OBJECTIVE: The purpose of this dissertation is to examine the oral health, caregivers’ perception of oral health, and dental services utilization among children with learning disabilities (LD). METHODS: We used the National Health And Nutrition Examination Survey 1999-2004 data to investigate the oral health and caregivers’ perception of oral health among children with LD alone, ADHD alone, and LD with ADHD. We used the National Survey of Children’s Health 2011-2012 data to examine dental services utilization and unmet dental needs among children with LD alone, non-LD CSHCN, and LD CSHCN. RESULTS: Children with LD alone have greater likelihood of having dental caries in permanent dentition compared to non-LD, non-ADHD children (OR: 1.6, 95% CI: 1.1-2.2), while the likelihood of dental caries in permanent dentition among children with combined LD and ADHD is much greater (OR: 1.9, 95%CI: 1.3-2.7). Caregivers of children with LD, ADHD, and LD with ADHD perceived their oral health to be poorer when compared to non-LD, non-ADHD (OR: 1.8, 95% CI: 1.2-2.8, OR: 1.9, 95% CI: 1.1-3.0, OR: 2.0, 95% CI: 1.3-3.1, respectively). The accuracy of caregivers’ assessments of their children’s oral health was lower among those with LD, ADHD, and LD with ADHD children. Children with ADHD alone had the least accurate caregivers’ perception (OR: 0.5, 95% CI: 0.3-0.8). Children with LD alone were less likely to have a dental visit within the past year, whether for preventive visit (OR: 0.6, 95% CI: 0.5- 0.9) or any other dental visits (OR: 0.7, 95% CI: 0.5- 0.9). While LD severity did not impact dental visit receipt, children with moderate to severe LD have higher unmet dental needs than non-LD and mild-LD (OR: 1.8, 95% CI: 1.3- 2.5). CONCLUSION: Children with learning disabilities have significant oral health needs and are at a greater risk for dental disease. Despite that, children with LD are less likely to utilize preventive and other dental services. Future interventions need to target this vulnerable population to improve their oral health and reduce these disparities.

The US criminal justice system holds more than 2.3 million people, with approximately 641,000 being released back into the community each year (Carson & Anderson, 2016). One in five of those incarcerated in 2015 were convicted of a drug related offense (Carson & Anderson, 2016). With a specific focus on how the formerly incarcerated with substance use disorders reenter the community from prison, this dissertation examines the role of postincarceration policy, as well as other factors, that impact the use of physical, mental, and substance use services in the community post release. Study 1 is a critical policy analysis, arguing that in addition to postincarceration policies being punitive, they result in significant social, financial, educational, housing, and health care barriers to reentry and reintegration of prisoners into their communities as productive citizens. This article describes the types of postincarceration policies in place in the US currently and provides implications for future postincarceration policy development, program implementation, and research. Study 2 is a qualitative pilot study, presenting descriptive results from in-person semi-structured interviews with reentry clients (n=10) and reentry staff (n=10). Both clients and reentry staff view client’s mental health needs as priority at reentry. For clients, enabling factors included remaining abstinent from drugs or alcohol, informal support from family and friends, as well as professional support from agencies and barriers included long wait times for services, issues with their insurance coverage, stigma related to their drug use and time spent incarcerated. Staff, meanwhile, described systems level factors as facilitating or enabling, such as postincarceration policies limiting those with incarceration histories in accessing basic necessities and health services. Study 3 aims to expand on the Study 2 pilot with a larger, in-person interview study featuring 100 clients. Results also show high levels of chronic medical problems, clinical PTSD diagnoses, experiences of both physical and sexual abuse, and injection drug use. Additionally, signaling need for mental health service, less substance use related issues in the past 30 days, and being male all predicted service need.

This paper explains the increased use of hospital-based emergency facilities for primary care. The analysis identifies socio-demographic characteristics, individual resources and selected access variables which influence use of physician services or emergency rooms. The selection of variables is based on a model of facility use which has been derived from the literature on medical care. The results from the analysis concluded that socio-demographic characteristics are both directly and indirectly related to facility use, but there is no apparent association between health insurance as an individual resource and access variables, and use of health care services. Suggestions of further research ar:e proposed based upon a theoretical model of health care choice behavior. / Master of Urban Affairs

No description available.

The study focused on the attitudes and beliefs regarding perceived and actual burden experienced by Latino caregivers and their use of formal support services. It also looked at the needs of Latino caregivers and explored their beliefs about why they had taken on the caregiver role, the responsibilities the role entailed, and coping skills used by these caregivers. Participants were obtained from two Alzheimer's caregiver support groups in the East Los Angeles area, and an adult day health care center in the high desert area of San Bernardino county. The author used both qualitative interviews and quantitative questionnaires. The findings suggest that high beliefs about responsibility to the family and low levels of service use may contribute to the stress and strain that these caregivers feel. Latino caregivers have been providing a significant amount of care without the help of sufficient formal services. Recommendations for social work practice, policy and further research are provided. Statistics for the study were generated by using SPSS Graduate Pack 13 for Windows.

Contexto: O diagnóstico de saúde de comunidades é fundamental para que os serviços de saúde possam ser implementados de acordo com as necessidades das mesmas, além de auxiliar sobremaneira no monitoramento e no planejamento de novas intervenções. No Brasil, poucos são os serviços que realizam diagnósticos de saúde antes de sua implementação, sendo que na maioria das vezes o monitoramento e a reorganização dos serviços são feitos somente através de diagnósticos de demanda. Objetivos: Descrever a metodologia empregada em um Diagnóstico de Saúde realizado em uma comunidade vulnerável e avaliar as necessidades em saúde dessa comunidade através do uso de serviços, bem como seus fatores associados. Métodos: Foi realizado um estudo transversal de base populacional cuja amostra foi constituída por indivíduos adultos com 20 anos ou mais, moradores dos Distritos Sanitários da Restinga e Extremo Sul da cidade de Porto Alegre–RS. A amostragem foi do tipo sistemática com probabilidade proporcional ao tamanho do setor censitário. Inicialmente, foi contado o número de domicílios habitados existentes na região e, a partir de então, foram amostrados os 1.750 domicílios que constituíram a amostra. A coleta de dados foi realizada no período de junho a dezembro de 2009 através da aplicação de questionários por entrevistadores submetidos a treinamento de 80 horas. Os dados foram digitalizados no software Office Remark e analisados no programa Stata. Resultados: Do total dos 3.699 adultos elegíveis, encontrados nos 1.750 domicílios amostrados, 3.391 aceitaram participar do estudo. A prevalência de internação hospitalar no último ano foi de 11,1% (IC95% 10,1; 12,2). Destas, 24,5% (IC95% 20,1; 28,9) foram internações por condições sensíveis à atenção primária à saúde (CSAPS) Na análise ajustada permaneceram significativas as associações de internação hospitalar com o aumento da idade (p<0,001), ser viúvo (p=0,04), possuir IMC maior do que 30 (p=0,01), ter autopercepção de saúde regular ou ruim/muito ruim (p<0,001), possuir morbidades crônicas (p=0,003), ter consultado nos três meses que precederam a entrevista (p=0,003) e consultar em ambulatórios públicos de atenção secundária (p=0,002). A prevalência de consulta médica no último ano e nos últimos três meses foi de 76,2% (IC95% 74,8; 77,6) e 64,8% (IC95% 63,0; 66,7), respectivamente. Entre os homens, a prevalência de consulta nos últimos três meses foi de 60,2% (IC95% 57,1; 63,2) e entre as mulheres esse valor foi de 67,8% (IC95% 65,5; 70,1) (p<0,001). Na análise ajustada, entre os homens, ter consultado nos últimos três meses associou-se de forma positiva com o aumento da idade, ter autopercepção de saúde ruim/muito ruim, possuir médico de referência e morbidades crônicas, consultar em locais conveniados e ter sido hospitalizado no último ano. Na análise ajustada, entre as mulheres, evidenciouse associação de consulta com o aumento da idade, ser de cor da pele branca, autoperceber a saúde como regular, pertencer às classes sociais A/B, possuir menor escolaridade, médico de referência e morbidades crônicas, consultar em locais conveniados ou ambulatórios e ter internado no último ano. Conclusões: A descrição da metodologia empregada no Diagnóstico de Saúde poderá servir de ferramenta para o planejamento de redes de serviços de saúde coordenadas pela Atenção Primária de acordo as necessidades locais, tanto em outras regiões do Brasil quanto em outros países em desenvolvimento. Os resultados relacionados à utilização dos serviços de saúde — consultas e internações — permitirão o planejamento de uma rede integrada de serviços focada nos principais preditores de consumo de serviços. / Background: The community health diagnosis is essential so that health services can be implemented according to the needs of the community, and also it can greatly help on monitoring and planning new interventions. In Brazil, there are few services that perform community health diagnosis before its implementation, and most of the time the monitoring and the reorganization of services are made only through demand diagnostics. Objectives: To describe the methodology employed in a health diagnosis performed in a vulnerable community and assess the health needs of this community through the use of services as well as the associated factors. Methods: We conducted a cross-sectional population-based study with a sample of adults aged 20 years or more living in two health districts, Restinga and Extremo Sul, of Porto Alegre. The sampling was systematic with probability proportional to size of census tracts. Initially, we counted the number of dwellings in the region and then we sampled 1.750 households. Data collection was carried out between June and December 2009. Questionnaires were applied by interviewers who underwent training for 80 hours. The data were scanned in the Office Remark software and analyzed using Stata program. Results: Out of 3.699 eligible adults, found in 1.750 households, 3.391 accepted to participate of the study. The prevalence of hospitalizations in the previous year was 11.1% (95% CI 10.1, 12.2), out of these 24.5% (95% CI 20.1, 28.9) were hospitalizations for Ambulatory Care Sensitive Conditions (ACSC). In the adjusted analysis remained significant associations of hospitalization with increasing age (p <0.001), being widowed (p = 0.04), having a BMI greater than 30 (p = 0.01), having regular health perception or poor / very poor (p <0.001), have chronic morbidities (p = 14 0.003) having consulted the 3 months preceding the interview (p = 0.003) and consult in clinics (p = 0.002). The prevalence of medical consultation in the last year and the last three months was 76.2% (95% CI 74.8, 77.6) and 64.8% (95% CI 63.0, 66.7), respectively. Among men the prevalence of consultations in the last three months was 60.2% (95% CI 57.1, 63.2) and among women this figure was 67.8% (95% CI 65.5, 70.1 ) (p <0.001). In the adjusted analysis, among men, have consulted over the past 3 months was associated positively with increasing age, having self-perception of health as bad / very bad, have medical reference and chronic morbidities, consult local plan systems and have been hospitalized in the last year. In the adjusted analysis, among women, have consulted over the past three months was associated with increasing age, being of white skin color, self perceive health as fair, belonging to social classes A/B, have less education, medical reference and chronic morbidities, consult with local clinics and have agreed or admitted last year. Conclusions: The description of the methodology employed in this Health Diagnosis may serve as a tool for network planning of health services coordinated by the Primary Health Care and according to local needs, even in other regions of Brazil and others developing countries. The results related to the use of health services - consultations and hospitalizations - allow the planning of an integrated network of services focused on the main predictors of service consumption.

Background / Objective: Children under the age of 5 years bear a disproportionate burden of oral disease. The aim of this study is to investigate how child, family, and community determinants impact dental care utilization, and parental report of child’s oral health. Methods: Data for this study came from the 2011/2012 National Survey of Children’s Health for children aged 1 to 5 years old. Dependent variables evaluated were if the child had an oral health problem, been to a dentist in the past year, and parents description of the child’s teeth. Independent variables were selected from child, family, and community levels. Binary logistic methods were applied to each outcome and predictor variable. Stepwise logistic regression models were constructed for child, family, and community variables. Additionally the mediating effect of oral health services utilization in the association between child, family and community factors and parental perception of child’s oral health was evaluated. National results and Health Resource Service Area (HRSA) region IV results were compared. Results: In the national (n=24,875) and HRSA region IV sample (n=4,017) 9.7% and 10.2% of caregivers, reported that the child had an oral health problem in the past 12 months. Fewer than half (46.7%) of caregivers reported that their child had visited a dentist in the past 12 months. Absence of neighborhood cohesion, neighborhood amenities, and residence in metropolitan statistical area all had positive significant effects on children seeing a dentist. There was a mediating effect by utilization of oral health services between child with special health care needs (p=0.005), number of children (p=0.045) and adults (p=0.046) in the household, and tobacco use (p=0.018) and parents perception of oral health in the HRSA region IV population. Conclusion: This study identified several factors as correlates of poor oral health outcomes. Our results expand our knowledge of early childhood oral health by studying how oral health is impacted not only by child factors but also the family and community at large. Our results begin identifying the unique constellation of risk factors that contribute to early childhood oral health.

We assessed how estimates of need-expected inpatient hospital use differ depending on whether need-expected use was estimated for a population of all Canadians, Canadian health regions, or a subpopulation of higher income Canadians, who likely had minimal healthcare access problems. Data came from the 2009/2010 Canadian Community Health Survey, a national cross-sectional survey. Using zero-inflated negative binomial regression, we modeled inpatient hospital use separately based on the three aforementioned choices of population. We adjusted for demographic, health behaviour, health status, socioeconomic, and health care supply factors. We then estimated need-expected inpatient hospital use and compared the estimates across individuals and by income and province. The three choices of population that we used in this study had similar results. Our estimates of the average need-expected use by province or income group were not sensitive to the choice of population used to estimate need-expected use.

To compare health care use from neonatal discharge to 18 months corrected age of two groups of extremely preterm children (&lt; 26 vs. 26-29 weeks of gestation), we used a province-wide database containing neonatal and follow-up data on 254 infants (77% of survivors) born at &lt; 29 weeks of gestation and cared for at 3/6 neonatal units in Quebec in 2003-2004. Neonatal data were abstracted from medical records by trained personnel. At 18 months corrected age, neurodevelopmental status was assessed by psychologists and paediatricians. Data on health care use were collected from charts and parent interviews. Descriptive statistics are provided and logistic regression analysis was carried out to evaluate perinatal and social determinants of re-hospitalization and frequent use of health services resources. Results show that 57% of infants born at &lt; 26 weeks (n=49) and 49% of those born at 26-29 weeks (n=205) were re-hospitalized, mostly for respiratory illness. Both groups used a significant amount of health resources: 61% vs. 59%, respectively, received physical or occupational therapy, 29% vs. 17%, respectively, required long-term rehabilitation, 38% vs. 28%, respectively, used prescribed medication, and 59% vs. 33%, respectively, required home medical equipment (home oxygen, apnea monitors, orthopaedic devices and visual aids). Risk of re-hospitalization was associated with severe brain injury, use of an apnea monitor, and older age at neonatal discharge. Multiple birth, severe brain injury, suspected neonatal sepsis, and single-parent household were independently associated with the risk of using health care services above average. These results highlight the importance of resource allocation to preterm infants for medical and rehabilitation services after discharge from the neonatal intensive care unit.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.