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PubMed2005

Preparing dental graduates to provide care to individuals with special needs.

In 2004, the Commission on Dental Accreditation (CODA) adopted a new standard that directs dental and dental hygiene programs to prepare dental professionals for the care of persons with special health care needs. This article reviews the demographics of individuals with special needs, documents that most dental schools provide their students with very limited educational opportunities related to the care of this population, describes the path that was followed to bring about change in the accrediting standard, and discusses the difficulties involved in developing the needed educational programs. Educational programs at two dental schools are presented as examples of how schools can provide students with learning experiences pertinent to the new CODA standard that states: "Graduates must be competent in assessing the treatment needs of patients with special needs."

Accreditation↗
PubMed2005

Health status and access to care for children with special health care needs.

BACKGROUND: About 11-14% of children with special health care needs (CSHCN) have unmet needs during a given year. Little is known about the determinants of unmet health care needs for CSHCN. AIMS OF THE STUDY: The objective of this study was to explore the association between access to care (unmet needs) among CSHCN and their caregivers' mental health status as well as children's mental health status. METHODS: We surveyed a random sample of 1,088 caregivers of CSHCN who resided in the District of Columbia during the summer and fall of 2002. In the survey, we collected information on children's unmet needs mental health status (PARS) and their caregivers' mental health status (CES-D). We estimated the association between mental health status determinants of unmet needs adjusting for selection bias associated with plan choice (partially capitated managed care versus FFS) with an instrumental variables probit estimation technique. We used caregivers' preferences about physicians and hospitals networks, and whether the caregiver and child had the same last name to identify the plan choice equation. RESULTS: We found that caregivers with symptoms of depression were 26.3% more likely to report any unmet need, 67.6% more likely to report unmet hospital and physician need, 66.1% more likely to report unmet mental health care need and 38.8% more likely to report unmet need for other health care services. Caregivers of children with poor psychological adjustment were 26.3% more likely to report their child had an unmet need and 92.3% more likely to report an unmet mental health care need. DISCUSSION: Our analyses show that children whose caregivers experience symptoms of depression are significantly more likely to encounter difficulties obtaining needed medical and mental health care services. Furthermore, the findings reported here indicate that children with poor psychological adjustment are significantly more likely to experience unmet needs for medical and mental health care services. Our study has some limitations. First, most of the children in our sample are African-American, so these findings may differ for children of other races. Second, these findings may not be applicable to CSHCN who reside in rural areas. Third, we recognize the possibility that child and caregiver mental health is potentially endogenous. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The mental health status of CSHCN and their caregivers are barriers to care. IMPLICATIONS FOR HEALTH POLICIES: Policymakers should be concerned about the mental health status of children with special health care needs and their caregivers as such problems appear to be barriers to obtaining care. Therefore, to adequately address the access problems of children with special health care needs, policy must address the mental health problems of children and their caregivers. Providing mental health care for caregivers and children has the potential for improving overall access for CSHCN. IMPLICATION FOR FURTHER RESEARCH: Future research should determine the causal relationship between mental health problems of CSHCN and their caregivers and the level unmet health care needs.

Adolescent↗
PubMed2005

[The etiological study, diagnose and therapy of hand special chronic infections in littoral area].

OBJECTIVE: To explore the etiological factors of hand special chronic infections and their relationship with tuberculosis, and to give evidence for clinical diagnosis as well as treatments. METHODS: From 2002 to 2004 pathologic inspection, acid-fast stain, bacterial cultication, mycobacterial cultivation were performed in all 29 cases of hand special chronic infections. RESULTS: All cases showed granulomatous lesions in pathological appearance, 2 positive in acid-fast stain, 12 positive in bacteria cultivation, and 1 nocardiosis, 1 staphylococcus epidermidis, 7 M.marinum, 1 M.tuberculosis, 1 M.fortuitum, 1 M.kansasii. CONCLUSIONS: Non-tuberculo-mycobacterium (NTM) especially M.marinum are far more important as the major factor than tuberculosis and other bacterial in hand special chronic infections. Bacteria cultivation should be routine examined for all cases.

Adult↗
PubMed2005

Sweetened medicines and hospitalization: caries risk factors in children with and without special needs.

AIM: This was to evaluate caries risk factors: medicine consumption level, oral hygiene frequency and oral hygiene habits during hospitalization of children with and without special needs. METHODS: A cross-sectional study was carried out using a pre-tested form, interviews were conducted with guardians of children with (G1-116) and without special needs (G2-86), from a public day nursery in Rio de Janeiro (Brazil). RESULTS: Average use of medications was at 21.8 months for G1--24.5 and G2--7.2 (Mann-Whitney: p-value = 0.0009). In the total sample, medicines were taken usually at night; 8.4% of parents sweetened them before ingestion and the majority of children did not brush their teeth after taking medicines. More than half (61.9%) had been hospitalized with an average duration of 21.8 days; 83 (66.4%) had had few hospitalizations; G1--62.8% and G2--77.4%. Some 81.6% of the sample reported no tooth brushing while in hospital. STATISTICS: The data were entered in the EPI INFO 6.04d program, and the tests used were Fisher Exact, Mann-Whitney, Kruskal-Wallis and Chi-square with a 5% significance level. CONCLUSIONS: Poor oral hygiene habits when taking medicines and during hospitalizations were observed, mainly among children with special needs.

Administration, Oral↗
PubMed2006

[Specialized gene expression and regulation in the epididymis].

The epididymis is a single and highly convoluted tubule system in mammals. The epithelium is the major compartment for epididymal function. Proteins synthesized and secreted by epididymal epithelium provide a special and ever-changing luminal fluid environment for sperm as they progress through the epididymis, which makes sperm achieve motility and ultimately results in sperm functional maturation. Specialized genes expressed in the epididymis have regional-specific characteristics. They are regulated by androgen and/or testicular factors and present spatial and tempel-specialized expression pattern in postnatal development, all these hint that they play important and unique roles in epididymis.

Animals↗
PubMed2006

[Specialized care program for end-stage heart failure patients. Initial experience in a heart failure unit].

INTRODUCTION AND OBJECTIVES: End-stage heart failure is associated with very high morbidity and mortality. Palliative care has been little studied in affected patients. PATIENTS AND METHOD: Between January 1998 and December 2004, 61 patients with end-stage heart failure participated in a specialized advanced heart failure care program. The program included patient education on advanced heart failure, with day-care and home-care elements, and involved intravenous drug administration when necessary. RESULTS: The mean age of the study population was 64 (13) years (range 32-87 years), with 92% being male. Their mean ejection fraction was 23 (6%), mean systolic blood pressure 100 (16) mm Hg, mean blood sodium level 137 (4) mEq, mean creatinine level 1.7 (0.8) mg/dL, and mean hemoglobin level 12 (2) mg/dL. The number of hospitalizations, number of days in hospital per admission, and number of emergency room visits in the year before inclusion in the specialized heart failure care program were 5.7 (0.5), 53 (5), and 8.3 (1.1), respectively. After inclusion, these figures decreased significantly to 1.9 (0.2) (P=.0001), 19 (3) (P=.0001), and 1.2 (0.2) (P=.0001), respectively. During a mean follow-up period of 11 (10) months, 28 patients died (47%) and 23 (38%) underwent heart transplantation. In addition, use of the program led to a reduction in healthcare costs. CONCLUSIONS: Although mortality in end-stage heart failure patients remained very high, use of a specialized advanced heart failure care program decreased the number of hospitalizations, days per hospitalization, and emergency room visits, and reduced the cost of care.

Adult↗
PubMed2005

Effect of diabetes drug counseling by pharmacist, diabetic disease booklet and special medication containers on glycemic control of type 2 diabetes mellitus: a randomized controlled trial.

BACKGROUND: type 2 diabetes mellitus continues to increase in prevalence worldwide. Many factors have been cited as contributing to compliance, such as family and social support, education, number of tablets per dose, frequency of administration and health care provider communication. Toward these goals, the present study was developed to measure the effect offactors on glycemic control such as diabetes education by pharmacists, a diabetes disease booklet and special medication containers. MATERIAL AND METHOD: A total of 360 volunteers with type 2 DM patients were recruited, participants were simple randomized to control 180 and intervention 180 patients. Which intervention categorized to 4 groups; all intervention groups received diabetes drug counseling by a pharmacist, one group received plus a diabetes booklet, one received plus special medical containers and the last group received all of them. The interventions were done at the 1st time of visit. Both the control and intervention groups were monitored for fasting plasma glucose and HbA1c at 0, 3, 6 months and glycemic level in both groups was compared. RESULTS: After 3 months, mean fasting plasma glucose and HbA1c decreased wiih the intervention group vs. control group (152.36 +/- 39.73 to 131.52 +/- 35.22 mg%) and (150.16 +/- 41.78 to 153.98 +/- 47.95 mg%) respectively; (p < 0.001). HbA1c level 8.16 +/- 1.44 to 7.72 +/- 1.26 vs 8.01 +/- 1.51 to 8.38 +/- 1.46 respectively; (p < 0.001). After 6 months, mean fasting plasma glucose and HbA1c decreased with the intervention group vs. control group (152.36 +/- 39.73 to 145.20 +/- 46.07 mg%) and (150.16 +/- 41.78 to 159.16 +/- 54.90 mg%) respectively; (p < 0.013). HbA1c level 8.16 +/- 1.44 to 7.91 +/- 1.27 vs. 8.01 +/- 1.51 to 8.80 +/- 1.36 respectively; (p < 0.001). The most favorable glycemic outcome was the group that received all of the interventions; mean FPG was reduced from 147.46 +/- 36.07 to 125.38 +/- 31.12 mg% (p < 0.000) in 1nd visit (3 months later) and still reducing effect on the 2nd visit (6 month later) mean FPG from 147.46 +/- 36.07 to 130.21 +/- 33.96 mg% (p < 0.016) also the same way in HbA 1c level. The group that received only drug counseling by pharmacist had no significant reduction in FPG and HbA1c. (p > 0.05). CONCLUSION: Drug counseling by a pharmacist has little beneficial effect on diabetes management outcome compared to the diabetes booklet and special drug container. To improve glycemic control of type 2 DM is to integrate self-management in daily life, wide a variety of education, drug taken behavior and health care provider available communication produce improvement in patient management and is somewhat better when used in combination.

Adult↗
PubMed2006

Prevalence of children with special health care needs in Milwaukee, Wisconsin: data from the Milwaukee metropolitan statistical area.

BACKGROUND: The Milwaukee Health Department and the Wisconsin Southeast Regional Center for Children with Special Health Care Needs (CSHCN) were interested in understanding the level of need and prevalence of CSHCN in the city of Milwaukee. It was determined that a survey of the Milwaukee area was needed to obtain a prevalence estimate. METHODS: A survey to identify children with special health care needs in the Milwaukee metropolitan statistical area (MSA) was conducted using the CSHCN Screener. The survey was administered as part of the Greater Milwaukee Survey in October and November of 2004. Results from this survey were compared to state and national data from the National Survey of Children with Special Health Care Needs, 2001. RESULTS: The prevalence of CSHCN in Milwaukee (23.5%) was found to be almost double that of the surrounding Milwaukee MSA counties (12.1%), the state (13.4%), and the nation (12.8%). The number and type of positive screener questions were not significantly different among the geographic areas. CONCLUSIONS: The prevalence of CSHCN has been consistently associated with poverty in numerous other studies. The survey conducted in Milwaukee MSA indicated increased prevalence in Milwaukee among poor and African American children. Improvement and augmentation of services available to urban poor is necessary to alleviate this excessive burden.

Adolescent↗
PubMedDate not supplied

Medical homes for children with special healthcare needs in North Carolina.

BACKGROUND: The American Academy of Pediatrics defines a medical home as medical care for children that is accessible, continuous, comprehensive, family-centered, coordinated, and compassionate. North Carolina uses the medical home concept as a model for providing high quality care to children with special healthcare needs (CSHCN). However, until recently, information on medical homes for CSHCN in North Carolina has not been available. METHODS: Using North Carolina data from the National Survey of Children with Special Health Care Needs (2000-2002), we describe the characteristics of children having a special healthcare need. We conducted bivariate analysis of socio-demographic factors with medical home and its five components (family-centered care, effective care coordination, personal doctor or nurse, usual source of care, and referrals for specialty care) and multivariate analysis to identify the predictors of having a medical home. RESULTS: Fifty-six percent of CSHCN in North Carolina have a medical home. White CSHCN are 1.7 times more likely to have a medical home compared to non-white CSHCN. CSHCN with no functional limitations are 1.6 times more likely to have a medical home compared to children with some or severe limitations of their functional status. CONCLUSIONS: Current, population-based information about CSHCN and their families is essential for assessing needs and evaluating pediatric initiatives at the state level. Disparities among CSHCN due to race and functional status should be considered in organizing services for CSHCN in North Carolina.

Child↗
PubMedDate not supplied

Admission criteria for a special care unit for residents with dementia.

The recent trend in caregiving for cognitively impaired residents has been to provide special care units. One of the questions in establishing a special unit is deciding on admission criteria. What range of impairment will benefit the most from this type of environment? This paper reports on how one facility developed specific assessment criteria for admission to a special unit. The goals were to identify potential residents for the unit, reduce subjectivity in the assessment process and be able to screen both residents and community applicants. Results of the screening instrument demonstrated that it was effective in identifying a range of impairments, it screened out the cognitively well and long standing psychiatric disorders, and also demonstrated that a pre-set bias did exist as to who should be admitted.

Aged↗
PubMed1991

Understanding the child with special health care needs: a developmental perspective.

Children with special health care needs and their families are becoming a greater part of pediatric nursing practice, and often present with major health and psychosocial needs that interfere with their ability to function. Optimal intervention with these children requires an understanding of their chronic conditions as well as their unique developmental needs. This paper reviews the characteristics of children with special health care needs and introduces some of the most salient theories of child development in order to provide a perspective from which to view this population. A case example that illustrates some of the features discussed is presented. Because a knowledge of theories of child development can improve the care provided to children with special health care needs, it should be included as part of nursing curricula.

Child Development↗
PubMed1991

Early onset duodenal ulcer with special reference to serum alpha-1-antitrypsin activity.

Thirteen patients of duodenal ulcer, below 20 years of age, ten age and sex matched controls and 17 first probands were studied to find out (i) the special characteristics of this duodenal ulcer subtype and (ii) the serum alpha-1-antitrypsin (alpha-1-AT) activity in these patients and their first probands. Basal and maximal acid output, and serum level of alpha-1-AT were measured, and serum agar gel electrophoresis done, in the above subjects. Special characteristics like positive family history, and high basal (p less than or equal to 0.01) and maximal (p less than or equal to 0.001) acid output were noted in these patients. Serum alpha-1-AT was found to be deficient in nine patients. Five first probands also had the heterozygous level of the enzyme deficiency. Thus, patients of early onset duodenal ulcer seem to have special characteristics with alpha-1-antitrypsin deficiency in them as well as in their first probands.

Adolescent↗
PubMed1990

Should neonates with specific "risk factors" be admitted to the special care nursery?

Existing criteria for admission of newborns to the special care nursery, Sarawak General Hospital, resulted in the admission of many neonates with certain risk factors ("at risk" neonates). To test whether such babies could be safely and better cared for in postnatal wards, 392 of these babies were randomly allocated into two groups. One group of 196 was admitted to the special care nursery and the other group of 196 was cared for with their mothers in the postnatal wards. The two groups were compared for mortality, morbidity and breastfeeding. There was no significant difference in mortality and morbidity between the two groups. While in hospital a larger proportion of babies cared for in postnatal wards were breastfed, compared to babies admitted to the special care nursery. In addition, they initiated their breastfeeding earlier. Babies with these risk factors should therefore be cared for with their mothers in the postnatal wards.

Breast Feeding↗
PubMed1990

Epidemiology of HIV infections. Design options with special reference to developing countries.

Health research and planning need valid data for decision making. In a developing country cost-effectiveness in research design is of special significance. In such situations, population-based data are needed. This paper reviews the literature on HIV/AIDS studies published during 1982-88 with respect to epidemiological methods and study designs and with special relevance to developing countries. A methodological taxonomy is presented based on this review illustrating the special need for analytic epidemiology. The paper also presents experiences and results from an ongoing collaborative project on HIV infections between Tanzanian and Swedish researchers. The project, which was launched in 1987 in the Kagera region where the first AIDS cases were seen in 1983, applies both epidemiological and behavioural methods.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Special needs of the young spinal cord injured patient in a nursing home.

Discharge plans for some spinal cord individuals may include nursing home placement. Since many spinal cord injured patients are young males, what special needs are expressed by this patient population? To determine specific concerns from a patient's perspective, structured interviews were conducted with 15 spinal cord injured patients under 35 years of age. Special needs were organized into six major categories: physical locations, staff interactions, nutrition, physical therapy, social activities, and sexuality. The purpose of this article is to describe the special needs identified by spinal cord injured patients in each of these areas. Although nursing home placement is rarely the first choice in discharge plans for a young spinal cord injured patient, staff need to be aware of criteria for helping patients make the best possible choice.

Female↗
PubMed1990

A plan for special interest divisions and study sections.

The establishment of special interest divisions and study sections within the American Speech-Language-Hearing Association was initiated with the approval of LC 21-88 by the Legislative Council. Plans for the initial stages for implementation were developed by the Ad Hoc Committee to Implement Special Interest Divisions: Barbara B. Shadden (chair), Larry E. Dalzell, Judith S. Gravel, Nancy P. Huffman, Sandra R. Ulrich, Peggy S. Williams (ex officio), Lynette R. Goldberg (ex officio), under the guidance of Robert L. Douglass, vice president for planning. More detailed guidelines are currently being developed that will lead to full implementation, beginning this year. Special interest divisions and study sections are being developed in accordance with the full plan approved by the Legislative Council.

Audiology↗
PubMed1989

The histopathologic diagnosis of head and neck tumors by special stains.

Various histochemical and immunocytochemical stains were useful in the diagnosis of six unusual head and neck neoplasms that included spindle-cell squamous carcinoma, synovial sarcoma, mucoepidermoid carcinoma, melanoma, T-cell lymphoma, and B-cell lymphoma. Close cooperation with a pathologist ensured rapid diagnosis and the initiation of appropriate therapy. Three cases required special histochemical stains to make a diagnosis or determined tumor differentiation. The three other cases would have been identified as poorly-differentiated tumors of unknown origin without the use of special immunocytochemical stains. These latter findings influenced our final therapeutic strategy, which emphasizes the uses of special stains and studies to accurately identify tumors of the head and neck.

Adolescent↗
PubMedDate not supplied

Meeting minority health needs through special MCH projects.

The maternal and child health programs of the Public Health Service have always been directed to minority populations; however, the recent surges of immigrants from Asian and Central American countries have caused the agency to appraise its efforts to meet the special health needs of these people. Through grants for special projects of regional and national significance (SPRANS), the Office of Maternal and Child Health is funding projects to break down language, culture, and access barriers to health services for pregnant women, infants, and children. Recent and current SPRANS projects have taken innovative approaches to solving the special health problems of the minority populations. They range from a breastfeeding initiative in the Commonwealth of the Northern Mariana Islands to an areawide genetic service program in the Virgin Islands. Examples of projects that have been conducted are presented.

Asia↗