Arnaldo Perez

Factors associated with patient and parent satisfaction after orthodontic treatment: A systematic review

INTRODUCTION Our objective was to identify factors associated with orthodontic treatment satisfaction of patients and their caregivers, when applicable. METHODS MEDLINE via Ovid, PubMed, EBM Reviews and EMBASE via OVIDSP, LILACS, Web of Science, and Google Scholar were searched electronically. Reference lists of included articles were also screened for potential relevant studies missed during the electronic searches. Studies evaluating the satisfaction levels of patients or caregivers after orthodontic treatment were considered. Methodologic quality of the included studies was assessed using a modified Newcastle-Ottawa scale. RESULTS Eighteen studies satisfied the inclusion criteria, representing 2891 patients and 464 parents. The risk of bias was moderate in 13 and low in 4 of the included articles. The studies used different questionnaires and timings to assess postorthodontic treatment satisfaction. Based on the available limited evidence, satisfaction was associated with perceived esthetic outcomes, psychological benefits, and quality of care. The latter was specifically linked to dentist-staff-patient interactions. Dissatisfaction was associated with treatment duration, pain levels and discomfort, and the use of retention appliances. When both assessments were available, the patients and the parents satisfaction levels were strongly correlated. CONCLUSIONS Based on the limited available evidence with moderate risk of bias, we identified factors that appear to be more commonly associated with a high or low level of satisfaction. Consideration of these factors could be important for practitioners attempting to set realistic expectations of their patients and caregivers regarding orthodontic treatment outcomes.

Paradoxically speaking about engagement in pediatric weight management

Consistent with previous research showing that childhood obesity is more prevalent in low-income children (1), a paper recently published in Pediatric Obesity reported a positive relationship between children’s BMI and social adversities including financial difficulties in families (2). In the present article, we argue that children representing ethnic minority populations and lower-income families are not only at greater risk of obesity but also at heightened risk of poor engagement and utilization of pediatric weight management services. Along with effective interventions, optimal engagement of children and families is required to address pediatric obesity and its adverse medical (e.g. risk of type 2 diabetes), emotional (e.g. depression) and social (e.g. isolation) consequences (3). Engagement in pediatric weight management, broadly defined as broadly defined as treatment-related decisions and actions that may or may not benefit patients, is characterized by low enrolment, high attrition and poor adherence (4–6). It is our view that three paradoxes related to engagement might help to explain why many children and families fail to achieve optimal outcomes in pediatric weight management.

Dimensional Analysis of Psychosocial Barriers to Prevention of Early Childhood Caries Among Recent Immigrants

The objective of this article is to define the underlying dimensions of psychosocial barriers to obtaining and providing dental care for young children among recent immigrants. Fifteen focus groups were conducted with 99 primary caregivers from African, South Asian, and Chinese recent immigrants. A secondary analysis of identified barriers using dimensional analysis methodology was performed to determine dimensions and properties of barriers. The analysis continued until irreducible properties were found or emerging dimensions were not relevant to the study. Identified dimensions were associated with barriers and individuals. Type, number, level, objectiveness, nature, and impact were barrier-related; awareness and controllability were individual-related dimensions. Type refers to barriers themselves. Number and level indicate the amount and location of barriers, respectively. Objectiveness refers to the extent that perceived barrier reflects reality and nature indicates its intrinsic characteristic. Impact concerns behaviors, goals, and outcomes compromised by barriers. Awareness alludes to the extent that individuals are aware of the barriers and controllability explains how much control people perceive to have over barriers. Identified dimensions are useful for better understanding and addressing existing barriers to children’s optimal oral health.

Predicting Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management

Objectives To characterize the children who were referred, determine the proportion of referred children who enrolled, and examine factors associated with enrollment in multidisciplinary clinical care for pediatric weight management. Study design This cross‐sectional study included the population of children (2‐17 years of age; body mass index of ≥85th percentile) referred to 1 of 3 hospital‐based multidisciplinary weight management clinics in Alberta, Canada, from April 2013 to April 2016. Referral and enrollment data were obtained from Alberta Health Services databases. Bivariate and multivariable logistic regression models were used to determine the independent and combined effects of predictors of enrollment. Results Of the 2014 children (51.8% male; mean body mass index z‐score: 3.42 ± 0.03) referred to multidisciplinary clinical care, 757 (37.6%) enrolled in care. Most referred children had severe obesity and were referred by physicians. Several factors independently predicted enrollment; however, in our most parsimonious multivariable model, only the time gap (OR, 0.94; 95% CI, 0.88‐0.99; P = .03) between the attendance date of the orientation session and the booking date of initial appointment predicted enrollment for all children. Body mass index z‐score (OR, 0.81; 95% CI, 0.67‐0.98; P = .03) and time gap (OR, 0.92; 95% CI, 0.85‐0.99; P = .02) predicted enrollment in children with severe obesity exclusively. Conclusions Fewer than 40% of referred children enrolled in multidisciplinary clinical care. Reducing the duration of enrollment and providing additional support for treatment initiation to children with severe obesity may enhance treatment uptake for pediatric weight management.

Parent Recommendations to Enhance Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management.

Objective To explore parents’ recommendations to enhance enrollment in multidisciplinary clinical care for managing pediatric obesity. Study design Data for this interpretative description study were collected through individual, semistructured interviews that were audiorecorded, transcribed verbatim, and analyzed thematically. Parents (n = 79) were recruited from 4 multidisciplinary weight management clinics in Canada located in Edmonton, Hamilton, Montreal, and Vancouver. Results Most interviewed parents had children with obesity (body mass index ≥95th percentile; 84.2%), were female (87.3%), had postsecondary education (69.6%), and were white (75.9%). Parents’ recommendations referred to enrollment opportunities, information about obesity services, motivation for treatment, and accessibility to obesity services. Specifically, parents recommended to increase referral options and follow‐up contacts with families during the enrollment process, inform referring physicians and families about the availability and characteristics of obesity services, enhance families’ motivation for treatment, prevent families from getting discouraged, make services more appealing to families, and address accessibility issues (eg, offering multiple options for appointment times, providing support for transportation). Conclusions Parents’ recommendations support the need for family‐centered approaches to enhance enrollment; however, their feasibility, acceptability, and effectiveness remain to be tested empirically.

Helping children and families to enrol in weight management: What can stakeholders do?

Many children and their families do not benefit from multidisciplinary clinical care (MCC) for paediatric weight management because they do not enrol in (initiate) treatment. The purpose of this report was to highlight practical recommendations to enhance the enrolment of Canadian children in MCC, which were drawn from multisite Canadian studies (quantitative and qualitative) that we completed recently. Recommendations to stakeholders, including primary care providers, MCC providers and decisions makers, were organized according to opportunities, motivation and barriers to enrol. Findings from our research suggested that enrolment in MCC can be improved by increasing opportunities and motivation to enrol as well as reducing the impact of enrolment barriers.

Is there a role for shared decision-making in pediatric weight management?

Shared decision-making (SDM) is central to personalising health and medical decisions. This decisional model encourages patients to act as managers of their own care while maintaining a partnership with health professionals. Although applied to some conditions, SDM has been used infrequently in pediatric weight management (PWM). Herein, we highlight the applicability and usefulness of SDM in making several important decisions related to PWM, including referral-making to different levels of care and treatment initiation and implementation. We conclude by describing possible challenges that may arise when implementing this model and suggest strategies to optimise the use of SDM in PWM.

The engagement pathway: A conceptual framework of engagement-related terms in weight management

Engagement denotes the extent to which, and how, individuals participate in weight management (WM) services. Effective WM services should generate meaningful outcomes and promote high participant engagement; however, research is predominantly focused on the former. Given that engagement is a poorly understood phenomenon, and that engagement-related concepts are often used synonymously (e.g., dropout and attrition), the engagement pathway is hereby introduced. This pathway defines key concepts (e.g., recruitment, adherence, attrition) and their relationships in the enrolment, intervention, and maintenance stages of treatment. The pathway will help researchers and practitioners better understand engagement-related concepts whilst encouraging greater conceptual consistency between studies.

Families’ perceived benefits of home visits for managing paediatric obesity outweigh the potential costs and barriers

Home visits have successfully been used to deliver various health services, but what role could they play in paediatric weight management? Low treatment initiation and high attrition prompted our multidisciplinary paediatric weight management clinic to investigate how families perceived the benefits and barriers of home visits.

Letter to the Editor: "Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline"

We read with interest the recently published clinical practice guidelines for preventing and treating childhood obesity (1). The authors reported their evaluation of the quality of the evidence and an assessment of the strength of recommendations according to objective criteria across a diverse literature. In our view, however, this excellent and comprehensive report does not mention two relevant issues: attrition and enrollment. These issues are likely to be of concern for clinicians, administrators, and researchers because they can have a substantial impact on clinical care.