management intervention using technology-assisted strategies in a format that may complement and reduce face-to-face sessions.

Treating obesity with a novel hand-held device, computer software program, and Internet technology in primary care: the SMART motivational trial.

OBJECTIVE: The purpose of this study was to evaluate the short-term motivational effect of a technology-based weight reduction program for obese adults. METHODS: One hundred and eleven obese (37.0+/-5.8 kg/m(2)) middle aged (45.5+/-10.8 years) adults (62% female) were randomly assigned to a usual care or experimental (SMART: self-monitoring and resting metabolic rate technology) group. The usual care group received a standard nutritional program in accordance to national guidelines. All participants received a comprehensive weight management program consisting of motivational interviewing (MI) sessions and automated e-mail behavioral newsletters. Bodyweight, arterial blood pressure, and psychobehavioral constructs were assessed over 12 weeks. RESULTS: Completer analysis (n=80) indicated a significant improvement in bodyweight (-3.9%), systolic arterial pressure (-4 mmHg), and all motivational constructs following the 12-week study (p

Employing RMR technology in a 90-day weight control program.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of a weight management program using indirect calorimetry to set energy goals. METHODS: 54 overweight, active duty adult employees of the US Air Force (age 18-46 years, BMI 25.2-35.6 kg/m(2)) participated in this quasi-experimental control design study. All participants were enrolled in a four-session US Air Force 'Sensible Weigh' group weight control program. Treatment participants received a personalized nutrition energy goal message developed using measured resting metabolic rate (RMR) from a hand-held indirect calorimeter (MedGem). Usual care participants received a nutritional message using a standard care equation (25 kcal/day x body weight) to set energy intake goals. RESULTS: Treatment participants lost significantly more weight than usual care participants (p < or = 0.05). Difference in weight loss between the treatment and usual care group were -4.3 kg +/- 3.3 vs. -1.8 kg +/- 3.2, respectively. There were no significant differences in reported food intake or energy expenditure between groups. CONCLUSION: The use of indirect calorimetry to assess RMR and set energy intake goals positively influences weight loss success in overweight Air Force personnel.

Systematic review on use of a handheld indirect calorimeter to assess energy needs in adults and children.

With the number of individuals becoming overweight or obese, health care professionals are in need of accurate, reliable, and convenient tools to help personalize weight-loss programs. Recently, a new handheld indirect calorimeter (i.e., MedGem/BodyGem; also know as "Gem") was introduced as a convenient way to assess resting metabolic rate (RMR) to determine daily energy needs. Several validation and comparison studies were conducted to determine whether the Gem device is accurate and reliable, and results from these studies are mixed. Fourteen human studies (12 adult, 2 pediatric) were conducted, and 12 met the established criteria for this review. In all Douglas-bag (DB; n = 4) validation studies, the Gem device was not significantly different than the DB (mean difference adult +/-1%, pediatric +/-1%). The intraclass reliability of the Gem ranged from 0.97 to 0.98, and the interclass reliability to the DB ranged from 0.91 to 0.97. Although few (n = 2) studies have demonstrated that the Gem device measures RMR significantly lower (-8.2% to 15.1%) than traditional metabolic carts, it performs very comparably (RMR values 0.1-4.0%, interclass reliability 0.76-0.92) to traditional metabolic carts in most (n = 6) of the comparison studies. Based on these data, the Gem device is a valid and reliable indirect calorimeter for energy assessment in most adults and children.