Biomedical subjects
Publications and source records attributed to Steven P Perlman.
Federal and state governments are in the midst of a fiscal crisis that has led to cuts--which may increase in the future--in vital programs for the health and welfare of children. The impact of these reductions is considered in terms of the current economic and social environment of children who rely on many of these programs for needed services.
Reporting that there are millions of children (and adults) with disabilities reduces these individuals to just numbers-not actual people. The use of mega numbers and national averages obscures the major disparities that exist in the proportion of children with special needs in different areas of the country. In an effort to personalize these national numbers and bring about increased attention to the 2.6 million children (5-15 years of age) with disabilities, a review of the proportion of noninstitutionalized children with disabilities is reported by a series of geopolitical jurisdictions. The profession is challenged to increase care to children with disabilities--children who may be members of families being treated in many dental practices.
Government programs, particularly Medicare, provide extremely limited funds for dental services. As a result, the government absorbs fewer dental costs than the costs for other health services. Despite the need for support of dental services for children, it may become politically expedient to support the expansion of Medicare to include dental care for the increasing numbers of dentate baby boomers. The economic case for Medicare dentistry is presented as a harbinger for continued underfunding by the federal government for dental care for children.
A series of large city rankings developed from federal agency reports were reviewed to increase appreciation of the factors that impact the general health of newborns. Efforts to provide the "right start" for the beginning of life may decrease the incidence of children with developmental disabilities.
The 2000 Census data indicating the numbers of children with disabilities in Pennsylvania is presented and broken down by city, metropolitan area and congressional districts. There are numerous difficulties associated with the delivery of dental care to these youngsters with special needs. Nevertheless, if all dentists were willing to help, each practitioner would need to care for only 14 of these youngsters.
The first National Health Interview Survey to collect data on children, 6 to 11 years of age, with attention deficit disorder (ADD) and/or learning disability (LD) provided specific information on: (1) the widespread demographic distribution of children with ADD and LD, (2) related health conditions, (3) use of special education programs, and (4) the extensive use of health care services. The underlying reality was the increasing need for information because dental practitioners provide services to many of these children in their communities.
Evolving residential requirements for individuals with mild and moderate intellectual disabilities and related developmental disabilities increasingly place these persons in community settings. The increasing numbers of these individuals are dependent upon local practitioners for needed health services. National and Pennsylvania data are reviewed in an effort to provide a general awareness of these community living arrangements, which in turn may assist in the delivery and the follow-up of oral health services.
Increased numbers of female pediatric and general dentists are considered in terms of their potential to provide services for children (and adults) with special health care needs. Reviewed in this are: (1) practitioner work patterns; (2) increasing numbers of children in community residences; (3) the general need for dental services; (4) changing educational standards; and (5) practitioner willingness to provide care.
In 2000, an estimated 4,420 children (33 per 1,000 births) were born with a disability in Pennsylvania. In addition, more than 1.8 million Medicare enrollees (age 65 and older) were residents of the state. Selected estimated costs were developed for these two populations at state and county levels.
National surveys demonstrate an increased proportion of children with health insurance coverage. Much of this rise is a reflection of increases in public insurance arrangements. Nevertheless, in the early 2000s, millions of children, particularly Hispanic children, continued to lack health insurance. There were marked differences in coverage rates between different Hispanic subgroups, with 34% of Mexican American children, compared to 10% of Cuban American children, lacking insurance. The purpose of this case report was to show that the absence of insurance coverage is associated with limited access to care.
Increasing urbanization of Native Americans will bring community health practitioners into contact with a patient population that has potentially different cultural orientations and with individuals in difficult general health and living conditions. Pediatric providers will be faced with a population of youngsters, a greater percentage of whom will have disabilities than the general pediatric population. The challenge will be to meet the "usual" oral health needs of community youngsters--family members whose heritage and culture may be quite different from those of the practitioner and staff.
Explore the source record for details and available documents.
The purpose of this review of the 2001 National Survey of Children with Special Health Care Needs (SHCN) was to offer an overview of these youngsters from the perspective of parents. Survey findings include: (1) Nearly 13% (9.4 million) of US children were reported to have SHCN, with the highest prevalence rates among children living in poverty and among Native American children. (2) Dental care was the most commonly reported needed service that was not received. (3) Despite the availability of public forms of insurance, compared to children with private insurance, low-income SHCN children are 2 to 3 times more unlikely to obtain needed health services. (4) SHCN children have a significant impact on family time requirements, economics, and employment patterns. The challenge is to use this information to improve services for SHCN children.