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Author(s): Deborah Allen [sup.1] , Chad Abresch [sup.2] Author Affiliations: (Aff1) 0000 0004 0428 8718, grid.416097.d, Health Promotion, Los Angeles County Department of Public Health, , 1000 S. Fremont Ave. [...]

A study was conducted to describe the United States population's use of, access to, insurance coverage for, and costs of medical and dental care. Data from the 2005 Medical Expenditure Panel Survey (MEPS) for children younger than 18 years are used. Findings indicate that unmet dental care needs are associated independently with special health care needs status and complexity.

Objective To study trends in the quality of the healthcare provided to children aged less than 5 years in Afghanistan between 2004 and 2006. In particular, to determine the effect on such quality of a basic package of health services (BPHS), including Integrated Management of Childhood Illness (IMCI), introduced in 2003. Methods In each year of the study, 500-600 health facilities providing the BPHS were selected by stratified random sampling in 29 provinces of Afghanistan. We observed consultations for children aged less than 5 years, interviewed their caretakers, interviewed health-care providers and measured adherence to case management standards for assessment and counselling in a random sample. Findings The quality of the assessment and counselling provided to sick children aged less than 5 years improved significantly between 2004 and 2006. A 43.4% increase in the assessment index and a 28.7% increase in the counselling index (P< 0.001) were noted. Assessment quality improved significantly every year and was statistically associated with certain characteristics of the provider (being a doctor, having a higher knowledge score, being trained in IMCI, being part of a "contracting-in" mechanism and providing a longer consultation time) and the child (being younger and having a female caretaker). Counselling quality was also significantly associated with these characteristics, except for provider cadre and child age. The presence of clinical guidelines and the frequency of supervision were significantly associated with improved quality scores in 2006 (P < 0.05 and< 0.01, respectively). Conclusion Quality of care improved over the study period, but performance remained suboptimal in some areas. Continued investments in Afghanistan&apos;s health system capacity are needed. Objectif Etudier les tendances de la qualite des soins de sante delivres aux enfants de moins de 5 ans en Afghanistan entre 2004 et 2006. Determiner en particulier les offets sur cette qualite d&apos;un ensemble de services de sante essentiels (BPHS), incluant ia Prise en charge integree des maladies de l&apos;enfant (PCIME), introduite en 2003. Methodes Pour chaque annee d&apos;etude, 500 a 600 etablissements de soins delivrant le BPHS ont ete seiectionnes par sondage aleatoire stratifie dans 29 provinces d&apos;Afghanistan. Nous avons observe ies consultations dont ont benoficie les enfants de moins de 5 ans, interroge les personnes s&apos;occupant de ces enfants et les prestateurs de soins et mesure sur un echantillon aleatoire l&apos;observance des normes de prise en charge des cas pour ce qui concerne l&apos;evaluation et les conseils. Resultats La qualite de l&apos;evaluation et des conseils delivres aux enfants maiades de moins de 5 ans s&apos;est amelioree significativement entre 2004 et 2006. On a ainsi note une augmentation de 43,4 % de l&apos;indice d&apos;evaluation de l&apos;evaluation medicale et de 28,7 % de l&apos;indice d&apos;evaluation des conseils (p < 0,001). La qualite de l&apos;evaluation a progresse significativement chaque annee et etait statistiquement associee a certaines caracteristiques du prestateur (etre medecin, obtenir un score de connaissances plus eleve, etre formee a la PCIME, travailler sous contrat pour le gouvernement et assurer une consultation plus longue) et de l&apos;enfant (jeune age et prise en charge par une femme dans la vie courante). La qualite des conseils presentait egalement une association statistique avec ces caracteristiques, excepte le niveau de qualification du prestateur et l&apos;age de l&apos;enfant. L&apos;existence de directives cliniques et la frequence de la supervision etaient significativement associees a une amelioration des scores de qualite en 2006 (p < 0,05 et p < 0,01, respectivement). Conclusion La qualite des soins s&apos;est amelioree sur la periode etudiee, mais les performances sont restees sous-optimales dans certaines zones. Il faut continuer a investir dans le renforcement des capacites du systeme de sante afghan. Objetivo Estudiar las tendencias de la calidad de la atencion sanitaria proporcionada a los menores de cinco anos en Afganistan entre 2004 y 2006. En particular, determinar el ofecto de la calidad de un paquete basico de servicios de salud (PBSS) que incluia la atencion Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI), introducida en 2003. Metodos Mediante muestreo aleatorio estratificado, cada ano dei estudio se seleccionaron 500-600 centros de salud que empleaban el PBSS en 29 provincias de Afganistan. Observamos las consultas de atencion a menores de cinco anos, entrevistamos a sus cuidadores y a los profesionales que los atendieron, y medimos su cumplimiento de las normas de manejo de casos para evaluacion y asesoramiento en una muestra aleatoria. Resultados La calidad de la evaluacion y de los consejos proporcionados para los ninos enfermos de menos de 5 anos de edad mejoro significativamente entre 2004 y 2006. Se observo un aumento del 43,4% del indice de evaluacion y un aumento dei 28,7% del indice de asesoramiento (p < 0,001). La calidad de la evaluacion mejoro considerablemente cada ano y demostro estar relacionada de forma significativa con determinadas caracteristicas del proveedor (condicion de medico, mayor puntuacion de sus conocimientos, capacitacion en la AIEPI, participacion en un mecanismo de contratacion de la Administracion, y mayor duracion de la consulta) y dei nino (una menor edad, y el hecho de tener a una mujer como cuidadora). Se observo que la calidad del asesoramiento tambien estaba asociada significativamente a esos factores, exceptuando la profesion del trabajador sanitario y la edad dei nino. La existencia de directrices clinicas y la frecuencia de la supervision se asociaron significativamente a mejores puntuaciones de la calidad en 2006 (p < 0,05 y p < 0,01, respectivamente). Conclusion La calidad de la atencion mejoro a lo largo del periodo de estudio, pero el desempeno seguia siendo suboptimo en algunas zonas. Es preciso seguir invirtiendo de forma continuada en la capacidad del sistema de salud de Afganistan., Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol. Introduction Afghanistan has some of the poorest [...]

Objective To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs. Methods We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United Republic of Tanzania, and an ecological study of factors associated with health worker training in IMCI. Explanatory factors included district population, distance from the capital, human development index, other socioeconomic indicators and baseline mortality rates in children younger than five years. Findings In line with recommendations by WHO, early implementation districts were characterized by proximity to the capital and suitable training sites, presence of motivated health managers and a functioning health system. In the expansion phase, IMCI tended to be adopted by other districts with similar characteristics. In Brazil, uptake by poor and small municipalities and those further away from the state capital was significantly lower. In Peru, there was no association with distance from Lima, and a non-significant trend for IMCI adoption by small and poor departments. In the United Republic of Tanzania, the only statistically significant finding was a lower uptake by remote districts. Implementation was not associated with baseline mortality levels in any country studied. Conclusion Whereas clear and reasonable guidelines are provided for selection of early use districts, no criteria for promoting IMCI expansion had been issued, and areas of greatest need were not prioritized. Equity analyses based on the geographical deployment of new programmes and strategies can contribute to assessing whether they are reaching those who need them most., Voir page 799 le resume en francais. En la pagina 800 figura un resumen en espanol. Introduction There is ample literature on how the availability and quality of health care [...]

Objective: The aim of this study was to examine the trajectory of cases through four systems: child protection, law enforcement, the dependency courts, and the criminal courts. Method: This study focused on a county selected from a 41-county telephone survey conducted for the National Incidence Study of Child Abuse and Neglect (NIS-3). For this analysis prospective samples were drawn from law enforcement (n = 225) and the county child protection (CPS) agency (n = 225) and followed through in-depth case tracking across all agencies and through both the dependency and criminal court systems. Results: The percentage of CPS cases opened in dependency court was similar to prior studies (29%), but the acceptance and prosecution rates were much higher--92% of the cases referred from CPS, including many cases of physical abuse. Compared to referrals from CPS to law enforcement (93%), few cases were referred from law enforcement to CPS (17%). Anecdotally, case referral patterns appeared to be influenced by communication patterns and mutual positive regard, regardless of the collaborative protocols in place. One of the most instructive findings was the degree of difficulty in tracking cases across organizations and the types of obstacles that impeded success. Disorganization was not an issue, rather internal structures set up to facilitate intra-organizational processing were the same structures that actually impeded cross-organizational case finding. Conclusions: It is not sufficient to rely on the existence of multi-disciplinary teams or Child Advocacy Centers to ensure collaboration. More attention to daily tasks and activities as well as the nature and quality of communication is warranted. On the technical side, use of common case identifiers on cases that are cross-referred is strongly recommended. Future studies should broaden the scope of inquiry to include the consequences of all case trajectories, rather than solely focusing on the justice system. Keywords: Child protection; Justice systems; Child abuse and neglect

Sound policy and program decisions require timely information based on valid and relevant measures. Recent findings suggest that despite the availability of effective and affordable guidelines for the management of sick children in first-level health facilities in developing countries, the quality and coverage of these services remains low. We report on the development and evaluation of a set of summary indices reflecting the quality of care received by sick children in first-level facilities. The indices were first developed through a consultative process to achieve face validity by involving technical experts and policymakers. The definition of evaluation measures for many public health programs stops at this point. We added a second phase in which standard statistical techniques were used to evaluate the content and construct validity of the indices and their reliability, drawing on data sets from the multi-country evaluation of integrated management of childhood illness (MCE) in Brazil, Tanzania and Uganda. The statistical evaluation identified important conceptual errors in the indices arising from the theory-driven expert review. The experts had combined items into inappropriate indicators resulting in summary indices that were difficult to interpret and had limited validity for program decision making. We propose a revised set of summary indices for the measurement of child health care in developing countries that is supported by both expert and statistical reviews and that led to similar programmatic insights across the three countries. We advocate increased cross-disciplinary research within public health to improve measurement approaches. Child survival policymakers, program planners and implementers can use these tools to improve their monitoring and so increase the health impact of investments in health facility care. Keywords: Child health care; Integrated management of childhood illnesses (IMCI); Measurement; Brazil; Tanzania; Uganda

Does the utilization of modern maternal and child health (MCH) services influence subsequent contraceptive use? The answer to this question holds important implications for proposals which advocate MCH and family planning service integration. This study uses data from the 1995/6 Guatemalan Demographic Health Survey and its 1997 Providers Census to test the influence of MCH service utilization on individual contraceptive use decisions. We use a full-information maximum likelihood regression model to control for unobserved heterogeneity. This model produces estimates of the MCH effect, independent of individual women's underlying receptiveness to MCH and contraceptive messages. The results of the analysis indicate that the intensity of MCH service use is indeed positively associated with subsequent contraceptive use among Guatemalan women, even after controlling for observed and unobserved individual-, household-, and community-level factors. Importantly, this finding holds even after controlling for the unobserved factors that 'predispose' some women to use both types of services. Simulations reveal that, for these Guatemalan women, key determinants such as age and primary schooling work indirectly through MCH service use to increase contraceptive utilization. Keywords: Contraceptives; MCH; Guatemala; Family planning

Forty-seven million Americans, or 18% of the U.S. population, speak a language other than English at home, up from 31.8 million (14% of the population) in 1990 and 23.1 million […]

Objectives. In light of the alarming increase in childhood obesity and lack of evidence for the effectiveness of school programs, we studied the effects of school programs in regard to preventing excess body weight. Methods. In 2003, we surveyed 5200 grade 5 students along with their parents and school principals. We measured height and weight, assessed dietary intake, and collected information on physical and sedentary activities. We compared excess body weight, diet, and physical activity across schools with and without nutrition programs using multilevel regression methods while adjusting for gender and socioeconomic characteristics of parents and residential neighborhoods. Results. Students from schools participating in a coordinated program that incorporated recommendations for school-based healthy eating programs exhibited significantly lower rates of overweight and obesity, had healthier diets, and reported more physical activities than students from schools without nutrition programs. Conclusions. Our finding that school programs are effective in preventing childhood obesity supports the need for broader implementation of successful programs, which will reduce childhood obesity and, in the longer term, comorbid conditions and health care spending.

Objectives. The aims of this study are to 1) assess parent satisfaction with well-child care for their young child and 2) identify how global satisfaction ratings and parent reports on the processes of care vary with child and family characteristics, health care received, and health system factors. Methods. The National Survey of Early Childhood Health is a telephone survey that used a stratified random-digit-dial sampling design to achieve a nationally representative sample of 2068 children and 4 to 35 months. Parents provided global ratings of satisfaction with their child&apos;s well-child visits (range 0-100) and reported their satisfaction with information provided and the time spent with the provider. A subsample of parents whose child has a particular provider for well-child care (n = 930) also reported their likelihood of recommending their provider. Results. The mean global satisfaction rating is 86.9 (standard error: 6.1). Approximately 94% of parents of young children reported information satisfaction, 88% reported time satisfaction, and 79% would recommend their child&apos;s provider. Bivariate analysis shows lower satisfaction for uninsured children but few differences associated with insurance type or health care setting. In multivariate analyses including child and family factors and health system factors, Hispanic, Spanish-speaking mothers of young children have lower odds than non-Hispanic white mothers of reporting information (odds ratio [OR]: 0.32; 95% confidence interval [CI]: 0.13-0.79) and time satisfaction (OR: 0.44; 95% CI: 0.21-0.90). Parents of children who experienced missed or delayed care have lower odds of time satisfaction (OR: 0.27; 95% CI: 0.16-0.46) and have lower global satisfaction. Greater length of well-child visits is consistently associated with greater satisfaction on all 4 measures. Conclusion. Although most parents reported relatively high levels of satisfaction with well-child care, shorter length of well-child visits and experiencing missed or delayed care are the 2 factors consistently associated with lower satisfaction using each of the measures. Efforts to improve satisfaction ratings might focus on improving the delivery of well-child care and ensuring that parents get the time they need. Pediatrics 2004; 113:1965-1972; quality of care, child health, satisfaction., ABBREVIATIONS. CAHPS, Consumer Assessment of Health Plan Satisfaction; NSECH, National Survey of Early Childhood Health; MHI-5, 5-item Mental Health Index; CI, confidence interval; OR, odds ratio. Consumer reports of health [...]

Background. Insurance status has been shown to have an impact on children&apos;s use of preventive and acute health services. The objective of this study was to determine the relationship between insurance status and vaccination coverage among US preschool children aged 19 to 35 months. Methods. We linked data from 2 national telephone surveys, the National Immunization Survey and the National Survey of Early Childhood Health, conducted during the first half of 2000. Children were considered up to date (UTD) when they had received at least 4 diphtheria-tetanus-acellular pertussis/diphtheria-tetanus-pertussis vaccines, 3 poliovirus vaccines, 1 MMR vaccine, 3 Haemophilus influenza vaccines, and 3 hepatitis B vaccines at the time the interview was conducted. Results. Among the 735 children in our study sample, 72% were UTD. The vast majority (94%) reported some type of health insurance at the time of the survey. Children with private insurance were more likely to be UTD (80%) than those with public insurance (56%) or no insurance (64%). In a multivariate analysis that controlled for child&apos;s race/ethnicity; household income; maternal age/marital status/educational level; location of usual care; and Special Supplemental Nutrition Program for Women, Infants, and Children participation, insurance was no longer an independent predictor of vaccination. Conclusions. The disparity in vaccination coverage among publicly, privately, and uninsured children is dramatic, underscoring its importance as a marker for underimmunization, despite the multivariate findings. The Vaccines for Children Program, a partnership between public health and vaccination providers who serve uninsured children and those enrolled in Medicaid, is well suited to target and improve vaccination coverage among these vulnerable children. Pediatrics 2004;113:1959-1964; children, insurance status, vaccination, vaccination coverage., ABBREVIATIONS. SCHIP, State Children's Health Insurance Program; NIS, National Immunization Survey; NSECH, National Survey of Early Childhood Health; CDC, Centers for Disease Control and Prevention; UTD, up to date; WIC, [...]

Objectives. We estimated the effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dental services use by Medicaid children in North Carolina. Methods. We used linked Medicaid claims and enrollment files, WIC files, and the area resource file to compare dental services use for children enrolled in WIC with those not enrolled. We used multivariate models that controlled for child clustering and employed 2-step methodology to control for selection bias. Results. Children who participated in WIC had an increased probability of having a dental visit, were more likely to use preventive and restorative services, and were less likely to use emergency services. Conclusions. Children's WIC participation improved access to dental care services that should lead to improved oral health. (Am J Public Health. 2004;94:772-777)

This article examines the effectiveness of current treatments used with children from low-income families who are diagnosed with attention deficit hyperactivity disorder. Findings indicate that both voluntary parenting classes and medication have beneficial effects on inattention, but only parenting classes help reduce defiant behaviors in children.

A study of 106 children from varied ethnic backgrounds, 42 European, 45 Asian and 19 Afro-Caribbean, reveals that health services were used primarily for epilepsy, hearing and vision, cardiovascular, mobility, and ear nose and throat problems. Ethnicity did not have an effect on the pattern of contact with health professionals and, although two thirds of the children had special needs such as hyperactivity, only 18% received treatment from psychological experts.

Child life services are traditionally employed to reduce stress levels for both families and children in hospital and to encourage normal family and child developent while children are in hospital. A study has shown that parental satisfaction levels were not affected by involvement with child life services. Parental satisfaction dropped as waiting times in treatment rooms rose, and as illnesses became more serious. Experience with child life services was linked to greater satisfaction with the communicative behavior of physicians,

Results are detailed from a five-year research collaboration, from 1990-1995, between U.S. and Malawi nursing schools and the Malawi Ministry of Health. The goal of the project was to find ways to improve delivery and quality of health care for women and children in Malawi villages. The project's three phases included cooperative development of proposals, data collection and project funding, and review of progress. Participants agree the research project was successful in improving care for Malawi women and children.

Mothers and respondents with less formal education are more involved in mental health services for children, than fathers and those with more education. A Family Involvement Scale and a Family Empowerment Scale help in the measurement of involvement and empowerment, respectively, in families with children having emotional and behavioral disorders. A study of the demographic correlates shows that involvement is a determinant of the level of parental empowerment, while the level of family involvement affects personal empowerment.

This paper draws on two recent research studies to consider negotiations and relationships between parents and health staff as regards child health care and child rearing, to which each side contributes. The value of the concept of an intermediate domain, located between the public world of paid work and the private world of the family is explored to throw light on the character of these negotiations and relationships. The implications of gender for relationships between parent and health staff are considered.

Fifteen extended essays about working experiences with migrants, written by district nurses, were analyzed as part of a larger research project on the perception of child rearing practices in and family relations in migrant households. The nurses have all been working in child health centers and intended to improve their expertise in the position of migrant women and the background of child rearing practices in migrant households by means of a graduate project during their training as a district nurse or senior staff member. I was especially interested to learn how the huge amount of literature about the different cultural background of Turkish and Moroccan migrants was used by the nurses to elaborate ideas about the specific problems of migrant mothers and the possibilities of professional support in child rearing affairs. The analysis of the essays revealed that in most essays the concepts of 'ignorance', 'unequal gender relations' and 'isolation' are central in the construction of the category of Turkish and Moroccan mothers as a specific risk or problem group; and that 'cultural differences', 'transiency' and 'deficiency' play an important part in the nurses' 'explanatory model' of the risks and problems in these households. It is argued, that the meaning and interrelationship of the nurses' definitions and explanations of characteristics and problems in migrant households should be understood in the context of (1) the orientalist literature about the population of 'eastern' countries which is recommended in the professional trainings, (2) former and current perceptions of class differences in child rearing practices by professionals and (3) traditional ideas about the position and responsibilities of mothers which dominate in youth health care in the Netherlands. Supporting a minority standpoint in the essays a plea is made for the elaboration of the concept 'migrant culture' and the investigation of the (in)accessibility of Dutch facilities for migrant women.

Helpful keywords in accessing literature on the use made of hospital accident and emergency (A&E) departments are 'misuse' 'abuse' and 'inappropriate'. While the medical literature is inclined to present patients (and, in the case of children, their parents) as irresponsible, or misguided, social scientists looking at similar data have tended to act as apologists for patients, explaining A&E attendance in terms of poor access to GPs, mistaken beliefs about the relative skills of hospital-based doctors and GPs and |lay' health beliefs. Both of these approaches see the patient (or parent) as passive recipients of health care, rather than active caretakers of their own or their children's health. On the basis of a study of minor ailments presenting at a children's A&E department, this paper explores the diffeing views of health workers and parents. It suggests that a view of patients (parents) as largely passive custodians of their own or their children's health is inadequate. Patients (parents) can and do play an active part as providers of primary health care and their decisions to use A&E are not as irrational as health providers sometimes suppose. In this light, attempts to |re-educate' parents to use A&E in a way which would be more acceptable to health providers is unlikely to succeed.