A preventative approach to oral health for children in a regional/rural community in south-west Victoria Australia

Abstract Dental caries is a major health problem in most industrialised countries. Childhood dental disease can cause acute pain, difficulty eating resulting in reduced self-esteem and sleep deprivation. The treatment of oral disease using traditional methods is costly and in industrialized countries currently rates the fourth most expensive disease to treat. Dental professionals are currently facing an unfathomable task of how to manage the large burden of consequences associated with caries progression across the world. The Barwon South-West Region of Victoria, Australia is a diverse regional/rural area. Some communities are quite remote. Barwon Health and Colac Area Health Oral Health Services developed an outreach program to improve access to dental services for children. A Minimal Intervention Dentistry approach was incorporated and includes early diagnosis, risk assessment, early detection of mineral loss, non-surgical treatment and preservation of the tooth structure. Kindergartens throughout the region and children in the first year of Primary School are visited by Oral Health Therapists. Teeth are scored according to the International Caries Detection Assessment System and any early 'white spot' lesions identified have fluoride varnish applied. Children receive up to three dental check-ups during the year and given a toothbrush and toothpaste at each visit. Parent engagement sessions are conducted during Visit 2. Examinations and fluoride application take only 3 - 6 minutes for each child, compared with the usual 30 minute appointments in dental clinics. Two virtual chairs have been created as two dental teams visit Kindergartens throughout the Barwon Region, significantly easing pressure at Community dental clinics. The Kinder Wide Smiles program successfully intervened in the oral health of 5,305 children in the region. Most importantly, one of the barriers for children not presenting to static dental clinics for screening has been eliminated.

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

The incidence of Clostridium difficile infection (CDI) continues to rise, whilst treatment remains problematic due to recurrent, refractory and potentially severe nature of disease. The treatment of C. difficile is a challenge for community and hospital-based clinicians. With the advent of an expanding therapeutic arsenal against C. difficile since the last published Australasian guidelines, an update on CDI treatment recommendations for Australasian clinicians was required. On behalf of the Australasian Society of Infectious Diseases, we present the updated guidelines for the management of CDI in adults and children.

Psychosocial research with children in Iraq : current health practice and policy in a context of armed conflict

There is a need to show how psychosocial issues affect children in conflict areas like Iraq. Raising knowledge and awareness of children’s mental health status in Iraq has been difficult and the knowledge base has been limited by the shortage of resources, international sanctions and the isolation of Iraqi scholars. Many obstacles to research in Iraq exist but an agenda should be developed emphasising the need for high-quality contextualised psychosocial research. Health researchers in the country need to clarify basic population parameters and to provide culturally appropriate, evidence-based interventions for practitioners.

Mothers’ ideals and experiences of raising children in inner and outer suburban Melbourne, Australia

Parents’ perceptions of their neighbourhoods are important for child health outcomes. This study compared views among mothers in inner versus outer suburbs of Melbourne, Australia using a mixed methods approach. Mothers of preschool-aged children were recruited via playgroups, mother’s groups and preschools and interviewed face-to-face regarding their local area as a good place to raise a family, with a second open-ended interview focussing on mothers’ ideals and experiences of raising children in their current location. Findings demonstrated that mothers had different ideals for, and experiences of, raising their children in their neighbourhoods. Inner suburban mothers valued a manageable work/family balance and access to public transport over the size of their homes. However, access to childcare, secondary schooling and heavy traffic were issues, with the latter two being reasons for moving from the municipality. In contrast, outer suburban mothers preferred a larger home in neighbourhoods that they perceived as low crime, over accessibility to work. Access to a car and activities for their children were also important. Findings suggest no ‘one size fits all’ in respect to what features mothers expect from a good place to raise a family, or how they experience these features. This has implications for service delivery and social planning of suburbs.

Individual differences in children's suggestibility : a comparison between intellectually disabled and mainstream samples

This study examined whether age, gender, intelligence, communication ability and shyness predict intellectually disabled children’s susceptibility to an interviewer’s misleading suggestions. Further, the study examined whether the relative influence of these factors differs between intellectually disabled and mainstream samples. Participants included 75 children with mild and borderline intellectual disabilities (aged 77–158 months) and 83 mainstream children (aged 68–152 months). All children were individually administered the Yield and Shift subscales of the Gudjonsson Suggestibility Scale (Form 2) as well as standardised measures of IQ, shyness and communication ability. For the intellectually disabled children, multiple regression analyses revealed that age, IQ and communication inversely predicted Yield suggestibility, however, none of the factors predicted Shift suggestibility. For the mainstream children, age made a significant independent contribution to both Yield and Shift suggestibility, while IQ was a significant predictor of Shift suggestibility. When comparing the relative impact of these factors across the samples, age had a significantly greater impact on mainstream (compared with intellectually disabled) children’s Shift suggestibility, while IQ had a significantly greater influence on intellectually disabled (compared with mainstream) children’s Yield scores. These findings highlight the limited generalisability of previous findings involving mainstream children’s suggestibility to intellectually disabled samples.

Obesity prevention in the family day care setting : impact of the romp & chomp intervention on opportunities for children's physical activity and healthy eating

Background The Romp & Chomp intervention reduced the prevalence of overweight/obesity in pre-school children in Geelong, Victoria, Australia through an intervention promoting healthy eating and active play in early childhood settings. This study aims to determine if the intervention successfully created more health promoting family day care (FDC) environments.
Methods The evaluation had a cross-sectional, quasi-experimental design with the intervention FDC service in Geelong and a comparison sample from 17 FDC services across Victoria. A 45-item questionnaire capturing nutrition- and physical activity-related aspects of the policy, socio-cultural and physical environments of the FDC service was completed by FDC care providers (in 2008) in the intervention (n = 28) and comparison (n = 223) samples.
Results Select results showed intervention children spent less time in screen-based activities (P = 0.03), organized active play (P < 0.001) and free inside play (P = 0.03) than comparison children. There were more rules related to healthy eating (P < 0.001), more care provider practices that supported children’s positive meal experiences (P < 0.001), fewer unhealthy food items allowed (P = 0.05), higher odds of staff being trained in nutrition (P = 0.04) and physical activity (P < 0.001), lower odds of having set minimum times for outside (P < 0.001) and organized (P = 0.01) active play, and of rewarding children with food (P < 0.001).
Conclusions Romp & Chomp improved the FDC service to one that discourages sedentary behaviours and promotes opportunities for children to eat nutritious foods. Ongoing investment to increase children’s physical activity within the setting and improving the capacity and health literacy of care providers is required to extend and sustain the improvements.

Parent's views of the importance of making changes in settings where children spend time to prevent obesity

Aim : To examine the kinds of changes parents would like to see in those settings where children spend time (kindergartens and schools, child care centres and after-school care facilities, and the local neighbourhood) in policies and practices that impact on children’s risk of obesity, and to establish whether parents might be willing to advocate for changes in these settings.

Materials and Methods : 175 parents from five randomly selected primary schools and five randomly selected kindergartens located in suburbs of metropolitan Melbourne completed a questionnaire in which they rated the importance of a number of potential changes to promote healthy eating and increase physical activity in their children.

Results : Parents of children in kindergarten most commonly rated changes to the eating environment as important. In contrast, parents of primary school children believed changes related to both eating and physical activity in school were important. Ninety-five per cent of parents of kindergarten children and 89% of parents of primary school children believed it was possible for parents to bring about change to provide more opportunities for their child to eat more healthily and be more physically active. One in four parents reported that they had thought about or had tried to bring about changes in their community.

Conclusions : The findings suggest that mobilising parents to take an active role in advocating for change in those settings that have the potential to shape their children’s physical activity and eating behaviours may be feasible.

Interventions for preventing obesity in children (review)

Background

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear.
Objectives

This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?"
Search methods

The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted.
Selection criteria

The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required.
Data collection and analysis

Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings).
Main results

This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m2 (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m2 (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m2 (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m2 (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies.
Authors' conclusions

We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:

· school curriculum that includes healthy eating, physical activity and body image

· increased sessions for physical activity and the development of fundamental movement skills throughout the school week

· improvements in nutritional quality of the food supply in schools

· environments and cultural practices that support children eating healthier foods and being active throughout each day

· support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)

· parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities

However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.

Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

Prevalence and community variation in harmful levels of family conflict witnessed by children: implications for prevention

 Abstract
Children’s reports of high family conflict consistently predict poor outcomes. The study identified criteria for high family conflict based on prospective prediction of increased risk for childhood depression. These criteria were subsequently used to establish the prevalence of high family conflict in Australian communities and to identify community correlates suitable for targeting prevention programs. Study 1 utilised a longitudinal design. Grade 6 and 8 students completed a family conflict scale (from the widely used Communities That Care survey) in 2003 and depression symptomotology were evaluated at a 1-year follow-up (International Youth Development Study, N&thinsp;=&thinsp;1,798). Receiver-operating characteristic analysis yielded a cut-off point on a family conflict score with depression symptomatology as a criterion variable. A cut-off score of 2.5 or more (on a scale of 1 to 4) correctly identified 69 % with depression symptomology, with a specificity of 77.2 % and sensitivity at 44.3 %. Study 2 used data from an Australian national survey of Grade 6 and 8 children (Healthy Neighbourhoods Study, N&thinsp;=&thinsp;8,256). Prevalence estimates were calculated, and multivariate logistic regression with multi-level modelling was used to establish factors associated with community variation in family conflict levels. Thirty-three percent of Australian children in 2006 were exposed to levels of family conflict that are likely to increase their future risk for depression. Significant community correlates for elevated family conflict included Indigenous Australian identification, socioeconomic disadvantage, urban and state location, maternal absence and paternal unemployment. The analysis provides indicators for targeting family-level mental health promotion programs.

Australia's response to sexualised or sexually abusive behaviours in children and young people.

Responding to children and young people with sexualised or sexual offending behaviours presents significant challenges across the allied health, child protection, education and juvenile justice sectors. This report maps the specialised therapeutic services designed to effect positive behavioural change and thus divert young people with sexualised behaviours from the juvenile justice system. Accurate numbers on children with sexualised or sexual offending behaviours are difficult to determine. There are several factors contributing to this gap in understanding. These include entrenched ideals about children as inherently innocent, widespread ignorance about developmental sexuality, and the tendency of both young people and parents to deny or minimise incidents when they do occur.

In Australia, data on children with sexualised behaviours are not collected uniformly and nondisclosure contributes to what might be large numbers of offences going undetected. Mandatory reporting requirements apply where children display sexualised behaviours and are thought to be at risk of harm. Yet a general lack of knowledge as to what constitutes appropriate behaviour means that many may respond inappropriately to incidents of sexualised behaviours. This context of confusion, denial and non-disclosure creates a hidden population of children that continues to be at risk. Attention to redressing the contexts for non-disclosure is urgently required to ensure that children in need are provided with specialised therapeutic care.

This report presents qualitative data from interviews with specialised clinicians as well as submissions from service providers in both community and youth justice settings. In mapping the availability of therapeutic services, this report highlights a number of geographic and demographic gaps in service provision, including difficulties with eligibility criteria, referral pathways, funding arrangements and specialised workforce development. There are multiple challenges facing the tertiary services sector, yet the comprehensive provision of specialised services is just one part of the response required. This study emphasises the need for effective primary and secondary prevention to effect a reduction in the numbers of young people requiring counselling in the future. Consistent with the public health model, this report prioritises professional and community education strategies that would ultimately necessitate fewer tertiary services for young people and fewer places in juvenile detention centres.

Family day care educators’ knowledge, confidence and skills in promoting children’s social and emotional wellbeing: baseline data from Thrive

THIS PAPER PRESENTS BASELINE data from Thrive, a capacity-building program for family day care educators. Educators completed a self-report survey assessing knowledge and confidence in promoting children’s social and emotional wellbeing. An in-home observation was used to assess care quality. Twenty-four educators responded to the survey (40 per cent response rate). They had an average of nine years’ experience and 82 percent held childcare qualifications. Educators reported knowledge of, on average, three early signs of social and emotional problems in children, three risk factors and two protective factors. Using a scale from 0-10, mean educator confidence levels ranged from an average of 6.69 to 7.25. Quality of care ratings were moderate. Although educators had a good understanding of children’s social and emotional wellbeing, the study identified opportunities for significant changes in the quality of the educators’ interactions with children in their care and their professional development.

Descriptive study of carers' support, encouragement and modelling of healthy lifestyle behaviours in residential out-of-home care

OBJECTIVE: Given the high prevalence of overweight/obesity among young people in residential out-of-home care (OOHC), and as their carers are in loco parentis, this research aimed: 1) to examine the healthy lifestyle cognitions and behaviours of residential carers; and 2) to describe resources needed to improve diet and/or physical activity outcomes for residents. METHODS: Cross-sectional data were collected from 243 residential carers. Measures included: demographics; knowledge of dietary/physical activity recommendations; self-reported encouragement/importance of health behaviours; physical activity/screen time (at work); unit 'healthiness'; and necessary resources for creating a healthy environment. RESULTS: Staff placed importance on the residents eating well and being physically active. However, examination of carer knowledge found significant gaps in staff education. Three key priority areas were identified to help build a healthy food and activity environment in residential OOHC: funding, professional development and policy. CONCLUSION: Carer knowledge of healthy lifestyles can be improved and they need to be well resourced to ensure children in public care settings live in a healthy environment. IMPLICATIONS: These findings may inform the development of ongoing professional development to improve carers' health literacy, as well as policy to support dietary/activity guidelines for the OOHC sector.

Challenges of measuring and linking patient outcomes to nursing interventions in acute care settings

Measuring and linking patient outcomes to nursing intervention is an important task that has professional, financial and political ramifications. The importance and complexity of measuring patient outcomes accurately should not be overlooked, as there are a number of emergent factors that influence this process. These include the turbulent context of practise, variations in care due to the large number of health professionals, individual patient characteristics impacting on outcomes, determining appropriate nursing outcome measures, nursing's lack of autonomy within the system and difficulties experienced while trying to link patient outcomes to nursing interventions. So that the results reflect reality, it is important for researchers in the field to take note and consider these factors when measuring patient outcomes. The present article aimed to examine and discuss a number of these factors as they relate to the evaluation of patient care.

Fuzzy logic for decision support in chronic care

Computerized clinical guidelines can provide significant benefits in terms of health outcomes and costs, however, their effective computer implementation presents significant problems. Vagueness and ambiguity inherent in natural language (textual) clinical guidelines makes them problematic for formulating automated alerts or advice. Fuzzy logic allows us to formalize the treatment of vagueness in a decision support architecture. In care plan on-line (CPOL), an intranet-based chronic disease care planning system for general practitioners (GPs) in use in South Australia, we formally treat fuzziness in interpretation of quantitative data, formulation of recommendations and unequal importance of clinical indicators. We use expert judgment on cases, as well as direct estimates by experts, to optimize aggregation operators and treat heterogeneous combinations of conjunction and disjunction that are present in the natural language decision rules formulated by specialist teams.