Tuesday, April 28, 2009

The Health of Britain, Part II

Commenter "Thai" recently praised British socialized medicine:
The UK's NHS NICE is probably the fairest health care system on the planet. I would think conservatives would love it.
Keep that in mind as you read this Daily Mail (U.K.) story:
A mother-to-be has been turned down for free dental treatment -- because the surgery will not accept that she is expecting.

Sarah Luisis, 27, who is five months pregnant, has been told she needs to provide more proof that she has a baby on the way.


source: April 24th Daily Mail

That is despite the fact that she has a big bump, a doctor's certificate, antenatal notes and ultrasound pictures of her unborn child.

Miss Luisis, of Hornchurch, Essex, is desperate to see a dentist after enduring weeks of agony with bleeding gums.

But the only way she can afford crucial treatment is through maternity cover from the NHS.
Britain's National Health certainly promotes equality, but a universal right to bad healthcare is not fair--and hardly a conservative goal.

(via Don Surber)

16 comments:

Thai said...

Wow! I get my own post! Thanks for the high regard. And I am agnostic on how the issue is solved.

Even a partisan like you must understands that one case does not a system destroy. The examples of bumbling care I could share with you in America's bizarre system would fill this blog for weeks.

... Why am I even arguing with someone how isn't in the system? This is where I should have my head examined.

Though... I might direct you to do a little research project on your own. Look up the incidence of arrival to cut times for appendicitis (or appendiceal perforation rates) for single systems like Kaiser vs the median community hospital in the US.

Of course I already know the answer.


Remember, I am agnostic on the public vs. private issue.

Regards

Carl said...

I'm working on a cost/technology/effectiveness metric for OECD countries; I should have something by the weekend.

Thai said...

Thanks. I really am interested in such data and have never found one.

Also, thinking about this post, I just realized it is one of those "are you a lumper or are you a splitter things". Clearly in this case I am a "splitter" whereas you are a "lumper".

For I look at NICE as really being quite different than the NHS... In some ways akin to the way someone might look at the law and the police as different while recognizing that they are also really inseperable.

NICE is the rules of the game, the NHS are the teams which play by those rules.

I might have hoped you would see from this point of view why I like NICE and why I have a hard time seeing why conservatives don't like it as well. But if you don't, oh well. But I have a hard time seeing where your rules come from otherwise when it is easy to get around them.

I don't care if the citizens of a town own their football team or not.

OBloodyHell said...

> The examples of bumbling care I could share with you in America's bizarre system would fill this blog for weeks.

By all means, Thai. Take the time to list off, oh, FIVE, please, with attributions for verification of the facts as claimed.

Until then, I'm pointing out that I've long noted a strong tendency on your part to be long on claims but short on support.

:-/

Thai said...

OBH- I think you missed my point earlier.

I look at things through the lens of complexity science so at some level I guess that does make me a bit of a nihilist... Though I am not really one. ;-)

It is certainly true that I do tend to see the trade offs no matter what approach we take, that is for sure.

And I will pass on sharing on an public webpage for what I think should be obvious.

Regards

OBloodyHell said...

Nice tap dancing.

Doesn't do a thing towards what I asked about, though...

Perhaps, if I was rude to you earlier, it was probably due to this kind of "evade evade evade until he drops it" tactic that you tend to utilize.

Not dropping it: Put up or shut up.

If they are as common as you claimed, it should be virtually trivial to come up with documented examples, n'cest pas?

Thai said...

Trivial "yes"... the question is how long I would keep my job as a quality officer. ;-)

Thai said...

One other thing to ponder.

This article is all about the bumbling application of rationing rules in the UK.

NICE says "no dental care" (with a carve out for pregnancy... you can see all the loopholes and bizarre behavior this might cause but that is a different issue).

So our unfortunate Sarah has bad gums/teeth.

Normally should would not qualify for ANY dental care, but due to a "carve out" in the rationing policies of NICE, Sarah does qualifies for dental care because of her pregnancy. According to the system's rules she should get care but some bozo miss applies the rules and says "no".

The bozo is a bozo.

There is nothing about this article that would indicate why America is ANY superior.

America does not provide free dental care to all its citizens either. But similarly to the UK, we do have a rulebook which says poor women can get Medicaid if they are pregnant and Medicaid will cover SOME dental procedures.

But since Medicaid pays so much less for these dental procedure than anyone else pays, Americans in Sarah's position still find it nearly impossible to see anyone willing to accept (a very low) payment for the dental procedure.


I am not at all clear on how this article helps your case other than to show the said truth of life for people when they run up against rationing rules which apply to them.

If you see this as evidence of why America's system is better, we indeed look at things differently.

Most of my patients have bleeding gums and they can't find anyone to help them out.

You clearly do not understand health care systems very well if you do not see this.

I stick by my observation that it is better to be rich than poor when it comes to health care and that this is just as true for nations as it is for people.

OBloodyHell said...

> There is nothing about this article that would indicate why America is ANY superior.

There's also NOTHING in your statement which PROVES AMERICA ANY WORSE EITHER -- despite REPEATED REQUESTS for support for your clearly BOGUS CLAIMS Thai.

.

I quote: "The examples of bumbling care I could share with you in America's bizarre system would fill this blog for weeks. "

=================================================
All the evidence to this point is that you can't even fill a **single** line with examples.
=================================================
.


If you can't support a single claim, despite your own exhortations that it would be "easy", then why should ANYONE listen to ANYTHING you say?And this constant avoidance of anything actually supporting any claim you decide to toss out, no matter how bogus, questionable, counter-intuitive, or otherwise, shows why I was rude to you, assuming I was (you also made *that* claim unsupported, too).


IF I was ever rude to you, it was because I got tired of listening to you SPOUT UNSUPPORTED BULLSHIT.


I repeat -- PUT UP OR SHUT UP, THAI.

.

All the signs say you're a liar and a faker.

.

FESS UP:

.
You're actually writing your blathering missives from the 20yo 386-25 machine in your mom's basement, where you live, aren't you?

OBloodyHell said...

P.S. that BS claim that you couldn't keep your job as a "quality officer" is ALSO crap -- if you work in ANY profession you can relate tales which ARE NOT your own but which there are adequate documentation available for -- I COULD easily fill this blog with horror stories about computer problems of any sort.

Because I know of a blog that actually DOES THAT.

So far, you can't even cough up ONE example of that which you speak which can be trusted as anything beyond a complete fabrication by you or someone you asked to do so.

.

Sorry, that's not respect worthy around here.

So do everyone a favor and stop making crap up, and go away until you can actually make statements you can support, hey?
>:-/

Carl said...

I'm still working on my metric. I've produced a chart, and I'm trying to check the formulas. Stay tuned.

Thai said...

Carl, thanks, I Look forward

For OBH

Cheers

Thai said...

... I just realized you probably don't have a medical provider password for Medscape searches (and I am certainly NOT sharing mine with OBH).

Let's hope I am not committing too much of a usage infringement by doing this.

Also, I have a hunch the tables are not going to come out too well from cut and paste (which is a shame since they make my point quite clear).

Cheers

PS- From the American Journal of Public health


/2004
Abstract and Introduction

Abstract

Objectives: We examined the relationships between risk factors amenable to intervention and the likelihood of dental care use during pregnancy.
Methods: We used data from the Washington State Department of Health's Pregnancy Risk Assessment Monitoring System.
Results: Of the women surveyed, 58% reported no dental care during their pregnancy. Among women with no dental problems, those not receiving dental care were at markedly increased risk of having received no counseling on oral health care, being overweight, and using tobacco. Among women who received dental care, those with dental problems were more likely to have lower incomes and Medicaid coverage than those without dental problems.
Conclusions: There is a need for enhanced education and training of maternity care providers concerning oral health in pregnancy.

Introduction

One of the Healthy People 2010 objectives is to increase the proportion of adults who use the oral health care system each year.[1] Prevalence rates of dental care use during pregnancy have been reported to range from 23% to 43%.[2,3] Previous studies indicate not only that pregnant women underuse dental care but that poor women disproportionately fail to obtain such care.[2,3]

Although there have been recent increases in research on maternal oral health during and after pregnancy,[4-11] little is known about amenable factors that could be addressed during the prenatal period by maternity care clinicians, dental care providers, public health policymakers, and women themselves. Only 2 studies to date, to our knowledge, have examined predictors of dental care use during pregnancy.

A population-based cross-sectional study conducted in North Dakota revealed that young women, women in poverty, and women with Medicaid coverage were at increased risk of not having a dentist visit during their pregnancy.[3] In another study, Gaffield et al. analyzed Pregnancy Risk Monitoring System data from 4 states.[2] They found a modest increase in risk of dental care underuse associated with poverty, Medicaid coverage, and late-onset prenatal care among women who reported having a dental problem during pregnancy. However, neither of these studies accounted for confounding variables likely to distort the actual relationship between such factors and dental care use.

In 2000, the surgeon general issued a call for action to expand research efforts aimed at improving oral health; this report indicated the need for studies describing the magnitude of the problem, assessing care delivery characteristics, and identifying mitigating factors that promote or hinder good oral health.[12] Many factors associated with dental care use during pregnancy are not amenable to intervention; however, provision of counseling on oral health care by maternity care providers is a simple, low-cost intervention.

In addition, increased understanding of mutable factors such as obesity and smoking could offer the potential for developing prenatal screening and referral strategies.[13,14] Clinicians and public health care providers who care for women during pregnancy need new practical information concerning factors that affect dental care use to allow development and implementation of oral health counseling, screening, and referral strategies. The present study was undertaken to examine the association between selected sociodemographic, pregnancy, and health service factors amenable to intervention and the likelihood of dental care use during pregnancy.

Methods

Data for this study were derived from the Washington State Department of Health Pregnancy Risk Assessment Monitoring System (PRAMS). The PRAMS surveillance project study methodology has been described in detail previously.[15] Briefly, the study involved a cross-sectional, population-based mail/ telephone survey of a stratified systematic sample of Washington mothers who had recently delivered a live-born infant. Washington State birth certificates were the sampling frame source; women from minority racial/ethnic groups were oversampled. Seventy-four percent of the 2147 women who delivered a live-born infant between January 1 and December 31, 2000, responded to the Washington PRAMS survey (n=1592). Comparisons of birth certificate information among respondents and nonrespondents showed that the latter were more likely to be multiparous, unmarried, and Black and less likely to have completed high school.[16]

In January 2000, several dental care questions were added to the Washington PRAMS survey. The revised survey assessed the care of women's teeth during their pregnancy by asking whether they (1) had needed to see a dentist for a problem, (2) had visited a dentist or dental clinic, or (3) had discussed with a dental or other health care worker how to care for their teeth and gums. Eighty-four percent (n=1343) of the respondents completed all 3 questions on dental care use during pregnancy, and 95% (n=1513) answered 2 of these questions. Information on sociodemographic, prenatal, and health service factors was taken from the PRAMS questionnaire.

We assessed women according to reported absence or presence of self-reported dental problems. Analyses focusing on women with no reported dental problems examined the association between receipt of preventive care and selected risk factors; the goal of analyses focusing on women with reported dental problems separately was to help provide an understanding of the association between receipt of dental care and selected risk factors. In addition, we examined the association between receipt or nonreceipt of care and reported dental problems to assess the risk factors associated with such problems.

In terms of dental care use variables, women were categorized as follows: (1) those who reported that they had no dental problems yet had received dental care; (2) those who reported that they had no dental problems and did not receive dental care; (3) those who reported that they had dental problems and received dental care; and (4) those who reported that they had dental problems but did not receive dental care. The primary risk factors of interest were household monthly income; participation or nonparticipation in the Special Supplemental Nutrition Program for Women, Infants, and Children; type of prenatal care insurance coverage; trimester in which prenatal care was initiated; prenatal care site; counseling on oral health care; body mass index; smoking status before the pregnancy; smoking status during the final 3 months of the pregnancy; and history of ever having smoked.

We conducted unconditional logistic regression analyses to estimate, by means of odds ratios (ORs), associations between risk factors and dental care use during pregnancy according to self-reported dental problems. We also evaluated the relationship between risk factors and risk of reported dental problems according to receipt or nonreceipt of dental care. Estimates of model parameters were computed via maximum likelihood techniques, and 95% confidence intervals (CIs) were based on coefficient standard errors and the normal approximation.

Established and suggested risk factors were evaluated as potential confounders, including maternal age, marital status, race/ethnicity, educational level, income, parity, body mass index, and smoking status during the final 3 months of pregnancy, along with infant birthweight and estimated gestational age. Those risk factors that resulted in changes of 10% or more in dental care use odds ratio estimates were included in the covariate-adjusted model.

Stata version 7.0 (Stata Corp, College Station, Tex) software was used to account for the complex multistage sampling design implemented to produce population estimates in the modeled analyses. Specifically, individual PRAMS respondents are assigned an analysis weight that is the product of the sampling weight, the nonresponse weight, and the frame noncoverage weight. Sampling weights are calculated by dividing the number of women in the sample frame for a given stratum by the number of women actually sampled in that stratum. These weights are then adjusted by the response rates and noncoverage rates associated with each stratum.

Results

Overall, 58% of the pregnant women surveyed here reported receiving no dental care during their pregnancy. Fifteen percent of the respondents reported that they had no dental problems but received dental care; 38% reported that they had no dental problems and did not receive dental care; 26% reported that they did have dental problems and received dental care; and 21% reported that they had dental problems but did not receive dental care. Table 1 shows the distribution of selected sociodemographic, prenatal, and health service characteristics according to self-reported dental problems and receipt of dental care. Women who had no dental problems but received dental care were more likely than women in the other groups to be older, married, White, and primiparous; to be at higher educational and income levels; to have private insurance coverage; and to have received care from a private physician or a health maintenance organization. They were less likely to be obese or to smoke.

Table 1.

Characteristic No Dental Problem/Received Care No Dental Problem/No Care Had Dental Problem/Received Care Had Dental Problem/No Care
Sample (n=374), No.(%) Weighted Distribution, %a Sample (n=659), No. (%) Weighted Distribution, %a Sample (n=312), No. (%) Weighted Distribution, %a Sample (n=168), No. (%) Weighted Distribution, %a
Maternal age, y
<20 37 (10) 6 78 (12) 10 44 (14) 13 24 (14) 11
20-24 56 (15) 10 178 (27) 23 84 (27) 28 63 (38) 41
25-29 108 (29) 34 190 (29) 31 73 (23) 23 35 (21) 21
30-34 99 (26) 30 139 (21) 23 69 (22) 21 34 (20) 20
≥35 74 (20) 20 74 (11) 13 42 (14) 15 12 (7) 7
Marital status
Married 285 (76) 84 413 (63) 71 181 (58) 65 81 (48) 59
Unmarried 89 (24) 16 244 (37) 28 127 (41) 33 86 (51) 40
Unknown 0 (0) 0 2 (0) 1 4 (1) 2 1 (1) 1
Race/ethnicity
White 160 (43) 82 150 (23) 63 67 (22) 59 42 (25) 70
Hispanic 45 (12) 7 126 (19) 16 79 (25) 22 26 (15) 14
Asian/Pacific 76 (20) 6 152 (23) 10 58 (19) 8 28 (17) 7
Islander
Black 46 (12) 2 109 (17) 5 51 (16) 4 34 (20) 6
American Indian 43 (12) 1 115 (17) 3 53 (17) 3 38 (23) 3
Unknown 4 (1) 2 7 (1) 3 4 (1) 4 0 (0) 0
Maternal education, y
<12 33 (9) 5 141 (22) 18 78 (25) 20 29 (17) 13
12 69 (18) 17 180 (27) 27 87 (28) 24 67 (40) 46
>12 246 (66) 72 273 (41) 49 110 (35) 45 57 (34) 34
Unknown 26 (7) 6 65 (10) 6 37 (12) 11 15 (9) 7
Washington income, $ (monthly)
<1200 49 (13) 11 168 (26) 22 96 (31) 25 75 (45) 38
1200-2099 59 (16) 12 173 (26) 24 96 (31) 31 41 (24) 24
2100-2999 48 (13) 13 83 (12) 14 31 (10) 14 19 (11) 18
≥3000 218 (58) 64 235 (36) 40 89 (28) 30 33 (20) 20
WIC participation
Yes 116 (31) 21 347 (53) 44 199 (64) 51 105 (63) 62
No 255 (68) 78 304 (46) 55 110 (35) 48 61 (36) 37
Unknown 3 (1) 1 8 (1) 1 3 (1) 1 2 (1) 1
Prenatal care payer
Insurance/HMO 77 (20) 79 236 (36) 60 148 (47) 46 78 (46) 52
Medicaid 260 (70) 14 337 (51) 28 118 (38) 40 64 (38) 35
Self-pay 7 (2) 1 9 (1) 2 4 (1) 1 1 (1) 1
Military 12 (3) 3 26 (4) 3 8 (3) 4 6 (4) 3
Other 15 (4) 3 32 (5) 5 22 (7) 7 13 (8) 6
Unknown 3 (1) 0 19 (3) 2 12 (4) 2 6 (3) 3
Trimester prenatal care initiated
First 308 (82) 83 461 (70) 71 220 (71) 75 118 (70) 79
Second or third 40 (11) 11 131 (20) 20 54 (17) 13 38 (23) 16
No care 0 (0) 0 3 (0) 0 2 (1) 1 3 (2) 1
Unknown 26 (7) 6 64 (10) 9 36 (11) 11 9 (5) 4
Prenatal care site
Private physician's office/HMO clinic 243 (65) 76 338 (51) 63 134 (43) 56 80 (47) 60
Hospital clinic 69 (19) 12 136 (21) 15 83 (27) 19 40 (24) 15
Health department clinic 20 (5) 3 61 (9) 5 36 (12) 8 20 (12) 10
Community or migrant health center 10 (3) 1 23 (4) 3 14 (4) 3 5 (3) 3
Other 28 (7) 8 82 (12) 12 33 (10) 12 18 (11) 9
Unknown 4 (1) 0 19 (3) 2 12 (4) 2 5 (3) 3
Counseled on oral health care
Yes 294 (79) 79 112 (17) 15 245 (79) 80 27 (16) 14
No 79 (21) 20 545 (83) 85 63 (20) 19 140 (83) 86
Unknown 1 (0) 1 2 (0) 0 4 (1) 1 1 (1) 0
Parity
1 182 (49) 45 270 (41) 41 117 (38) 34 59 (35) 33
≥2 192 (51) 55 389 (59) 59 195 (62) 66 109 (65) 67
Body mass index, kg/m2
<18.5 (underweight) 21 (6) 4 42 (6) 5 20 (6) 6 13 (8) 6
18.5-24.9 (normal) 245 (65) 66 310 (47) 48 153 (49) 54 80 (48) 47
25.0-29.9 (overweight) 57 (15) 16 153 (23) 25 70 (23) 20 33 (19) 21
≥30.0 (obese) 51 (14) 14 154 (24) 22 69 (22) 20 42 (25) 26
Smoked before pregnancy
Yes 46 (12) 13 124 (19) 22 63 (20) 22 55 (33) 38
No 324 (87) 87 520 (79) 75 239 (77) 72 109 (65) 60
Unknown 4 (1) 0 15 (2) 3 10 (3) 6 4 (2) 2
Smoked during last 3 months of pregnancy
No 356 (95) 96 593 (90) 85 278 (89) 89 133 (79) 78
Yes 16 (4) 4 61 (9) 14 31 (10) 10 34 (20) 22
Unknown 2 (1) 0 5 (1) 1 3 (1) 1 1 (1) 0
Ever smoked
Yes 17 (5) 4 63 (10) 14 33 (11) 10 34 (20) 22
No 356 (95) 96 593 (90) 86 278 (89) 89 133 (79) 78
Unknown 1 (0) 0 3 (0) 0 1 (0) 1 1 (1) 0
Birthweight, g
<2500 20 (6) 3 52 (8) 6 8 (3) 3 10 (6) 8
≥2500 349 (93) 96 604 (92) 93 304 (97) 97 158 (94) 92
Unknown 5 (1) 1 3 (0) 1 0 (0) 0 0 (0) 0
Estimated gestational age, wk
<37 28 (7) 5 58 (9) 8 20 (7) 7 11 (6) 12
≥37 339 (91) 92 586 (89) 91 285 (91) 91 151 (90) 86
Unknown 7 (2) 3 15 (2) 1 7 (2) 2 6 (4) 2
Table 1. Selected Sample Characteristics, According to Dental Care Group: Washington State PRAMS Study, 2000

We examined the association of potential risk factors with receipt of dental care among women who did not report dental problems during pregnancy and those who did report such problems ( Table 2 ). Among women reporting no dental problems, those who did not receive dental care were at markedly increased risk, relative to those who did receive care, to have not been counseled on oral health care during their pregnancy (OR=22.32; 95% CI=14.22, 35.02) ( Table 2 ).

Table 2.

Characteristica No Reported Dental Problems Reported Dental Problems
OR 95% CI OR 95% CI
Income (monthly), $b
<1200 1.27 0.58, 2.76 1.74 0.66, 4.59
1200-2099 1.62 0.78, 3.37 0.61 0.24, 1.59
2100-2999 1.00 1.00
≥3000 0.65 0.35, 1.20 0.48 0.18, 1.24
WIC participationc
Yes 1.75 1.04, 2.94 1.34 0.62, 2.90
No 1.00 1.00
Prenatal care payerc
Medicaid 1.05 0.56, 1.94 0.53 0.24, 1.15
Insurance/HMO 1.00 1.00
Self-pay 1.73 0.38, 7.89 0.63 0.08, 4.97
Military 1.15 0.38, 3.48 0.52 0.11, 2.55
Other 1.19 0.43, 3.29 0.64 0.20, 2.08
Trimester prenatal care initiatedd
First 1.00 1.00
Second or third 1.59 0.89, 2.85 1.00 0.47, 2.12
No care -- 0.62 0.05, 7.19
Prenatal care sitee
Private physician's office/HMO clinic 1.00 1.00
Hospital clinic 0.84 0.46, 1.56 0.65 0.29, 1.47
Health department clinic 0.58 0.24, 1.38 1.00 0.33, 3.05
Community or migrant health center 0.66 0.17, 2.51 1.01 0.24, 4.36
Other 1.10 0.53, 2.30 0.68 0.24, 1.92
Counseled on oral health care
Yes 1.00 1.00
No 22.32 14.22, 35.02 26.42 12.46, 56.02
Body mass index, kg/m2c
<18.5 (underweight) 1.90 0.82, 4.41 1.12 0.33, 3.81
18.5-24.9 (normal) 1.00 1.00
25.0-29.9 (overweight) 1.89 1.14, 3.13 1.18 0.54, 2.59
≥30.0 (obese) 1.88 1.09, 3.25 1.52 0.73, 3.14
Smoked before pregnancyf
Yes 1.74 0.98, 3.08 1.86 0.87, 3.94
No 1.00 1.00
Smoked during last 3 months of pregnancyg
Yes 3.52 1.53, 8.08 1.83 0.79, 4.22
No 1.00 1.00
Ever smokedg
Yes 3.57 1.57, 8.12 1.80 0.79, 4.12
No 1.00 1.00
Table 2. Risk of Nonreceipt of Dental Care During Pregnancy Associated With Selected Characteristics, by Presence or Absence of Self-Reported Dental Problems: Washington State PRAMS Study, 2000

Table 2.

Characteristica No Reported Dental Problems Reported Dental Problems
OR 95% CI OR 95% CI
Income (monthly), $b
<1200 1.27 0.58, 2.76 1.74 0.66, 4.59
1200-2099 1.62 0.78, 3.37 0.61 0.24, 1.59
2100-2999 1.00 1.00
≥3000 0.65 0.35, 1.20 0.48 0.18, 1.24
WIC participationc
Yes 1.75 1.04, 2.94 1.34 0.62, 2.90
No 1.00 1.00
Prenatal care payerc
Medicaid 1.05 0.56, 1.94 0.53 0.24, 1.15
Insurance/HMO 1.00 1.00
Self-pay 1.73 0.38, 7.89 0.63 0.08, 4.97
Military 1.15 0.38, 3.48 0.52 0.11, 2.55
Other 1.19 0.43, 3.29 0.64 0.20, 2.08
Trimester prenatal care initiatedd
First 1.00 1.00
Second or third 1.59 0.89, 2.85 1.00 0.47, 2.12
No care -- 0.62 0.05, 7.19
Prenatal care sitee
Private physician's office/HMO clinic 1.00 1.00
Hospital clinic 0.84 0.46, 1.56 0.65 0.29, 1.47
Health department clinic 0.58 0.24, 1.38 1.00 0.33, 3.05
Community or migrant health center 0.66 0.17, 2.51 1.01 0.24, 4.36
Other 1.10 0.53, 2.30 0.68 0.24, 1.92
Counseled on oral health care
Yes 1.00 1.00
No 22.32 14.22, 35.02 26.42 12.46, 56.02
Body mass index, kg/m2c
<18.5 (underweight) 1.90 0.82, 4.41 1.12 0.33, 3.81
18.5-24.9 (normal) 1.00 1.00
25.0-29.9 (overweight) 1.89 1.14, 3.13 1.18 0.54, 2.59
≥30.0 (obese) 1.88 1.09, 3.25 1.52 0.73, 3.14
Smoked before pregnancyf
Yes 1.74 0.98, 3.08 1.86 0.87, 3.94
No 1.00 1.00
Smoked during last 3 months of pregnancyg
Yes 3.52 1.53, 8.08 1.83 0.79, 4.22
No 1.00 1.00
Ever smokedg
Yes 3.57 1.57, 8.12 1.80 0.79, 4.12
No 1.00 1.00
Table 2. Risk of Nonreceipt of Dental Care During Pregnancy Associated With Selected Characteristics, by Presence or Absence of Self-Reported Dental Problems: Washington State PRAMS Study, 2000

In addition, among women without dental problems, risk of not receiving dental care was significantly associated with body mass index. The odds ratio among overweight women receiving no dental care was 1.9 (95% CI=1.1, 3.1), and the same odds ratio was observed among obese women who did not receive dental care (OR=1.9; 95% CI=1.1, 3.3). Among women with no dental problems, measures of smoking appeared strongly associated with risk of not receiving dental care; smoking during the final 3 months of pregnancy was associated with a 3.5-fold increase in risk of not receiving care (95% CI=1.5, 8.1). The results for women who had ever smoked were similar (OR=3.6; 95% CI=1.6, 8.1).

We also examined whether the association between selected risk factors and receipt of dental care during pregnancy varied among the women who reported having dental problems during their pregnancy ( Table 2 ). Nonreceipt of counseling on oral health care during pregnancy was associated with a high risk of not receiving dental care (OR=26.42; 95% CI=12.46, 56.02), and this was the most significant factor of those listed in Table 2 . None of the other associations between risk factors and nonreceipt of care were statistically significant.

Table 2.

Characteristica No Reported Dental Problems Reported Dental Problems
OR 95% CI OR 95% CI
Income (monthly), $b
<1200 1.27 0.58, 2.76 1.74 0.66, 4.59
1200-2099 1.62 0.78, 3.37 0.61 0.24, 1.59
2100-2999 1.00 1.00
≥3000 0.65 0.35, 1.20 0.48 0.18, 1.24
WIC participationc
Yes 1.75 1.04, 2.94 1.34 0.62, 2.90
No 1.00 1.00
Prenatal care payerc
Medicaid 1.05 0.56, 1.94 0.53 0.24, 1.15
Insurance/HMO 1.00 1.00
Self-pay 1.73 0.38, 7.89 0.63 0.08, 4.97
Military 1.15 0.38, 3.48 0.52 0.11, 2.55
Other 1.19 0.43, 3.29 0.64 0.20, 2.08
Trimester prenatal care initiatedd
First 1.00 1.00
Second or third 1.59 0.89, 2.85 1.00 0.47, 2.12
No care -- 0.62 0.05, 7.19
Prenatal care sitee
Private physician's office/HMO clinic 1.00 1.00
Hospital clinic 0.84 0.46, 1.56 0.65 0.29, 1.47
Health department clinic 0.58 0.24, 1.38 1.00 0.33, 3.05
Community or migrant health center 0.66 0.17, 2.51 1.01 0.24, 4.36
Other 1.10 0.53, 2.30 0.68 0.24, 1.92
Counseled on oral health care
Yes 1.00 1.00
No 22.32 14.22, 35.02 26.42 12.46, 56.02
Body mass index, kg/m2c
<18.5 (underweight) 1.90 0.82, 4.41 1.12 0.33, 3.81
18.5-24.9 (normal) 1.00 1.00
25.0-29.9 (overweight) 1.89 1.14, 3.13 1.18 0.54, 2.59
≥30.0 (obese) 1.88 1.09, 3.25 1.52 0.73, 3.14
Smoked before pregnancyf
Yes 1.74 0.98, 3.08 1.86 0.87, 3.94
No 1.00 1.00
Smoked during last 3 months of pregnancyg
Yes 3.52 1.53, 8.08 1.83 0.79, 4.22
No 1.00 1.00
Ever smokedg
Yes 3.57 1.57, 8.12 1.80 0.79, 4.12
No 1.00 1.00
Table 2. Risk of Nonreceipt of Dental Care During Pregnancy Associated With Selected Characteristics, by Presence or Absence of Self-Reported Dental Problems: Washington State PRAMS Study, 2000

Table 2.

Characteristica No Reported Dental Problems Reported Dental Problems
OR 95% CI OR 95% CI
Income (monthly), $b
<1200 1.27 0.58, 2.76 1.74 0.66, 4.59
1200-2099 1.62 0.78, 3.37 0.61 0.24, 1.59
2100-2999 1.00 1.00
≥3000 0.65 0.35, 1.20 0.48 0.18, 1.24
WIC participationc
Yes 1.75 1.04, 2.94 1.34 0.62, 2.90
No 1.00 1.00
Prenatal care payerc
Medicaid 1.05 0.56, 1.94 0.53 0.24, 1.15
Insurance/HMO 1.00 1.00
Self-pay 1.73 0.38, 7.89 0.63 0.08, 4.97
Military 1.15 0.38, 3.48 0.52 0.11, 2.55
Other 1.19 0.43, 3.29 0.64 0.20, 2.08
Trimester prenatal care initiatedd
First 1.00 1.00
Second or third 1.59 0.89, 2.85 1.00 0.47, 2.12
No care -- 0.62 0.05, 7.19
Prenatal care sitee
Private physician's office/HMO clinic 1.00 1.00
Hospital clinic 0.84 0.46, 1.56 0.65 0.29, 1.47
Health department clinic 0.58 0.24, 1.38 1.00 0.33, 3.05
Community or migrant health center 0.66 0.17, 2.51 1.01 0.24, 4.36
Other 1.10 0.53, 2.30 0.68 0.24, 1.92
Counseled on oral health care
Yes 1.00 1.00
No 22.32 14.22, 35.02 26.42 12.46, 56.02
Body mass index, kg/m2c
<18.5 (underweight) 1.90 0.82, 4.41 1.12 0.33, 3.81
18.5-24.9 (normal) 1.00 1.00
25.0-29.9 (overweight) 1.89 1.14, 3.13 1.18 0.54, 2.59
≥30.0 (obese) 1.88 1.09, 3.25 1.52 0.73, 3.14
Smoked before pregnancyf
Yes 1.74 0.98, 3.08 1.86 0.87, 3.94
No 1.00 1.00
Smoked during last 3 months of pregnancyg
Yes 3.52 1.53, 8.08 1.83 0.79, 4.22
No 1.00 1.00
Ever smokedg
Yes 3.57 1.57, 8.12 1.80 0.79, 4.12
No 1.00 1.00
Table 2. Risk of Nonreceipt of Dental Care During Pregnancy Associated With Selected Characteristics, by Presence or Absence of Self-Reported Dental Problems: Washington State PRAMS Study, 2000

In an effort to assess risk factors associated with self-identified dental problems during pregnancy, we stratified women according to receipt and nonreceipt of dental care ( Table 3 ). In the analysis involving women who received dental care during their pregnancy, low monthly income (in the $1200 to $2099 range) was the factor most strongly associated with an increased risk of reports of dental problems (OR=2.32; 95% CI=1.01, 5.3) ( Table 3 ). The results were similar (2-fold increased risk) among women with Medicaid coverage and among women who reported ever having smoked (OR=2.64; 95% CI=1.13, 6.19). Finally, no measures of selected risk factors were significantly associated with the presence or absence of reported dental problems among the subgroup of women who did not receive dental care during their pregnancy.

Table 3.

Characteristica Received Dental Care Did Not Receive Dental Care
OR 95% CI OR 95% CI
Income (monthly), $b
<1200 1.11 0.46, 2.67 1.44 0.61, 3.38
1200-2099 2.32 1.01, 5.34 0.77 0.32, 1.86
2100-2999 1.00 1.00
≥3000 0.55 0.26, 1.15 0.37 0.16, 0.87
WIC participationc
Yes 1.62 0.83, 3.18 1.37 0.68, 2.77
No 1.00 1.00
Prenatal care payerc
Medicaid 2.24 1.14, 4.38 0.87 0.39, 1.94
Insurance/HMO 1.00 1.00
Self-pay 0.57 0.10, 3.17 0.32 0.04, 2.58
Military 1.40 0.41, 4.78 0.99 0.24, 4.08
Other 2.50 0.80, 7.83 1.07 0.35, 3.28
Trimester prenatal care initiatedd
First 1.00 1.00
Second or third 0.71 0.35, 1.44 0.60 0.32, 1.13
No care -- 2.76 0.33, 22.97
Prenatal care sitee
Private physician's office/HMO clinic 1.00 1.00
Hospital clinic 0.98 0.42, 2.87 1.62 0.56, 4.66
Health department clinic 1.09 0.42, 2.87 1.62 0.56, 4.66
Community or migrant health center 0.81 0.17, 3.96 1.39 0.32, 5.94
Other 0.81 0.31, 2.11 0.73 0.29, 1.80
Counseled on oral health care
Yes 1.00 1.00
No 0.95 0.56, 1.60 1.12 0.55, 2.26
Body mass index, kg/m2c
<18.5 (underweight) 2.33 0.87, 6.22 1.20 0.39, 3.68
18.5-24.9 (normal) 1.00 1.00
25.0-29.9 (overweight) 1.65 0.89, 3.05 0.92 0.45, 1.85
≥30.0 (obese) 1.31 0.66, 2.60 1.17 0.61, 2.25
Smoked before pregnancyf
Yes 1.72 0.86, 3.44 1.69 0.88, 3.26
No 1.00 1.00
Smoked during last 3 months of pregnancyg
Yes 2.63 0.90, 7.69 1.15 0.54, 2.45
No 1.00 1.00
Ever smokedg
Yes 2.63 1.13,6.19 1.10 0.52, 2.34
No 1.00 1.00
Table 3. Risk of Dental Problems Associated With Selected Characteristics, by Receipt or Nonreceipt of Dental Care During Pregnancy: Washington State PRAMS Study, 2000

Table 3.

Characteristica Received Dental Care Did Not Receive Dental Care
OR 95% CI OR 95% CI
Income (monthly), $b
<1200 1.11 0.46, 2.67 1.44 0.61, 3.38
1200-2099 2.32 1.01, 5.34 0.77 0.32, 1.86
2100-2999 1.00 1.00
≥3000 0.55 0.26, 1.15 0.37 0.16, 0.87
WIC participationc
Yes 1.62 0.83, 3.18 1.37 0.68, 2.77
No 1.00 1.00
Prenatal care payerc
Medicaid 2.24 1.14, 4.38 0.87 0.39, 1.94
Insurance/HMO 1.00 1.00
Self-pay 0.57 0.10, 3.17 0.32 0.04, 2.58
Military 1.40 0.41, 4.78 0.99 0.24, 4.08
Other 2.50 0.80, 7.83 1.07 0.35, 3.28
Trimester prenatal care initiatedd
First 1.00 1.00
Second or third 0.71 0.35, 1.44 0.60 0.32, 1.13
No care -- 2.76 0.33, 22.97
Prenatal care sitee
Private physician's office/HMO clinic 1.00 1.00
Hospital clinic 0.98 0.42, 2.87 1.62 0.56, 4.66
Health department clinic 1.09 0.42, 2.87 1.62 0.56, 4.66
Community or migrant health center 0.81 0.17, 3.96 1.39 0.32, 5.94
Other 0.81 0.31, 2.11 0.73 0.29, 1.80
Counseled on oral health care
Yes 1.00 1.00
No 0.95 0.56, 1.60 1.12 0.55, 2.26
Body mass index, kg/m2c
<18.5 (underweight) 2.33 0.87, 6.22 1.20 0.39, 3.68
18.5-24.9 (normal) 1.00 1.00
25.0-29.9 (overweight) 1.65 0.89, 3.05 0.92 0.45, 1.85
≥30.0 (obese) 1.31 0.66, 2.60 1.17 0.61, 2.25
Smoked before pregnancyf
Yes 1.72 0.86, 3.44 1.69 0.88, 3.26
No 1.00 1.00
Smoked during last 3 months of pregnancyg
Yes 2.63 0.90, 7.69 1.15 0.54, 2.45
No 1.00 1.00
Ever smokedg
Yes 2.63 1.13,6.19 1.10 0.52, 2.34
No 1.00 1.00
Table 3. Risk of Dental Problems Associated With Selected Characteristics, by Receipt or Nonreceipt of Dental Care During Pregnancy: Washington State PRAMS Study, 2000

Discussion

In this cross-sectional survey, we identified previously unreported factors potentially amenable to clinical and public health interventions. Among women without reported dental problems, elevated risks of not receiving dental care were associated with not being counseled on oral health care, obesity, and either smoking during the final 3 months of pregnancy or ever having smoked. Obesity[17-19] and smoking[20-24] have previously been shown to have an adverse effect on dental health care among nonpregnant populations; however, to our knowledge this is the first study to report on these associations during pregnancy, providing new information on a serious and underaddressed problem among pregnant women.[2,3] Finally, the size of the increase in risk associated with not receiving dental care and not being counseled on oral health care was similar regardless of whether or not women reported dental problems.

When we conducted separate analyses according to receipt and nonreceipt of dental care during pregnancy, we found somewhat divergent risk factor patterns associated with self-reported dental problems. Among women who received dental care, the association with dental problems was significant for those with lower monthly incomes, those with Medicaid coverage, and those who reported ever having smoked. These results are generally consistent with the results of 2 cross-sectional studies suggesting that, among pregnant women, there is a relationship between low socioeconomic status and likelihood of not obtaining dental care.[2,3]

In contrast, we found no significant association between late prenatal care and dental care use. A previous PRAMS study conducted in Illinois, Louisiana, and New Mexico reported a 42% to 53% increased risk of nonuse associated with late prenatal care, but self-reported dental care problems were not examined.[2] In addition, this multistate PRAMS study did not control for confounders, which may have increased any risks associated with prenatal care; in this study, we controlled for multiple factors. Use of statewide PRAMS data to investigate the associations between risk factors and dental care allowed us to measure and take into account the influence of important confounding factors that have the potential to distort the associations between selected risk factors and dental care use, thus avoiding the probable overestimation or underestimation of reported associated risks.

Our study involved important methodological limitations. For example, our survey asked "Did you need to see a dentist for a problem?" but did not distinguish the type of dental problem or whether the woman underwent preventive care, a routine dental examination, restorative procedures, or emergency care. Data on type of care are important, because women who receive preventive care are less likely to develop periodontal disease, which has been linked to adverse birth outcomes such as preterm delivery.[4,7,9,10,25,26]

Similarly, PRAMS does not collect information on dental insurance coverage, which is a primary determinant in whether people obtain dental care.[27-31] Therefore, we were unable to assess the impact of dental coverage. Also, because we lacked important information on women's reasons for not obtaining dental care (e.g., perceived fear of harm to their fetus), our ability to examine behavioral determinants was limited. Finally, nonrespondents were more likely to be multiparous, unmarried, and Black and less likely to have completed high school than respondents, raising the possibility of nonresponse bias. However, because nonrespondents were similar, in terms of demographic characteristics, to respondents who did not have optimal dental care, we believe that such a bias would underestimate the reported risks.

Despite these limitations, our findings should illustrate to health care providers and public health clinics that pregnant women frequently do not obtain dental care and have unmet dental care needs. Our findings also suggest several important clinical and public health interventions. Since 83.4% of all women begin prenatal care in their first trimester, our results may encourage the development of strategies for early identification of risk factors among women who have dental care problems or do not receive dental care.[32]

Providers and public health clinics already have an established role in the prevention and early identification of health problems and routinely discuss a variety of topics; this role could be expanded to include provision of counseling and screening on oral health and dental care in early pregnancy. Surprisingly, 54% of the women taking part in our study reported that they had not been counseled on how to care for their teeth and gums, and the overall frequency of pregnant women not receiving dental care during pregnancy was relatively high. Since dental diseases are preventable, maternity care providers have a unique opportunity during routine prenatal visits to provide simple, preventive counseling on oral health. At a minimum, providers should advise women about proper care (e.g., flossing and brushing).[33] Our results indicate a need for repeated screening of women at greater risk of unmet oral care needs, particularly women who are obese or smoke.

Because, to our knowledge, no US general population-based surveys oversample pregnant women or provide sufficient dental care information on a representative sample of such women,[34] and because the PRAMS state-based population-based surveillance system is the closest we have to a national surveillance system, refinement of the dental care questions merits further consideration. Redesigned comprehensive questions with established psychometric properties regarding preventive and reparative care and dental insurance coverage would provide more useful information amenable to intervention and program planning. Also, explorations of linkages between PRAMS and dental claims data may allow not only evaluation of temporal issues surrounding dental care use but also determination of whether antenatal dental care events are related to subsequent outcomes such as preterm delivery or low birthweight.

In conclusion, given the markedly low rate of dental care counseling reported by the present sample of pregnant women, there is a need for enhanced education and training of physicians, midwives, and other practitioners concerning oral heath in pregnancy. Since women who do not receive dental care during their pregnancy are more likely to be obese or to smoke, lack of dental care may be a marker for poor health. Paralleling other perinatal health trends, oral health risk factors highlight the importance of known effective preventive prenatal care interventions such as smoking cessation. Finally, because obesity and tobacco use may spuriously indicate noncausal associations between dental problems such as periodontitis and adverse pregnancy outcomes, these factors should be taken into account in future research.[35]

References

Tracking Healthy People 2010. Washington, DC: US Dept of Health and Human Services; 2000.
Gaffield ML, Gilbert BJ, Malvitz DM, Romaguera R. Oral health during pregnancy: an analysis of information collected by the Pregnancy Risk Assessment Monitoring System. J Am Dent Assoc. 2001;132:1009-1016.
Mangskau KA, Arrindell B. Pregnancy and oral health: utilization of the oral health care system by pregnant women in North Dakota. Northwest Dent. 1996;75:23-28.
Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenerg RL, Hauth JC. Periodontal infection and preterm birth: results of a prospective study. J Am Dent Assoc. 2001;132:875-880.
Offenbacher S, Jared HL, O'Reilly PG, et al. Potential pathogenic mechanisms of periodontitis associated pregnancy complications. Ann Periodontol. 1998;3:233-250.
Offenbacher S, Katz V, Fertik G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol. 1996;67:1103-1113.
Mitchell-Lewis D, Engebretson SP, Chen J, Lamster IB, Papapanou PN. Periodontal infections and pre-term birth: early findings from a cohort of young minority women in New York. Eur J Oral Sci. 2001;109:34-39.
Gunay H, Dmoch-Bockhorn K, Gunay Y, Geurtsen W. Effect on caries experience of a long-term preventive program for mothers and children starting during pregnancy. Clin Oral Invest. 1998;2:137-142.
Dasanayake AP. Poor periodontal health of the pregnant woman as a risk factor for low birth weight. Ann Periodontol. 1998;3:206-212.
Dasanayake AP, Boyd D, Madianos PN, Offenbacher S, Hills E. The association between Porphyromonas gingivalis-specific maternal serum IgG and low birth weight. J Periodontol. 2001;72:1491-1497.
Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res. 2000;79:882-887.
Surgeon General's Report on Oral Health. Washington, DC: US Dept of Health and Human Services; 2000.
Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health. 2001;91:436-440.
Cnattingius S, Lambe M. Trends in smoking and overweight during pregnancy: prevalence, risks of pregnancy complications, and adverse pregnancy outcomes. Semin Perinatol. 2002;26:286-295.
Gilbert B, Shulman HB, Fischer LA, Rogers MM. The Pregnancy Risk Assessment Monitoring System: methods and 1996 response rates from 11 states. Maternal Child Health J. 1999;3:199-209.
Maternal and Child Health Assessment Section. Washington State Pregnancy Risk Assessment Monitoring System. Olympia, Wash: Washington State Dept of Health; 2000.
Forslund HB, Lindroos AK, Blomkvist K, et al. Number of teeth, body mass index, and dental anxiety in middle-aged Swedish women. Acta Odontol Scand. 2002;60:346-352.
Sheiham A, Steele JG, Marcenes W, Finch S, Walls AW. The relationship between oral health status and body mass index among older people: a national survey of older people in Great Britain. Br Dent J. 2002;192:703-706.
al-Isa AN, Moussa MA. Factors associated with overweight and obesity among Kuwaiti kindergarten children aged 3-5 years. Nutr Health. 1999;13:125-139.
Macek MD, Reid BC, Yellowitz JA. Oral cancer examinations among adults at high risk: findings from the 1998 National Health Interview Survey. J Public Health Dent. 2003;63:119-125.
Karikoski A, Murtomaa H. Periodontal treatment needs in a follow-up study among adults with diabetes in Finland. Acta Odontol Scand. 2003;61:6-10.
Kirkevang LL, Wenzel A. Risk indicators for apical periodontitis. Community Dent Oral Epidemiol. 2003;31:59-67.
Thomson WM, Williams SM. Partial- or full-mouth approaches to assessing the prevalence of and risk factors for periodontal disease in young adults. J Periodontol. 2002;73:1010-1014.
Mucci LA, Brooks DR. Lower use of dental services among long term cigarette smokers. J Epidemiol Community Health. 2001;55:389-393.
Lopez NJ, Smith PC, Gutierrez J. Higher risk of preterm birth and low birth weight in women with periodontal disease. J Dent Res. 2002;81:58-63.
Hill GB. Preterm birth: associations with genital and possibly oral microflora. Ann Periodontol. 1998;3:222-232.
Skaret E, Milgrom P, Raadal M, Grembowski D. Factors influencing whether low-income mothers have a usual source of dental care. ASDC J Dent Child. 2001;68:136-139.
Vargas CM, Ronzio CR, Hayes KL. Oral health status of children and adolescents by rural residence, United States. J Rural Health. 2003;19:260-268.
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Stewart DC, Ortega AN, Dausey D, Rosenheck R. Oral health and use of dental services among Hispanics. J Public Health Dent. 2002;62:84-91.
Manski RJ, Edelstein BL, Moeller JF. The impact of insurance coverage on children's dental visits and expenditures, 1996. J Am Dent Assoc. 2001;132:1137-1145.
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Authors and Disclosures
Mona T. Lydon-Rochelle is with the Department of Family and Child Nursing, School of Nursing, and the Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle. Paula Krakowiak is with the Department of Epidemiology, School of Public Health and Community Medicine, University of Washington. Philippe P. Hujoel is with the Department of Epidemiology, School of Public Health and Community Medicine, and the Departments of Dental Public Health Sciences and Oral Medicine, School of Dentistry, University of Washington. Riley M. Peters is with the Office of Maternal and Child Health, Washington State Department of Health, Olympia.

Acknowledgments
M.T. Lydon-Rochelle conceived the study and supervised all aspects of its completion. P. Krakowiak and R.M. Peters assisted with the programming and analyses. P.P. Hujoel assisted with data interpretation. All of the authors helped to conceptualize ideas, interpret findings, and review drafts of the article.
The Human Subjects Protection Review Board of the State of Washington Department of Health approved this study for minimal risk status.
Funding Information
This study was funded by a grant from the University of Washington Research and Intramural Fund.
Reprint Address
Mona T. Lydon-Rochelle, PhD, MPH, CNM, Mailstop 357262, University of Washington, Seattle, WA 98195-7262 (e-mail: minot@u.washington.edu).
American Journal of Public Health. 2004;94(5) © 2004 American Public Health Association


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From American Journal of Public Health
Dental Care Use and Self-Reported Dental Problems in Relation to Pregnancy
Mona T. Lydon-Rochelle, PhD, MPH, CNM; Paula Krakowiak, MS; Philippe P. Hujoel, PhD, MPH; Riley M. Peters, PhD
Published: 05/03

OBloodyHell said...

Thai, JUST FROM THE ABSTRACT:

Objectives: We examined the relationships between risk factors amenable to intervention and the likelihood of dental care use during pregnancy.
Methods: We used data from the Washington State Department of Health's Pregnancy Risk Assessment Monitoring System.
Results: Of the women surveyed, 58% reported no dental care during their pregnancy. Among women with no dental problems, those not receiving dental care were at markedly increased risk of having received no counseling on oral health care, being overweight, and using tobacco. Among women who received dental care, those with dental problems were more likely to have lower incomes and Medicaid coverage than those without dental problems.
Conclusions: There is a need for enhanced education and training of maternity care providers concerning oral health in pregnancy.
How does this support your generic, sweeping claim: The examples of bumbling care I could share with you in America's bizarre system would fill this blog for weeks."???

The abstract doesn't describe BUMBLING. It describes a possible weakness. It even NOTES up front that a lot of women don't have a problem AT ALL:

Among women with no dental problems, those not receiving dental care were at markedly increased risk of having received no counseling on oral health care, being overweight, and using tobacco.In short, they had NO PROBLEMS, but somehow the care received was *inadequate*? That's flat out STUPID to claim.
They had NO problems, but they clearly MUST get more counseling as a result. Yeah, right. WHO gts to define "adequate" ... the ones who stand to make more money if more care is provided? Ah, I see.COULD they use more care? Perhaps. You're not making the case for it here.

Did they NEED it? F*** no.And this is kind of relevant to your thesis:

One of the Healthy People 2010 objectives is to increase the proportion of adults who use the oral health care system each year.So their OBJECTIVE is to JUSTIFY more work for Dentists and other mouth care specialists.

Not to analyze the needs of the community, and identify where such supply may be falling short...

No, its STATED PURPOSE is to JUSTIFY more work for Dentists.===========

And THIS, Thai, is why I insist on more detail from you. That kind of shoddy reasoning and justification on your part is typical, in my experience, of people with your stance.

Either you have a vested interest for your own finances in "mo-money-mo-moneey-mo-money-mo!!"...

...or you have faulty justifications for taking the arguments you take seriously as gospel. For you, the latter is clearly the case, at the least.

Citing a single study which openly states it has an objective of jusifying more money spent on healthcare, rather than citing one which identifies serious shortfalls in the available care by showing the results of it, is just the sort of thing supporters of centralized health care do.

Clearly, there's no bias possible in the report you just cited, after all.
:-S

Excuse me while I trot out my statistics on the bad side of "gun control" that come from the "Happiness Is a Warm Gun" website... LOL.

Thai said...

@OBH

Are you even following the conversation between Carl and I?

Your responses suggest you are not following it and that you are just interested in more "I want to argue with Liberals" stuff that makes you so offensive in the first place and in which I have no interest.

I tolerate you ONLY because I am interested in conversion with Carl and he tolerates you. Otherwise, trust me, I would be gone.

Carl said...

First cut metric Monday morning.