Primary school mobile dental program in New South Wales, Australia: protocol for the evaluation of a state government oral health initiative.

BACKGROUND: Socioeconomically disadvantaged children are disproportionately affected by oral disease. Mobile dental services help underserved communities overcome barriers to accessing health care, including time, geography, and trust. The NSW Health Primary School Mobile Dental Program (PSMDP) is designed to provide diagnostic and preventive dental services to children at their schools. The PSMDP is mainly targeted toward high-risk children and priority populations. This study aims to evaluate the program's performance across five local health districts (LHDs) where the program is being implemented. METHODS: The evaluation will use routinely collected administrative data, along with other program-specific data sources, from the district public oral health services to conduct a statistical analysis that determines the reach and uptake of the program, its effectiveness, and the associated costs and cost-consequences. The PSMDP evaluation program utilises data from Electronic Dental Records (EDRs) and other data sources, including patient demographics, service mix, general health, oral health clinical data and risk factor information. The overall design includes cross-sectional and longitudinal components. The design combines comprehensive output monitoring across the five participating LHDs and investigates the associations between socio-demographic factors, service patterns and health outcomes. Time series analysis using difference-in-difference estimation will be conducted across the four years of the program, involving services, risk factors, and health outcomes. Comparison groups will be identified via propensity matching across the five participating LHDs. An economic analysis will estimate the costs and cost-consequences for children who participate in the program versus the comparison group. DISCUSSION: The use of EDRs for oral health services evaluation research is a relatively new approach, and the evaluation works within the limitations and strengths of utilising administrative datasets. The study will also provide avenues to improve the quality of data collected and system-level improvements to better enable future services to be aligned with disease prevalence and population needs.

"You need a designated officer" - Recommendations from correctional and justice health personnel for scaling up hepatitis C treatment-as-prevention in the prison setting.

INTRODUCTION: Hepatitis C (HCV) is highly prevalent among people who are incarcerated. HCV treatment-as-prevention was implemented in the SToP-C trial in four correctional centres in New South Wales , Australia to determine whether prison-wide scale up of antiviral treatment was an effective strategy to reduce HCV incidence and prevalence in the prison setting. A qualitative assessment was undertaken with prison-based correctional and health personnel at each of the four prisons to understand operational, sociological, and cultural barriers and enablers to scale up. Informed by a framework for scaling up population health interventions, this analysis examines recommendations by correctional and justice health personnel for HCV treatment-as-prevention scale up in the prison setting. METHODS: Correctional (n=24) and justice health (n=17) personnel, including officers, nurses, and senior administrators, participated in interviews across the four prisons where SToP-C was delivered and included two maximum security, one minimum security, and one women's medium/minimum security prisons. RESULTS: Scaling up HCV treatment-as-prevention was contingent on compatibility (including sentence length), efficacy (securely funded positions for dedicated personnel and continuity of care for patients transferring between prisons), stakeholder analysis (generally the whole of prison workforce, particularly custodial officers and senior administrators), reach (reliant on peer and officer champions), and legitimised change (via dedicated officers who could instigate cultural shifts). CONCLUSION: Achieving scale up of such an intervention should be guided by an understanding of the potential barriers and enablers. This analysis showed key considerations for HCV treatment-as-prevention scale up in correctional centres.

Process evaluation of the midwifery initiated oral health-dental service program: perceptions of pregnant women.

BACKGROUND: Pregnant women in Australia seldom seek dental care and are unaware of its importance. To address these gaps the midwifery-initiated oral health dental service (MIOH-DS) program was comprehensive trialled and found effective. The aim of this study was to undertake a process evaluation of the MIOH-DS using the perspectives of pregnant women who participated in the trial. METHODS: A qualitative research design was utilized, whereby content analysis was undertaken on data from 11 semi-structured interviews with women who participated in the program. RESULTS: All participants were receptive of the MIOH-DS intervention, and found it to be an acceptable intervention that met their needs, and encouraged future positive oral health practices and health-seeking behaviours. They expressed that midwives were an appropriate professional to conduct oral health assessments, education and referrals to affordable dental services. Although some participants were initially apprehensive towards receiving treatment during pregnancy, dental staff members were able to appropriately educate and reassure them during treatment. CONCLUSIONS: The MIOH-DS represents a promising and acceptable intervention strategy for pregnant women to promote their oral health. Findings merit further investigation on whether positive outcomes achieved can be sustained when implemented in other national or international settings similar to the study setting.

Evaluation of a pilot school-based physical activity challenge for primary students.

Issue addressed Physical inactivity and sedentary behaviour among children are growing public health concerns. The Culture Health Communities Activity Challenge (hereafter known as the Challenge) is a school-based pedometer program in which classes compete to achieve the highest class average daily steps in an 8-week period. The Challenge aims to encourage physical activity in primary school students, with a focus on engaging Aboriginal students. The program was piloted in 15 classes in New South Wales in 2014. Methods The evaluation aimed to explore students' and teachers' experiences of the Challenge, and assess its impact on the students' physical activity levels. Data sources were a pre- and post-intervention survey of students' physical activity levels and sedentary time (n=209), qualitative interviews with teachers (n=11) and discussions with 10 classes. Results Fifteen Year 5 and 6 classes comprising 318 students participated. Fifty percent of participants were girls, the average age was 11 years and the majority (57%) were Aboriginal students. Participation in the Challenge was associated with a slight but statistically significant increase in students' physical activity levels (P<0.05), and a significant decrease in weekend screen time (P<0.05). However, when stratified by Aboriginality these changes were not statistically significant for Aboriginal students. Qualitative feedback from teachers and students indicated high levels of engagement and satisfaction with the Challenge. Teachers and students reported positive impacts, including increased motivation to be physically active, and improved student attendance and engagement in class activities and teamwork. Conclusions Participation in the Challenge was associated with increased physical activity and decreased screen time for some students. Students and teachers also reported a range of positive social and educational outcomes. So what? The findings highlight the importance of primary schools as a setting for health promotion activities, and demonstrate that school-based physical activity programs can be engaging and appropriate for classes with high proportions of Aboriginal students.

Methodological considerations when conducting direct observation in an outdoor environment: our experience in local parks.

OBJECTIVE: This paper discusses some of the inherent methodological limitations of gathering data via direct observation using local parks as a case study. METHODS: Direct observation was carried out in five parks on seven non-consecutive days in 1998 and on matched days in 1999. Information recorded for each person included the time of park entry and exit, gender, age group, and activity/ies undertaken while in the park. METHODOLOGICAL CONSIDERATIONS: The location of the observation point, observer reliability, recording and accuracy of data, and specific issues related to outdoor observation areas should all be considered when designing a study incorporating direct observation as a data collection method. CONCLUSIONS: Direct observation can provide valuable information. However, pilot testing is essential for minimising potential problems associated with this method and optimising data quality. IMPLICATIONS: The issues discussed in this paper provide a useful guide for other researchers undertaking direct observation in outdoor environments.

[The assessment of the facial profile in relation to head posture]. / Beurteilung des Gesichtsprofils in Relation zur Kopfhaltung.

On the basis of Schwarz's [21] facial typology, soft tissue facial profile was evaluated in relation to 3 head positions: natural head position, head position according to the Frankfurter Horizontal, and head position according to a subjective personal appraisal of an aesthetically pleasing profile, i.e. aesthetic head position. Forty children (20 girls and 20 boys) and 40 adults (20 women and 20 men) with varying occlusal relationships constituted the study group. Facial photos oriented according to the above 3 head positions were evaluated. The results revealed that head posture had a decisive impact on the outcome of the facial profile evaluation. Significant differences existed between natural head position on the one hand and Frankfurter Horizontal and aesthetic head position on the other. Due to the relatively large methodological error in the registration of natural head position, and the resulting effect of this error on profile evaluation, natural head position can lead to misleading results. The advantage of Frankfurter Horizontal as opposed to aesthetic head position is the result of a subjective appraisal. Thus, when using Schwarz's method in evaluating facial profile, Frankfurter Horizontal still appears to be quite appropriate.