Oral Health of Women and Children: Progress, Challenges, and Priorities.

INTRODUCTION: Tooth decay remains the most prevalent chronic disease in children and adults, even though it is largely preventable. Studies show that mothers' oral and overall health is linked to children's oral health and pregnancy outcomes. This paper examines achievements during the last 20 years, assesses current challenges, and discusses future priorities. ORAL HEALTH STATUS: Data show a modest improvement in children's oral health during the last 20 years; however, tooth decay still affects more than half of adolescents. According to national survey data, about 26% of working-age adults had untreated tooth decay. Overall, significant oral health disparities by race/ethnicity and income persist. DENTAL SERVICE UTILIZATION: The annual dental visit rate for children in the 2015 Medical Expenditure Panel Survey was 48%. Among children enrolled in Medicaid, dental visit rates increased from 18% in 1993 to nearly 50% in 2018. About 46% of women are estimated to receive teeth cleaning during pregnancy. Over the years, race or ethnicity and income-level differences in dental visits observed in the early 2000s have narrowed substantially in children but not among pregnant women. DISCUSSION: Many effective interventions are available at the community and individual levels but are underutilized. Lack of integration of oral health into the overall health care system and programs, community conditions, poverty, and limited health literacy make it difficult for families to engage in healthy habits, use preventive interventions, and access treatment promptly. CONCLUSION: To further improve oral health, policy and system reforms are needed to address the factors mentioned above. Therefore, we urge the federal Maternal and Child Health Bureau to take steps to convene a workshop to develop a framework for future actions.

Improving parent oral health literacy in Head Start programs.

OBJECTIVES: Parental low oral health literacy is thought to contribute to child oral health disparities. Few large-scale interventions can improve oral health literacy for diverse, high-risk populations. We sought to determine whether an oral health literacy intervention aimed at parents of children attending Head Start programs improved oral health literacy and behaviors. METHODS: Staff from 29 Head Start agencies across the country were trained to deliver a parent oral health literacy intervention. Parent surveys were conducted at baseline and approximately 6 months later, following intervention completion. Surveys measured parent and child demographics, oral health knowledge, behaviors, information sources, and health care utilization. Paired t tests and mixed-effects regression models controlling for agency, child age, and race/ethnicity evaluated whether measures improved after the intervention. In addition, at follow-up, agency staff were asked to complete an open-ended survey reporting how the intervention impacted their site. Responses were coded using a grounded theory approach. RESULTS: A total of 2,011 (87%) parents completed both the baseline and follow-up surveys. All oral health knowledge and behaviors improved significantly from baseline to follow-up. In addition, parents reported using more oral health information sources, using more preventative oral health care, and less emergency room (ER) use for child dental problems. Head Start staff perceived that the intervention increased parental oral health literacy, enhanced parental oral health engagement, improved child oral health behaviors, and facilitated health communication with parents. CONCLUSIONS: Findings suggest that this intervention successfully improved oral health literacy for diverse parents of children at high risk for dental caries.

Healthy Futures: Engaging the oral health community in childhood obesity prevention - Conference summary and recommendations.

Childhood obesity is a major public health problem. An association between obesity and dental caries, the most prevalent disease of childhood, has been identified. One explanation for the association is that consumption of sugar-sweetened beverages and frequent snacking on carbohydrate-rich foods are common risk factors for development of both obesity and caries. The Robert Wood Johnson Foundation (RWJF) has been at the forefront of national efforts to promote healthy weight in children. As part of these efforts, RWJF sponsored the Healthy Futures: Engaging the Oral Health Community in Childhood Obesity Prevention National Conference, held on November 3-4, 2016, at Georgetown University in Washington, DC. The aim of the conference was to increase awareness of evidence-based recommendations; identify strategies; and promote collaborative efforts that oral health professionals, oral-health-related organizations, and others can employ to prevent childhood obesity. This report summarizes the findings presented at the conference and discusses their implications. The report also reviews recommendations made in the areas of research, education, and policy that resulted from the conference.

Introduction to proceedings of healthy futures: engaging the oral health community in childhood obesity prevention national conference.

OBJECTIVES: The Robert Wood Johnson Foundation (RWJF) has worked to ensure that all children have healthy weights. To promote this goal, the RWJF has supported the Healthy Futures: Engaging the Oral Health Community in Childhood Obesity Prevention National Conference, held on November 3-4, 2016, and the proceeding of this conference. The goals of the conference were to increase understanding of the science focusing on oral health and childhood obesity, increase understanding of how to prevent childhood obesity, and provide opportunities to network and plan activities to prevent childhood obesity. METHODS: The papers prepared for the conference identified through systematic reviews or scoping reviews the state of the science related to preventing childhood obesity and reducing children's consumption of sugar-sweetened beverages and strategies that oral health professionals and organizations can employ prevent childhood obesity. RESULTS: Causes of childhood obesity are multifactorial and include genetic components, environmental and lifestyle variables, and nutritional factors. Dental caries also is caused by a combination of factors, including cariogenic diet, inadequate fluoride exposure, a susceptible host, and the presence of caries-causing bacteria in the oral cavity. One key risk factors for both obesity and caries is excessive sugar consumption. CONCLUSIONS: To reduce the risk of obesity and dental caries in children, health professionals and parents need to be aware of the sugar content of processed foods and beverages as well as of current daily sugar-consumption recommendations. Additionally, oral health professionals must become more engaged in identifying children who are at risk for obesity and dental caries; and provide education, screening and referral to reduce these risks.

Academy of Nutrition and Dietetics: revised 2015 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in pediatric nutrition.

All of the health care professions recognize that care of infants and children is best managed as a specialty area of practice. Nutrition plays a key role in normal growth and development. Appropriate nutrition care is vital adjuvant therapy for infants and children with acute or chronic illness. Provision of nutrition services in pediatric practice requires that registered dietitian nutritionists (RDNs) have advanced knowledge in the focus area of pediatric nutrition. Therefore, the Pediatric Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed this revision of the Standards of Practice and Standards of Professional Performance for RDNs in Pediatric Nutrition as a resource for RDNs working in pediatric nutrition to assess skill level and to identify needs for professional development to advance practice in pediatric nutrition. This revision reflects recent advances in pediatric nutrition and replaces the previous Standards published in 2009. The Standards of Practice represent the four steps of the Nutrition Care Process as applied to the care of patients/clients. The Standards of Professional Performance represent six domains of professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. The Standards of Practice and Standards of Professional Performance are complementary resources for RDNs working in pediatric nutrition and dietetics practice.

Embedded effort scales in the repeatable battery for the assessment of neuropsychological status: do they detect neurocognitive malingering?

The current study examined two embedded response bias measures in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Effort Index (EI) and Effort Scale (ES), in relation to Malingered Neurocognitive Dysfunction criteria. We examined 105 individuals undergoing compensation-seeking disability evaluations. The results suggest the EI adequately differentiates the Probable/Definite Malingering group from the Incentive Only and Possible Malingering groups, while the ES does not, which is most likely representative of the current sample of disability litigants rather than its intended population of patients with amnesia. Classification accuracy statistics suggest that while the EI may not be an appropriate stand-alone measure in detecting neurocognitive malingering, it shows utility as a complementary or screening measure in forensic settings.

Management of child and adolescent obesity: study design and practitioner characteristics.

OBJECTIVE: A study was undertaken to examine the attitudes and practices of health care providers in the assessment and treatment of overweight and obese children and adolescents. This study describes the study design and the practice settings and person characteristics of the practitioners included in this study. METHODS: A needs assessment questionnaire was developed by a working group consisting of researchers, clinicians, educators, and representatives of the Maternal and Child Health Bureau, Health Resources and Services Administration (Department of Health and Human Services), National Center for Education in Maternal and Child Health, International Life Sciences Institute, and Harris Interactive, Inc. The questionnaire consisted of 35 questions divided into 3 topic areas and was disseminated to a sample of pediatricians (n = 1088), pediatric nurse practitioners (n = 879), and registered dietitians (n = 1652). RESULTS: Despite a low response rate (33% for pediatric nurse practitioners, 27% for registered dieticians, and 19% for pediatricians), descriptive data were obtained about a variety of practitioner characteristics. Some significant differences were observed across practitioner groups and between genders in regard to years in practice, body mass index, and dietary and physical activity behaviors. Significant relationships were also observed in some practitioner groups between body mass index and compliance with dietary and physical activity guidelines. CONCLUSIONS: Our data show there is a wide variance in practitioner characteristics, particularly in regard to gender, years of practice, body mass index, and obesity-related behaviors. It is hoped the analyses presented in this and in the subsequent articles will provide useful information on current attitudes and practices and will contribute to improvements in the treatment of overweight children and adolescents.

Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals.

OBJECTIVE: The primary aim of this study was to evaluate among health care professionals their attitudes, perceived barriers, perceived skill level, and training needs in the management of child and adolescent obesity. METHODS: A national needs assessment consisting of a mailed questionnaire was conducted among a random sample of health care professionals. The survey was completed by 202 pediatricians, 293 pediatric nurse practitioners, and 444 registered dietitians. RESULTS: The majority of all respondents felt that childhood obesity was a condition that needs treatment (75%-93%), and affects chronic disease risk (76%-89%) and future quality of life (83%-93%). The most frequent barriers were lack of parent involvement, lack of patient motivation, and lack of support services. Registered dietitians were less likely to identify barriers to treatment compared with pediatricians or pediatric nurse practitioners. The most common areas of self-perceived low proficiency were in the use of behavioral management strategies, guidance in parenting techniques, and addressing family conflicts. All 3 groups expressed high interest in additional training on obesity management of children and adolescents, especially in the area of behavioral management strategies and parenting techniques. Those practitioners with >10 years of practice reported the greatest interest in training. CONCLUSIONS: Pediatric practitioners view child and adolescent obesity with concern and feel that intervention is important. However, several important barriers interfere with treatment efforts and will need to be addressed. There is also a need for increased training opportunities related to obesity prevention and treatment. The results of this study provide directions and priorities for training, education, and advocacy efforts.