Knowledge and use of fluoride among Indiana dental professionals.

OBJECTIVES: This study assessed the knowledge of Indiana dentists and dental hygienists about fluoride's predominant mode of action and their protocols for the use of fluoride for dental caries prevention. METHODS: In 2000, questionnaires were mailed to 6,681 Indiana dentists and hygienists prior to the 2001 release of recommendations for the use of fluoride by the US Centers for Disease Control and Prevention. In 2005, the questionnaires were again sent to Indiana dental professionals to assess changes in knowledge and protocols. In addition, a 10 percent sample of Illinois dentists and hygienists were surveyed to determine the similarity of Indiana and Illinois responses. RESULTS: Questionnaires were anonymously completed and returned. In 2000, a minority of Indiana health professionals (17 percent) correctly identified that remineralization was fluoride's predominant mode of action. There was a significant increase in Indiana respondents correctly identifying this predominant mode of action between 2000 and 2005 (17 percent versus 25 percent, respectively, P < 0.0001). Fourteen percent of Illinois respondents answered correctly in 2005. Preeruptive incorporation of fluoride into enamel was the most frequently cited incorrect response (IN 2000, 79 percent; IN 2005, 71 percent; IL 2005, 82 percent). Some protocols for use of fluoride products reflected inadequate understanding of fluoride's predominant posteruptive mode of action. CONCLUSIONS: The majority of dental professionals surveyed were unaware of the current understanding of fluoride's predominant posteruptive mode of action through remineralization of incipient carious lesions. Additional research is indicated to assess fluoride knowledge and protocols of dental professionals nationwide. Educational efforts are needed to promote the appropriate use of fluoride.

Impact of the Oregon Health Plan on children with special health care needs.

OBJECTIVE: Although an increasing number of Medicaid children are enrolled in Medicaid managed care plans, little is known about how children with special health care needs fare under such programs. Of particular concern is the ability of such children to navigate a managed care system and gain access to specialty and other services. This study compares the managed care experiences of children with and without special care needs in the Oregon Health Plan. METHODOLOGY: Telephone surveys were conducted with a sample of parents of children enrolled in the Oregon Health Plan. Three groups of children were sampled: Supplemental Security Income (SSI) children with disabilities, children with asthma, and children without special health care needs. Descriptive and multivariate analyses were conducted to determine the impact of Medicaid managed care on access and satisfaction. RESULTS: Children with disabilities in managed care plans did not experience any more difficulty accessing needed specialty care than did those without special health care needs. Children with asthma, however, reported higher levels of unmet need. There were no differences in access between children with disabilities enrolled in managed care and those children with disabilities remaining in fee-for-service. CONCLUSIONS: Unlike SSI children with disabilities, children who were not SSI-eligible but had asthma seemed to have difficulty obtaining some services. These children were not eligible for the same consumer protections afforded SSI children by Oregon. If states want to enroll all children with special health care needs into managed care programs, they must develop mechanisms for identifying such children and ensuring that they receive medically necessary services.

Prenatal health behaviors as predictors of breast-feeding, injury, and vaccination.

OBJECTIVE: To identify maternal prenatal preventive health behaviors associated with breast-feeding, early childhood injuries, and vaccination. DESIGN: Secondary analysis of the 1988 National Maternal and Infant Health Survey. SETTING: Questionnaires were mailed to the mother's home. PATIENTS: The response rate to this nationally representative sample was 71%. These analyses include the 10,868 mothers whose infants had ever been at home. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): Multivariable logistic regression was used to predict the following: (1) having "ever" breast-fed; (2) having breast-fed for at least 6 weeks; (3) "an accident or bad fall" during any of the first 6 months of the child's life ("early" injury) or (4) in the month prior to the interview ("recent" injury); (5) having received "any" vaccinations or (6) having received three diphtheria, pertussis, tetanus immunizations. RESULTS: Children of mothers who reduced alcohol consumption during the pregnancy, had higher incomes, and were white had the best preventive health outcomes. Adequacy of prenatal care was predictive of vaccination, but not of breast-feeding or injury. CONCLUSIONS: These data suggest that prenatal sociodemographic characteristics and maternal health behaviors have significant and continued effects on the preventive health outcomes of infants and children.