Parental knowledge, beliefs and behaviours for oral health of toddlers residing in rural Victoria.

BACKGROUND: Little is known about the oral health of children under the age of four years. The determinants of early childhood caries (ECC) in this young age group are also not well understood despite a growing recognition that early interventions may deliver the greatest benefits. The aim of this study was to examine the oral health-related knowledge, attitudes and reported behaviours of parents of children aged 12-24 months living in rural areas of Victoria, Australia. METHODS: A robust theoretical model was utilized to identify oral health-related behaviours and their antecedent and reinforcing conditions within the context of this specific population group. Two hundred and ninety-four parent/child dyads were recruited through their maternal and child health nurses as part of a larger intervention trial. Parents completed a self-report questionnaire. RESULTS: Knowledge regarding risk and protective factors amongst parents was variable and sometimes at odds with contemporary evidence. Knowledge of the role of early infection with S. mutans was very low, with high levels of behaviours that may promote early transmission reported. Tooth cleaning was reported by most parents at least sometimes, however a large proportion lacked confidence and this was significantly related to the frequency of the cleaning. Parents were confused about the fluoride status of their water supplies. Most parents believed fluoride toothpaste reduced the risk of ECC but did not know whether it should be used with toddlers. CONCLUSIONS: The results of this study have implications for efforts to prevent dental decay in this very young age group. Health care professionals other than dentists need support to provide information and promote confidence with regard to optimal fluoride exposure. Attention should also be given to the contribution of early contact with particular bacteria in oral health education and promotion programmes.

Asthma in children: gaps between current management and best practice.

OBJECTIVES: To determine the extent to which steps three to six of the Australian six-step asthma management plan are being implemented in the community and to identify barriers to the adoption of best practice asthma management. METHODS: A cross-sectional descriptive study was conducted at the Royal Children's Hospital and Sunshine Hospital, Melbourne. Two hundred and thirty-one 2-5-year old children who visited the emergency department for asthma were enrolled in the study. Main outcome measures were frequency of asthma management practices and barriers, as measured by parent-completed questionnaire. RESULTS: Gaps: 51% of parents do not feel they have enough information about asthma triggers, more than 60% of children with persistent or frequent episodic asthma are not using regular preventive medication, 48% do not have a written action plan, 39% have not had their asthma reviewed in the last 6 months, and 38% of parents do not feel that they have enough information about their child's asthma. Areas where current practice was close to best practice: 83% of doctors had talked to parents about what causes or 'triggers' their child's asthma, less than 1% of children are using puffers without a spacer, 83% of parents who had an action plan used it for the current visit to the emergency department. CONCLUSIONS: Large gaps still exist between current management and best practice in this group of emergency department attenders. Improvements in asthma management could be achieved if the child's asthma doctor requested review visits for asthma, provided an action plan and followed best practice in relation to asthma medications.

The health and well-being of adolescents: a school-based population study of the self-report Child Health Questionnaire.

PURPOSE: To evaluate a new generic measure of adolescent health status, the self-report version of the Child Health Questionnaire (CHQ), and provide population-based data. Furthermore, we aimed to examine the impact of common adolescent illness and health concerns on their health and well-being. METHODS: A stratified, two-stage, random cluster sampling design was used to obtain a cross-sectional sample of subjects through schools. A written questionnaire included the 80-item 12-scale self-report CHQ and items measuring health concerns, illnesses/health conditions, and sociodemographics. RESULTS: A total of 2361 adolescents participated (response rate of 70%). Reliability was high: Tests of internal consistency and discriminant validity reported 90% of item-scale correlations >.4; all scales had Cronbach alpha coefficients >.7. Adolescents with illnesses/conditions or health concerns reported lower scores and larger differences for content-related scales, supporting content and construct validity. Statistically significant age and gender trends were observed for Mental Health, Self-Esteem, General Health, and Family Cohesion scales. Health status worsened as health concerns increased (X(2) linear trend, p =.00) with deterioration in health of 5-20% on all scales for emotional health concerns (40% of sample). CONCLUSIONS: The self-report CHQ is a reliable and seemingly valid measure of health and well-being for adolescent health research, although additional measures may be required where scales have high ceiling values. The significantly lower scores reported by adolescents with illness and/or health concerns lend support to the use of standardized health measures and longitudinal research to further examine the impact of adolescent comorbidities and their causal determinants.

How much observational data is enough? An empirical test using marital interaction coding.

Using three different samples of couples (clinic, nondistressed community, and engaged), we found that 15 minutes was sufficient to witness enough behavior to make reliable (i.e., internally consistent) estimations of most Rapid Marital Interaction Coding System (Heyman & Vivian, 1993) code frequencies. Ten minutes is sufficient for many codes of interest. The ease in which "how much time is necessary" calculations can be made should entice behavioral investigators from a variety of content areas to publish such figures. By empirically investigating a factor that in most fields becomes reified through convention, investigators can conduct observational research that is both maximally efficient and maximally scientifically defensible.

Public health and preventive healthcare in children: current practices of Victorian GPs and barriers to participation.

OBJECTIVES: To assess general practitioners' attitudes to and involvement in child public health activities and identify barriers affecting their participation. DESIGN: Cross-sectional written questionnaire survey of a representative sample of actively practising GPs. SETTING: General practices in the State of Victoria. PARTICIPANTS: 840 GPs returned questionnaires (65% response rate), and, of these, 792 (94%) saw children 0-12 years. MAIN OUTCOME MEASURES: Attitudes to and involvement in public health promotion; predictive factors for GPs' involvement. RESULTS: The odds of GPs' involvement in child public health issues were increased by being female (odds ratio [OR], 1.88), receiving basic medical qualifications outside Australia (OR, 1.55), attending continuing education and postgraduate training (OR, 1.60), and having confidence in dealing with newborns and infants (OR, 1.93) and preschool children (OR, 2.94) (both P < 0.05). Older GPs, compared with younger GPs, had significantly lower odds of involvement (P < 0.01). After adjustment, GPs had higher odds of involvement if they agreed it was important for them to take part in health promotion, or in screening and surveillance (OR, 2.76 and 1.94, respectively; P < or = 0.05); and lower odds if they agreed that screening and surveillance should be mainly done by maternal and child health nurses (OR, 0.60). The most common barriers to involvement were insufficient time, inadequate financial reimbursement for long consultations, inappropriateness of raising these issues in children presenting with illness, and lack of community resources. CONCLUSIONS: Increasing GPs' involvement in child public health will require attention to barriers (time, remuneration and perceived appropriateness), continuing education and changes in workforce composition and patterns.