A randomised, controlled clinical trial comparing chlorhexidine gel and low-dose fluoride toothpaste to prevent early childhood caries

Objectives This randomised, controlled trial compared the effectiveness of 0.12% chlorhexidine (CHX) gel and 304% fluoride toothpaste to prevent early childhood caries (ECC) in a birth cohort by 24 months. Methods The participants were randomised to receive either (i) twice daily toothbrushing with toothpaste and once daily 0.12% CHX gel (n = 110) or (ii) twice daily toothbrushing with toothpaste only (study controls) (n = 89). The primary outcome measured was caries incidence and the secondary outcome was percentage of children with mutans streptococci (MS). All mothers were contacted by telephone at 6, 12, and 18 months. At 24 months, all children were examined at a community dental clinic. Results At 24 months, the caries prevalence was 5% (3/61) in the CHX and 7% (4/58) in the controls (P = 0.7). There were no differences in percentages of MS-positive children between the CHX and control groups (54%vs 53%). Only 20% applied the CHX gel once daily and 80% less than once daily. Conclusions Toothbrushing using 304% fluoride toothpaste with or without the application of chlorhexidine gel (0.12%) reduces ECC from 23% found in the general community to 5–7%. The lack of effect with chlorhexidine is likely to be due to low compliance.

Cost-effectiveness of a telephone-delivered education programme to prevent early childhood caries in a disadvantaged area : a cohort study

Objectives Early childhood caries is a highly destructive dental disease which is compounded by the need for young children to be treated under general anaesthesia. In Australia, there are long waiting periods for treatment at public hospitals. In this paper, we examined the costs and patient outcomes of a prevention programme for early childhood caries to assess its value for government services. Design Cost-effectiveness analysis using a Markov model. Setting Public dental patients in a low socioeconomic, socially disadvantaged area in the State of Queensland, Australia. Participants Children aged 6 months to 6 years received either a telephone prevention programme or usual care. Primary and secondary outcome measures A mathematical model was used to assess caries incidence and public dental treatment costs for a cohort of children. Healthcare costs, treatment probabilities and caries incidence were modelled from 6 months to 6 years of age based on trial data from mothers and their children who received either a telephone prevention programme or usual care. Sensitivity analyses were used to assess the robustness of the findings to uncertainty in the model estimates. Results By age 6 years, the telephone intervention programme had prevented an estimated 43 carious teeth and saved £69 984 in healthcare costs per 100 children. The results were sensitive to the cost of general anaesthesia (cost-savings range £36 043–£97 298) and the incidence of caries in the prevention group (cost-savings range £59 496–£83 368) and usual care (cost-savings range £46 833–£93 328), but there were cost savings in all scenarios. Conclusions A telephone intervention that aims to prevent early childhood caries is likely to generate considerable and immediate patient benefits and cost savings to the public dental health service in disadvantaged communities.

The impact of professional development on early childhood educators’ confidence, understanding and knowledge of education for sustainability

In recent times, Australia has recognised and enacted a range of initiatives at service, system and community levels that seek to embed sustainability into the early childhood sector. This paper explores the impact of a professional development (PD) session that provided opportunities for early childhood educators to learn and share ideas about the theory and practice of sustainability generally and early childhood education for sustainability (ECEfS) specifically. The PD was entitled ‘Living and Learning about Sustainability in the Early Years’ and was offered on three occasions across Tasmania. A total of 99 participants attended the three PD sessions (one 5 hour; two 2 hour). The participants had varying levels of experience and included early childhood teachers, centre based educators and preservice teachers. At the start and end of the PD, participants were invited to complete a questionnaire that contained a series of likert scale questions that explored their content knowledge, level of understanding and confidence in regards to ECEfS. Participants were also asked at the start and end of the PD to ‘list five words you think of when you consider the word sustainability.’ A model of teacher professional growth was used to conceptualise the results related to the changes in knowledge, understanding and confidence (personal domain) as a result of the PD related to ECEfS (external domain). The likert-scale questions on the questionnaire revealed significant positive changes in levels of knowledge, understanding and confidence from the start to the end of the PD. Differences as a function of length of PD, level of experience and role are presented and discussed. The ‘5 words’ question showed that participants widened their understandings of ECEfS from a narrow environmental focus to a broader understanding of the social, political and economic dimensions. The early childhood education and care (ECEC) sector has been characterised as having a pedagogical advantage for EfS suggesting that early childhood educators are well placed to engage with EfS more readily than might educators in other education sectors. This article argues that PD is necessary to develop capability in educators in order to meet the imperatives around sustainability outlined in educational policy and curriculum documents in ECEC.

Choroidal thickness in childhood

Purpose To examine choroidal thickness (ChT) and its spatial distribution across the posterior pole in pediatric subjects with normal ocular health and minimal refractive error. Methods ChT was assessed using spectral domain optical coherence tomography (OCT) in 194 children aged between 4-12 years, with spherical equivalent refractive errors between +1.25 and -0.50 DS. A series of OCT scans were collected, imaging the choroid along 4 radial scan lines centered on the fovea (each separated by 45°). Frame averaging was used to reduce noise and enhance chorio-scleral junction visibility. The transverse scale of each scan was corrected to account for magnification effects associated with axial length. Two independent masked observers manually segmented the OCT images to determine ChT at foveal centre, and averaged across a series of perifoveal zones over the central 5 mm. Results The average subfoveal ChT was 330 ± 65 µm (range 189-538 µm), and was significantly influenced by age (p=0.04). The ChT of the 4 to 6 year old age group (312 ± 62 µm) was significantly thinner compared to the 7 to 9 year olds (337 ± 65 µm, p<0.05) and bordered on significance compared to the 10 to 12 year olds (341 ± 61 µm, p=0.08). ChT also exhibited significant variation across the posterior pole, being thicker in more central regions. The choroid was thinner nasally and inferiorly compared to temporally and superiorly. Multiple regression analysis revealed age, axial length and anterior chamber depth were significantly associated with subfoveal ChT (p<0.001). Conclusions ChT increases significantly from early childhood to adolescence. This appears to be a normal feature of childhood eye growth.

ICT and internet usage in early childhood education : a comparative study of Australian and Malaysian teachers' beliefs and current practices

The thesis is a comparative study of ICTs and Internet use of Australian and Malaysian early childhood teachers in terms of their personal and professional comfort with ICTs, pedagogical beliefs, and their reported classroom practice. The study discovered teachers from both countries as relatively comfortable with digital technologies and the Internet, with most teachers held positive beliefs about ICT usage. The structural barriers in classrooms include lack of Internet access and the wide gap that exists between teachers’ positive beliefs and classroom practice. The study suggests the need for strategic and targeted professional development for teachers.

Early life predictors of preschool overweight and obesity : a case–control study in Sri Lanka

Background Childhood obesity increases the risk of obesity in adulthood and is associated with cardiovascular disease risk factors. Our aim was to assess the early life risk factors associated with overweight and obesity among preschool children. Methods In this case–control study, from the 1087 preschool children measured, age, sex and ethnicity matched 71 cases and 71 controls were recruited. Cases and controls were defined according to the WHO 2006 growth standards. The birth and growth characteristics were extracted from the child health development records. Infant feeding practices and maternal factors were obtained from the mother. Rapid weight gain was defined as an increase in weight-for-age Z score (WHO standards) above 0.67 SD from birth to 2 years. The magnitude and significant difference in mean values of the variables associated with overweight and obesity were evaluated using logistic regressions and paired t-test, respectively. Results Cases had significantly shorter duration (months) of breastfeeding (19.4, 24.6, p = 0.003), and smaller duration (months) of exclusive breastfeeding (3.7, 5.1, p = 0.001) compared to controls. Rapid weight gain (OR = 6.3, 95% CI = 2.04–19.49), first born status (OR = 3.6, 95% CI = 1.17-10.91) and pre-pregnancy obesity (OR = 4.0, 95% CI = 1.46-10.76) were positively associated with overweight and obesity. Breastfeeding more than 2 years (OR = 0.2, 95% CI = 0.06-0.57) was negatively associated with overweight and obesity. Conclusion Rapid weight gain within first two years, first–born status and pre-pregnancy obesity of the mother contributed for preschool obesity. Our results suggest that intervention may be indicated earlier in infancy and during the toddler and preschool years to tackle the increasing prevalence of obesity.

A snapshot of 40 years in early childhood education and care through oral histories

The year 2012 marked 40 years since the introduction of the Child Care Act 1972 and the federal government introduced financial support for the provision of child care services in Australia. Significant changes have occurred in social, political and theoretical contexts of early childhood education and care (ECEC) during this time. Bringing these to life, this paper investigates archival data of key changes in ECEC in association with oral histories of staff, parents and children associated with The Gowrie Qld during the years 1972‒2012. With narrative analysis considered alongside historical information, two dominant issues emerge as integral to ECEC in the past, now and the future. These are: 1) what constitutes effective teaching and learning in the educational program and 2) professional expectations in ECEC. Building an historical picture, this paper provides for critical reflection on the past to inform current and future practices.

Self-Regulated Learning : key strategies and their sources in a sample of adolescent males

This study identified the key self-regulated learning (SRL) strategies and their sources for nine school-aged adolescent males aged 15 to 17 years. The Self-Regulated Learning Interview Schedule (SRLIS) was used along with semi-structured interviews with the participants and their parents to elicit information on SRL strategies and contexts for the formation of self-regulatory habits. Early habit-forming experiences of the family home in relation to homework and study routines were found to form an important base for effective SRL. Teachers were identified as the most common source of SRL strategies with important formative experiences occurring during the first two years of high school.

Satiety responsiveness in toddlerhood predicts energy intake and weight status at four years of age

The aim of this study was to examine whether maternal-report of child eating behaviour at two years predicted self-regulation of energy intake and weight status at four years. Using an ‘eating in the absence of hunger’ paradigm, children’s energy intake (kJ) from a semi-standardized lunch meal and a standardized selection of snacks were measured. Participants were 37 mother-child dyads (16 boys, Median child age = 4.4 years, Inter-quartile range = 3.7-4.5 years) recruited from an existing longitudinal study (NOURISH randomised controlled trial). All participants were tested in their own home. Details of maternal characteristics, child eating behaviours (at age two years) reported by mothers on a validated questionnaire, and measured child height and weight (at age 3.5-4 years) were sourced from existing NOURISH trial data. Correlation and partial correlation analyses were used to examine longitudinal relationships. Satiety responsiveness and Slowness in eating were inversely associated with energy intake of the lunch meal (partial r = -.40, p =.023, and partial r = -.40, p = .023) and the former was also negatively associated with BMI-for-age Z score (partial r = -.42, p = .015). Food responsiveness and Enjoyment of food were not related to energy intake or BMI Z score. None of the eating behaviours were significantly associated with energy intake of the snacks (i.e., eating in the absence of hunger). The small and predominantly ‘healthy weight’ sample of children may have limited the ability to detect some hypothesized effects. Nevertheless, the study provides evidence for the predictive validity of two eating behaviours and future research with a larger and more diverse sample should be able to better evaluate the predictive validity of other children’s early eating behaviour styles.

Perspectives on schooling from early adolescent video diaries

The aim of this project was to gain the voice of the early adolescent (aged between 11 and 13 years) about the things that are genuinely important to them in their lives. Eight participants were asked to record a private video diary entry each night for one week. A number of thematic topics were identified including: their experiences and perspectives on school curriculum and assessment, opinions about schooling structures, and importance of friendship and family. Giving young adolescents the opportunity to voice their opinions has been valuable in gaining insight to the relative impacts of teaching and learning approaches in their school contexts and the issues they consider as the most important in their lives.

Too early to proclaim the end of the war on childhood obesity

Parents winning childhood war on obesity, Australian Bureau of Statistics data reveals, screamed the headline. Sounds like a good news story to make every parent breathe a sigh of relief, but is it really true? The article in question quoted obesity expert and University of South Australia Professor Tim Olds, who argued that “the media and public health authorities are getting carried away” about childhood obesity. He pointed to the fact that recent ABS data showed rates of overweight and obesity in children plateaued between 2007/08 and between 2011/12. But that still means one in four Australian children is overweight or obese; it’s clear we still have a lot of work to do. As a nutritionist working with parents every day (both in practical obesity programs and in research into reducing this considerable health risk), I was concerned that the article could be taken at face value. Because there’s more, much more, to this story.

Segmental torso masses and joint torques produced by gravity in the adolescent scoliotic spine

Introduction Calculating segmental torso masses in Adolescent Idiopathic Scoliosis (AIS) patients allows the gravitational loading on the scoliotic spine during relaxed standing to be estimated. Methods Low dose CT data was used to calculate vertebral level-by-level torso masses and spinal joint torques for 20 female AIS patients (mean age 15.0 ± 2.7 years, mean Cobb angle 53 ± 7.1°). ImageJ software (v1.45 NIH USA) was used to threshold the T1 to L5 CT images and calculate the segmental torso volume and mass for each vertebral level. Masses for the head, neck and arms were taken from published data.1 Intervertebral joint torques in the coronal and sagittal planes at each vertebral level were found from the position of the centroid of the segment masses relative to the joint centres (assumed to be at the centre of the intervertebral disc). The joint torque at each level was found by summing torque contributions for all segments above that joint. Results Segmental torso mass increased from 0.6kg at T1 to 1.5kg at L5. The coronal plane joint torques due to gravity were 5-7Nm at the apex of the curve; sagittal torques were 3-5.4Nm. Conclusion CT scans were in the supine position and curve magnitudes are known to be smaller than those in standing.2 Hence, this study has shown that gravity produces joint torques potentially of higher than 7Nm in the coronal plane and 5Nm in the sagittal plane during relaxed standing in scoliosis patients. The magnitude of these torques may help to explain the mechanics of AIS progression and the mechanics of bracing. This new data on torso segmental mass in AIS patients will assist biomechanical models of scoliosis.

EGFR expression as a predictor of survival for first-line chemotherapy plus cetuximab in patients with advanced non-small-cell lung cancer : analysis of data from the phase 3 FLEX study

Background: Findings from the phase 3 First-Line ErbituX in lung cancer (FLEX) study showed that the addition of cetuximab to first-line chemotherapy significantly improved overall survival compared with chemotherapy alone (hazard ratio [HR] 0·871, 95% CI 0·762-0·996; p=0·044) in patients with advanced non-small-cell lung cancer (NSCLC). To define patients benefiting most from cetuximab, we studied the association of tumour EGFR expression level with clinical outcome in FLEX study patients. Methods: We used prospectively collected tumour EGFR expression data to generate an immunohistochemistry score for FLEX study patients on a continuous scale of 0-300. We used response data to select an outcome-based discriminatory threshold immunohistochemistry score for EGFR expression of 200. Treatment outcome was analysed in patients with low (immunohistochemistry score <200) and high (≥200) tumour EGFR expression. The primary endpoint in the FLEX study was overall survival. We analysed patients from the FLEX intention-to-treat (ITT) population. The FLEX study is registered with ClinicalTrials.gov, number NCT00148798. Findings: Tumour EGFR immunohistochemistry data were available for 1121 of 1125 (99·6%) patients from the FLEX study ITT population. High EGFR expression was scored for 345 (31%) evaluable patients and low for 776 (69%) patients. For patients in the high EGFR expression group, overall survival was longer in the chemotherapy plus cetuximab group than in the chemotherapy alone group (median 12·0 months [95% CI 10·2-15·2] vs 9·6 months [7·6-10·6]; HR 0·73, 0·58-0·93; p=0·011), with no meaningful increase in side-effects. We recorded no corresponding survival benefit for patients in the low EGFR expression group (median 9·8 months [8·9-12·2] vs 10·3 months [9·2-11·5]; HR 0·99, 0·84-1·16; p=0·88). A treatment interaction test assessing the difference in the HRs for overall survival between the EGFR expression groups suggested a predictive value for EGFR expression (p=0·044). Interpretation: High EGFR expression is a tumour biomarker that can predict survival benefit from the addition of cetuximab to first-line chemotherapy in patients with advanced NSCLC. Assessment of EGFR expression could offer a personalised treatment approach in this setting. Funding: Merck KGaA. © 2012 Elsevier Ltd.