Implementation salvage experiences from the Melbourne diabetes prevention study

Background Many public health interventions based on apparently sound evidence from randomised controlled trials encounter difficulties when being scaled up within health systems. Even under the best of circumstances, implementation is exceedingly difficult. In this paper we will describe the implementation salvage experiences from the Melbourne Diabetes Prevention Study, which is a randomised controlled trial of the effectiveness and cost-effectiveness nested in the state-wide Life! Taking Action on Diabetes program in Victoria, Australia.Discussion The Melbourne Diabetes Prevention Study sits within an evolving larger scale implementation project, the Life! program. Changes that occurred during the roll-out of that program had a direct impact on the process of conducting this trial. The issues and methods of recovery the study team encountered were conceptualised using an implementation salvage strategies framework. The specific issues the study team came across included continuity of the state funding for Life! program and structural changes to the Life! program which consisted of adjustments to eligibility criteria, referral processes, structure and content, as well as alternative program delivery for different population groups. Staff turnover, recruitment problems, setting and venue concerns, availability of potential participants and participant characteristics were also identified as evaluation roadblocks. Each issue and corresponding salvage strategy is presented.Summary The experiences of conducting such a novel trial as the preliminary Melbourne Diabetes Prevention Study have been invaluable. The lessons learnt and knowledge gained will inform the future execution of this trial in the coming years. We anticipate that these results will also be beneficial to other researchers conducting similar trials in the public health field. We recommend that researchers openly share their experiences, barriers and challenges when conducting randomised controlled trials and implementation research. We encourage them to describe the factors that may have inhibited or enhanced the desired outcomes so that the academic community can learn and expand the research foundation of implementation salvage.<br /

Prevalência de maloclusão e sua associação com alterações funcionais do sistema estomatognático entre escolares Prevalence of malocclusion and its association with functional alterations of the stomatognathic system in schoolchildren

Esta pesquisa objetivou estimar a prevalência de maloclusões entre escolares com 12 anos de idade do Município de Camaragibe, Pernambuco, Brasil. As maloclusões foram estratificadas em função do grau de severidade, analisando-se, ainda, a sua associação com as alterações das seguintes funções: fonoarticulação, respiração e deglutição. A oclusão foi avaliada por intermédio do Treatment Priotiy Index (TPI) e as referidas funções por meio de critérios utilizados na rotina clínica fonoaudiológica por um único examinador calibrado (valores de kappa variáveis entre 0,64 e 1,00). Os escolares foram selecionados randomicamente em 11 escolas públicas. Dos 173 sorteados, 82,1% apresentaram maloclusão (IC95%: 76,4-87,8), sendo 38,2% consideradas manifestações menores de maloclusões; 20,8% maloclusões definidas; 13,3% maloclusões severas; e 9,8% maloclusões muito severas. Conclui-se que há uma alta demanda reprimida por tratamentos ortodônticos e que quanto maior a severidade das maloclusões maior é a possibilidade de associação com alterações funcionais, fato que deve ser levado em consideração no planejamento de serviços públicos destinados aos referidos agravos.<br>The aim of this research was to estimate the prevalence of malocclusion among 12-year-old schoolchildren in Camaragibe, Pernambuco State, Brazil. Malocclusions were stratified by the degree of severity, and their association with alterations of the following functions was also analyzed: speech articulation, respiration, and deglutition. Occlusion was assessed by means of the Treatment Priority Index (TPI) and the functions referred to by means of the criteria used in routine clinical speech therapy by a single calibrated examiner (kappa values ranging from 0.64 to 1.00). Schoolchildren were selected randomly from 11 public schools. Of the 173 selected children, 82.1% presented malocclusion (95%CI: 76.4-87.8), with 38.2% classified as minor manifestations of malocclusion; 20.8% definite malocclusions; 13.3% severe malocclusions; and 9.8% very severe malocclusions. The conclusion was that there is a high repressed demand for orthodontic treatment, and that the greater the severity of the malocclusion, the stronger the possibility of association with functional alterations, which must be taken into consideration when planning appropriate public services for these conditions