A county-level cross-sectional analysis of positive deviance to assess multiple population health outcomes in Indiana.

OBJECTIVE: To test a positive deviance method to identify counties that are performing better than statistical expectations on a set of population health indicators. DESIGN: Quantitative, cross-sectional county-level secondary analysis of risk variables and outcomes in Indiana. Data are analysed using multiple linear regression to identify counties performing better or worse than expected given traditional risk indicators, with a focus on 'positive deviants' or counties performing better than expected. PARTICIPANTS: Counties in Indiana (n=92) constitute the unit of analysis. MAIN OUTCOME MEASURES: Per cent adult obesity, per cent fair/poor health, low birth weight per cent, per cent with diabetes, years of potential life lost, colorectal cancer incidence rate and circulatory disease mortality rate. RESULTS: County performance that outperforms expectations is for the most part outcome specific. But there are a few counties that performed particularly well across most measures. CONCLUSIONS: The positive deviance approach provides a means for state and local public health departments to identify places that show better health outcomes despite demographic, social, economic or behavioural disadvantage. These places may serve as case studies or models for subsequent investigations to uncover best practices in the face of adversity and generalise effective approaches to other areas.

A School-Based Dental Program Evaluation: Comparison to the Massachusetts Statewide Survey.

BACKGROUND: School-based dental programs target high-risk communities and reduce barriers to obtaining dental services by delivering care to students in their schools. We describe the evaluation of a school-based dental program operating in Chelsea, a city north of Boston, with a low-income and largely minority population, by comparing participants' oral health to a Massachusetts oral health assessment. METHODS: Standardized dental screenings were conducted for students in kindergarten, third, and sixth grades. Outcomes were compared in bivariate analysis, stratified by grade and income levels. RESULTS: A greater percentage of Chelsea students had untreated decay and severe treatment need than students statewide. Yet, fewer Chelsea third graders had severe treatment need, and more had dental sealants. There was no significant difference in the percentage of Chelsea students having severe treatment need or dental sealants by income level. CONCLUSIONS: Students participating in our program do not have lower decay levels than students statewide. However, they do have lower levels of severe treatment need, likely due to treatment referrals. Our results confirm that school-based prevention programs can lead to increased prevalence of dental sealants among high-risk populations. Results provide support for the establishment of full-service school-based programs in similar communities.

The Michigan Healthy School Action Tools process generates improvements in school nutrition policies and practices, and student dietary intake.

The Michigan Healthy School Action Tools (HSAT) is an online self-assessment and action planning process for schools seeking to improve their health policies and practices. The School Nutrition Advances Kids study, a 2-year quasi-experimental intervention with low-income middle schools, evaluated whether completing the HSAT with a facilitator assistance and small grant funding resulted in (1) improvements in school nutrition practices and policies and (2) improvements in student dietary intake. A total of 65 low-income Michigan middle schools participated in the study. The Block Youth Food Frequency Questionnaire was completed by 1,176 seventh-grade students at baseline and in eighth grade (during intervention). Schools reported nutrition-related policies and practices/education using the School Environment and Policy Survey. Schools completing the HSAT were compared to schools that did not complete the HSAT with regard to number of policy and practice changes and student dietary intake. Schools that completed the HSAT made significantly more nutrition practice/education changes than schools that did not complete the HSAT, and students in those schools made dietary improvements in fruit, fiber, and cholesterol intake. The Michigan HSAT process is an effective strategy to initiate improvements in nutrition policies and practices within schools, and to improve student dietary intake.

Oral health policy forum: developing dental student knowledge and skills for health policy advocacy.

This article describes the planning, sequential improvements, and outcomes of Indiana University School of Dentistry's annual Oral Health Policy Forum. This one-day forum for fourth-year dental students was instituted in 2005 with the Indiana Dental Association and the Children's Dental Health Project to introduce students to the health policy process and to encourage their engagement in advocacy. Following a keynote by a visiting professor, small student groups develop arguments in favor and in opposition to five oral health policy scenarios and present their positions to a mock or authentic legislator. The "legislator" critiques these presentations, noting both effective and ineffective approaches, and the student deemed most effective by fellow students receives a gift award. During the afternoon, students tour the Indiana State House, observe deliberations, and meet with legislators. In 2009, 92 percent of students reported a positive impression of the forum, up from 60 percent in 2005. Half (49 percent) in 2009 indicated that they were more inclined to become involved with the political process following the forum, up from 21 percent in 2005. Dental students' feedback became increasingly positive as the program was refined and active learning opportunities were enhanced. This model for engaging students in policy issues important to their professional careers is readily replicable by other dental schools.

Navigating career pathways--dental therapists in the workforce: a report of the career path subcommittee.

Creating career pathways to facilitate current dental and other healthcare providers becoming dental therapists can be an efficient means to expand the dental workforce and reduce barriers to access to oral health services. Career pathways are proposed to facilitate dental providers building on previously learned skills to broaden their scope of practice and become even more versatile and productive providers of oral health services. Creation of a unified and integrated curriculum will enable research to document the effectiveness of this new dental provider who will work as part of dental teams and with supervision by dentists. The goal of augmenting the current dental team and reducing barriers to access to dental services for underserved populations can be enhanced by offering alternative pathways to achieve the competencies required of dental therapists.

An international, multidisciplinary, service-learning program: an option in the dental school curriculum.

INTRODUCTION: Many health professions students who treat Spanish-speaking patients in the United States have little concept of their culture and health related traditions. The lack of understanding of these concepts may constitute major barriers to healthcare for these patients. International service-learning experiences allow students to work directly in communities from which patients immigrate and, as a result, students gain a better understanding of these barriers. OBJECTIVE: This article describes the implementation of an international, multidisciplinary, service-learning program in a dental school in the United States. PROGRAM DESCRIPTION: The Indiana University International Service-Learning program in Hidalgo, Mexico began in 1999 as an alternative spring break travel and clinical experience for medical students, focusing on the treatment of acute health problems. Travel-related preparatory sessions were offered, and no learning or service objectives had been developed. The program has evolved to include a multidisciplinary team of dental, medical, nursing, public health and social work students and faculty. The experience is now integrated into a curriculum based on the service-learning model that allows students to use their clinical skills in real-life situations and provides structured time for reflection. The program aims to enhance teaching and foster civic responsibility in explicit partnership with the community. Preparatory sessions have evolved into a multidisciplinary graduate level course with defined learning and service objectives. PROGRAM EVALUATION METHODS: In order to assess the program's operation as perceived by students and faculty and to evaluate student's perceptions of learning outcomes, evaluation tools were developed. These tools included student and faculty evaluation questionnaires, experiential learning journals, and a strengths, weaknesses, opportunities and threats analysis. FINDINGS: Evaluation data show that after program participation, students perceived an increase in their cultural awareness, cross-cultural communication skills and understanding of barriers and disparities faced by Latinos in the United States. Faculty evaluations offer insights into the lessons learned through the implementation process. CONCLUSION: The development of a service-learning based curriculum has posed challenges but has enriched international service experiences.

Dental providers' attitudes regarding the application of fluoride varnish by pediatric health care providers.

OBJECTIVES: To ascertain what proportion of dental hygienists and dentists in Indiana, United States, support the application of fluoride varnish in medical offices, and to determine if support differed by dental provider characteristics, practice characteristics, a limited assessment of knowledge about fluoride, or use of fluoride. METHODS: Practicing dental hygienists and dentists in 2005 were asked to fill out a mail questionnaire. Logistic regression models tested the association of independent variables with support for medical providers applying varnish. RESULTS: Response rates were 36% (dental hygienists) and 37% (dentists); median year of graduation was 1988 and 1981. Sixty-six percent of respondents were in solo practices, 82% of dentists in general practice, 5% in dental pediatrics, and 13% were other specialists. While 51.2% of dental professionals agreed that medical practices could apply fluoride varnish, 29% responded "none" should be allowed, and 19% were undecided. In the multivariable logistic regression for support of medical practices applying fluoride versus not supporting it, three practice characteristics and two measures of fluoride use were significant. Provider characteristics and a limited assessment about knowledge about fluoride were not significant. CONCLUSIONS: Half of dental professionals felt that it was appropriate for medical providers to apply fluoride varnish; pediatric dental professionals were less supportive. A few dental practice characteristics were associated with acceptance of the use of fluoride varnish by medical care providers: targeting messages to dental hygienists and those with practices in mixed rural-urban areas may be a useful approach to garner greater support for this medical/dental partnership.

Dental caries experience and association to risk indicators of remote rural populations.

BACKGROUND: Dental caries continues to be the most common infectious disease of childhood; however, it is no longer pandemic, but endemic in specific sectors of populations. Therefore, it is important to identify and target patients at risk of developing caries in order to develop specific preventive measures. AIM: This study aims to test dental caries risk indicators for significant associations with caries severity. DESIGN: Five separate, small, isolated rural villages in Mexico with varying degrees of caries prevalence were selected for this observational study. A total of 248 children were examined. Risk indicators were assessed via questionnaire and water and salt fluoride analysis. Caries severity was measured by the International Caries Detection and Assessment System (ICDAS-I). RESULTS: Prevalence of caries ranged from 95% to 100% for the five villages. Mean total DMFS (decayed, missing, or filled surfaces-permanent teeth) and dmfs (decayed, missing, or filled surfaces-primary teeth) scores ranged from 2.5 to 5.0 and from 11.3 to 16.9, respectively. Multivariable models showed age and drinking soda between meals to be significantly associated with DMFS, and drinking juice and being female were significantly associated with dmfs. CONCLUSION: DMFS and dmfs were high in each village, significantly different between villages, and associated with specific risk indicators.

Basic oral health needs: A professional priority?

The inadequacy of access to oral health care is a complex problem facing society. Many in society who need care are unable to obtain it or do not seek it for a variety of reasons. Most commonly, these are the unfunded, who simply have inadequate resources; the "unaccepted," who may not have dental coverage or have types of coverage that are not accepted by private practitioners; the inaccessible, who may be homebound or live in sparsely populated or low-income geographic areas without dental providers; the unconvinced, who may have resources but do not believe in or recognize the need for treatment; and the unmotivated, who may realize that they need care but for them it is not a priority. While the oral health care professions cannot be expected to shoulder the entire burden to "fix" inadequate access to care, we believe that they have important responsibilities. True professions have a unique relationship with society that places them in positions of trust. With this trust comes the responsibility for public policy advocacy and to actively participate in identifying realistic ways to reduce the access problem. The leadership of organized dentistry, as well as educational institutions, and practitioners themselves must be committed to improving access and thereby the health of those currently underserved.

A framework for service-learning in dental education.

Service-learning has become an important component of higher education. Integrating service-learning into dental and dental hygiene curricula will foster graduates who are better prepared to work effectively among diverse populations and to function dynamically in the health policy arena. Although the phrase is familiar to dental educators, there is not a consistent understanding of what comprises this pedagogy. This article offers a framework for service-learning in dental education and describes ten components that characterize true service-learning. This framework can provide a common understanding of this form of experiential education that brings community engagement and educational objectives together. More effective programs can be built around a shared understanding of the characteristics and goals of service-learning in dental education.