A qualitative study exploring barriers to a model of shared care for pre-school children`s oral health

Objective To explore the oral health beliefs and practices of primary health care professionals which may act as barriers to the development of a model of shared care for the oral health of pre-school children.

Design Qualitative focus group discussions and semi-structured interviews.

Setting Four rural local government areas in Victoria, Australia, 2003.

Subjects and methods Subjects: maternal and child health nurses, general medical practitioners, dental professionals and paediatricians working in the four local government areas. Data collection: discipline specific focus groups and semi-structured interviews. Data analysis: transcription, coding, clustering and thematic analysis.

Results Several strong themes emerged from the data. All participants agreed that dental caries is a significant health issue for young children and their families. Beliefs about the aetiology of dental caries and its prevention were variable and often simplistic, focusing predominantly on diet. Dental professionals did not believe that they had a primary role in the oral health of pre-school aged children but that others particularly maternal and child health nurses did. However other health care professionals were not confident in assuming this role.

Conclusions This study has identified important barriers and possible strategies for the development of an integrated and shared approach to preventing dental caries in pre-school aged children. Clear and consistent oral health information and agreed roles and responsibilities need to be developed.

Think global, act local: from naive comparison to critical participation in the teaching of strategic international human resource management

In this paper, we examine the implications of ethnocentrism and paternalism in teaching approaches for the field of strategic international human resource management (SIHRM), as an example of management studies. We argue that the teaching of SIHRM has been approached in a colonizing fashion, joining and extending the territories of human resource management and organizational strategy through the definition and teaching of a new language and conceptual vocabulary. We explore philosophical approaches and processes involved in teaching SIHRM, and consider implications of pedagogical developments in this field of management education.

The epidemiology of overweight and obesity among Australian children and adolescents, 1995-97

A study attempts to determine the population prevalence of overweight and obesity among Australian children and adolescents, based on measured body mass index (BMI) to determine if overweight and obesity are distributed differentially across the population of young Australians. Data from three independent surveys were analyzed and results indicate that the population prevalence and distribution of overweight, obesity and overweight/obesity combined were 79%-81%, 14%-16%, 5% and 19%-21% (boys) respectively, and 76%-79%, 16%-18%, 5%-6% and 21%-24% (girls). There were no consistent relationships between the prevalence of overweight/obesity and sex, age or SES. It is concluded that some 19%-23% of Australian children and adolescents are either overweight or obese. Only cultural background differential warrant a targeted health promotion response.

Children with persistent conduct problems who dropout of treatment

Dropout of treatment is one of the key issues in outcome in a child and adolescent mental health service. We report two studies focusing on the treatment process and the dropout rate of children with persistent conduct problems presenting to a community mental health service, using a prospective design. The first study included 32 children and used a randomised controlled treatment design comparing a CBT approach with conjoint family therapy and an eclectic approach. The overall dropout rate was 36%. Dropout occurred significantly less frequently in the CBT group. The dropout group was associated with mothers who were younger and less educated, a poorer rating by the clinicians at the last meeting, parental dissatisfaction with the treatment service and perception that the treatment was less organised and having less behavioural tasks. In the second study we used a naturalistic follow-up design. Forty-six children were included. The overall dropout rate was 48%. Again, the children who defaulted were rated by clinicians as less likely to have improved and dropout was also  significantly associated with parental perception of a less organised treatment. In both studies dropout usually occurred after assessment and at the early phase of treatment.

Evaluation of outcome in child and adolescent mental health services: children with persistent conduct problems

This article focuses on the evaluation of outcome in child and adolescent mental health services. We examined the outcomes of 46 children with persistent conduct problems by gathering at baseline and six months information from multiple informants on multiple domains including the functioning of the child, risk factors, and parents’ and children’s perceptions of the treatment process. A statistically significant reduction in oppositional/conduct symptoms was reported six months after the initial clinical contact. However, the majority of the group still scored within the clinical range. The various outcome measures are correlated to only a mild to moderate degree. Teachers did not notice the same degree of change at school, despite the changes noticed by parents. Symptom improvement and satisfaction with a service are two separate issues. Parents’ satisfaction was related to their perception of the therapist and the therapy offered. Their satisfaction was high if they perceived that the therapist was able to communicate well, show care and concern, and if the therapy was perceived as organized. Much can be learned from a comprehensive outcome measurement system within a mental health service.

The cost of seasonal respiratory illnesses in Australian children: the dominance of patient and family costs and implications for vaccine use

Respiratory viral infections are one of the next group of diseases likely to be targeted for prevention in childhood by the use of vaccines. To begin collecting necessary epidemiology and cost information about the illnesses caused by these viruses, we conducted a prospective cohort study in 118 Melbourne children between 12 and 71 months of age during winter and spring 2001. We were interested in calculating an average cost per episode of community-managed acute respiratory disease, in identifying the key cost drivers of such illness, and to identify the proportion of costs borne by the patient and family. There were 202 community-managed influenza-like illnesses identified between July and December 2001, generating 89 general practitioner visits, and 42 antibiotic prescriptions. The average cost of community-managed episodes (without hospitalisation) was $241 (95% CI $191 to $291), with the key cost drivers being carer time away from usual activities caring for the ill child (70% of costs), use of non-prescription medications (5.4%), and general practice visits (5.0%). The patient and family met 87per cent of total costs. The lowest average cost occurred in households from the highest income bracket. Acute respiratory illness managed in the community is common, with the responsibility for meeting the cost of episodes predominantly borne by the patient and family in the form of lost productivity. These findings have implications for preventive strategies in children, such as the individual use of, or implementation of public programs using, currently available vaccines against influenza and vaccines under development against other viral respiratory pathogens.

Interventions for educating children who have attended the emergency room for asthma (Review)

Background: Asthma is one of the most common reasons for paediatric admissions to hospital, with substantial cost to the community. There is some evidence to suggest that many hospital admissions could be prevented with effective education about asthma and its management.
Objectives: To conduct a systematic review of the literature in order to identify whether asthma education leads to improved health outcomes in children who have attended the emergency department for asthma.
Search strategy: We searched the Cochrane Airways Group trials register, including MEDLINE, EMBASE, and CINAHL databases, and reference lists of trials and review articles.
Selection criteria: Randomised controlled trials or controlled clinical trials of asthma education for children who had attended the emergency department for asthma, with or without hospitalisation, within the previous 12 months. Data collection and analysis:Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Main results: Eight trials involving 1407 patients were included, in all the education was provided by nurses or researchers. Compared to control (usual care or lower intensity education) education did not reduce subsequent emergency department (ED) visits [4 trials; relative risk (RR)= 0.87, 95% confidence interval (CI) 0.37 to 2.08], hospital admissions [5 trials; RR=0.74, 95% CI 0.38 to 1.46] and unscheduled doctor visits [5 trials; RR= 0.74, 95% CI 0.49 to 1.12). Each analysis showed evidence of heterogeneity among the studies (P<0.01). Subgroup analyses by the overall difference in scale of intervention between treatment and control groups (comprehensive programme versus information only) or the timing of the intervention/recruitment (early versus delayed) gave similar results to the main analysis and still revealed significant heterogeneity between trials. Authors' conclusions: On the basis of the published trials, there is no firm evidence to support the use of asthma education for children who have attended the emergency department for asthma as a means of reducing subsequent ED visits, hospital admissions or unscheduled doctor visits. Some trials appeared to show clear evidence of benefit, but reasons for differences between these and the negative studies is not clear. More research is required.

A guide to interviewing children : essential skills for counsellors, police, lawyers and social workers

This book has been written by two people who really understand children. [They show how to] create opportunities to reduce the trauma of the interview and significantly improve the quality of the information obtained. Chief Constable A.J. Butler Gloucestershire Constabulary A few years ago, a Chief Justice said that it was unnecessary to educate lawyers and judges in the techniques of interviewing children because it was 'just common sense'. The authors show that successful interviewing requires much more than 'common sense'. Freda Briggs, Professor of Child Development, University of South Australia...an excellent book for students and professionals in forensic psychology, policing and social work.Helen Westcott, PhD, The Open UniversityIt is critical that children are interviewed properly in cases of suspected abuse or where the children may be witnesses to or victims of a crime. Poor questioning can upset the child further and contaminate evidence that may be needed in court. Interviewing Children is a practical guide to interviewing techniques for a range of professionals including welfare workers, psychologists, schoolteachers and counsellors, police officers and lawyers. Step by step, it outlines the key stages of an interview, and how to respond to the child's needs during an interview. It explains how to deal with children of different ages and from different backgrounds, and also how to work with their parents. Particular attention is paid to the sensitive issue of sexual abuse, and the problems created by multiple interviews.Clare Wilson lectures in the Department of Psychology at the University of Sydney. Martine Powell lectures in the School of Psychology at Deakin University. Both have trained police officers, social workers and legal professionals in interviewing techniques in Australia and the UK.------------------Full quotes to go on half-title page:This book has been written by two people who really understand children. In passing on their knowledge to professionals who engage with children in the interview room, they create opportunities to reduce the trauma of the interview and significantly improve the quality of the information obtained. Writing in a clear and fresh style, the authors have produced a book which is valuable as a point of reference, a day to day tool and as a training aid to develop skills.Chief Constable A.J. Butler Gloucestershire ConstabularyThis book should be read by all professionals who work with children and could findthemselves receiving disclosures of abuse. It is practical, easy to read and full of examples and hints. It should be a compulsory text for social work studen

Consuming children : education, entertainment, advertising

"Schools are dull, adults are dim, kids rule, pleasure can be purchased - these are canons of children's consumer cultures. In the places where kids, commodities and images meet, education, entertainment and advertising merge. Kids consume the corporate abundance with an appetite. But what happens now that schools are on the market? Is this a form of corporate gluttony? Are designer schools educationally "grotesque"? How are students packaged? How can curriculum compete with other attractions constantly advertised to students? Are students themselves both purchasers and commodities for sale?"

This volume argues that people are entering another stage in the construction of the young as the demarcations between education, entertainment and advertising collapse and as the lines between the generations both blur and harden. Drawing from the voices of students and from contemporary cultural theory this book provokes the reader to ponder the role of the school in the "age of desire.

'Learning to cooperate': a study of how primary teachers and children construct classroom cultures

This paper reports on the findings of a study, the 'Constructing Classroom Cultures' project, funded by a small Australian Research Council grant at the University of Melbourne. Located in three primary school classrooms in Melbourne, Victoria, this study investigated how teachers and grade 3-4 students develop shared values and understandings concerning formal and informal codes of behaviour. Drawing on classroom observations, individual interviews with teachers and focus group interviews with children, this paper discusses the ways that teachers and children together build classroom cultures. Practices that work to produce supportive classroom environments as well as problem areas are identified. Examining classroom cultures at the micro-political level offers scope for considering how power relations can contribute positively to educational processes. Additionally, the ways in which informal interactions between teacher and students and among students call into play collaboration, compliance and resistance are opened up for examination. These case studies aim to contribute to understanding how productive classroom cultures are constructed in day-to-day interactions, a significant area of concern for teachers and teacher education students.

Children's literature matters

This volume is the product of the third conference of the Australian Children's Literature Association for Research held in Melbourne October 1999. The papers presented comprise an interesting cross section of current concerns about children's literature by the Australasian research community.

A qualitative examination of police officers' questioning of children about repeated events

For an offender to be convicted in relation to repeated child abuse, most jurisdictions require that each separate act be identified with reasonable precision with reference to time, place, or some other unique contextual detail (S v. R, 1989). The current study provided a qualitative examination of the way in which police officers assist children to identify and distinguish between occurrences of a repeated event. Field, as well as mock interviews (about an innocuous staged event) were examined, with child witnesses' ages ranging from 3 to 16 years. Overall, several problems in the questioning were highlighted. These included: over-reliance on specific questions, use of 'labels' for occurrences without inquiring as to whether these were unique, and frequent shifting of the focus between occurrences. The implications of these findings are discussed.

A prospective examination of children's time spent outdoors, objectively measured physical activity and overweight

Objective: This study aimed to determine whether time spent outdoors was associated with objectively measured physical activity, body mass index (BMI) z-score and overweight in elementary-school aged children, cross-sectionally and prospectively over 3 years.
Methods: Three-year cohort study with data collected during 2001 and 2004. Nineteen randomly selected state elementary schools across Melbourne, Australia. One hundred and eighty eight 5–6-year-old and 360 10–12-year-old children. Baseline parent reports of children’s time spent outdoors during warmer and cooler months, on weekdays and weekends. At baseline and follow-up, children’s moderate and vigorous physical activity (MVPA) was objectively assessed by accelerometry, and BMI zscore and overweight was calculated from measured height and weight.
Results: Cross-sectionally, each additional hour outdoors on weekdays and weekend days during the cooler months was associated with an extra 27 min week^-1 MVPA among older girls, and with an extra 20 min week^-1 MVPA among older boys. Longitudinally, more time outdoors on weekends predicted higher MVPA on weekends among older girls and boys (5 min week^-1). The prevalence of overweight among older children at follow-up was 27–41% lower among those spending more time outdoors at baseline.
Conclusion: Encouraging 10–12-year-old children to spend more time outdoors may be an effective strategy for increasing physical activity and preventing increases in overweight and obesity. Intervention research investigating the effect of increasing time outdoors on children’s physical activity and overweight is warranted.