How often should you have dental visits?

Dental diseases are a costly public health issue that disproportionately affect disadvantaged people.1,2 However in Australia, access to oral health care services is determined largely by the ability to pay. In recent years, there has been growing concern about inequities in access to care, with a particular focus on the length of time people are waiting to access state and territory-funded public dental services. In response to these concerns, the Gillard government established a National Advisory Council on Dental Health in 2011. In August 2012, the government announced a new dental reform package that would replace two of its existing dental programs – the Chronic Disease Dental Scheme and Medicare Teen Dental program – both of which provide benefits to patients through the Medicare scheme. In contrast, the new reform package provides more funding to state and territory governments so that they can reduce public dental waiting lists and establish more effective and efficient dental care for low income families and children. To implement the new reform package, policymakers will need to make important decisions about access to publicly-funded dental care: who should be eligible, how often should they be able to access services, and what services should be covered

Community water fluoridation : is it still worthwhile

Community Water Fluoridation (CWF) is the adjustment of fluoride concentration in community drinking water to a level that confers optimal protection from dental caries (Truman et al 2002). It is supported by many authorities as the single most effective public health measure for reducing dental caries (DHS 2007). It has consistently been shown to be effective in reducing the prevalence and severity of dental caries in populations following its introduction (NHMRC 1999). The most dramatic reductions (50-60%) were demonstrated in the earlier studies although more recent research has still shown reductions of between 30 and 50% (Truman et al 2002). Despite the strong scientific evidence for its beneficial effects and safety the issue of the appropriateness of CWF is often the focus of public debate. Proponents argue that it reduces dental caries. is safe and cost effective. and that it provides significant benefits to all social classes (Slade et al 1995: Slade et a 1996: Spencer et al 1996). Opponents question its efficacy and safety and argue that its addition to community water supplies is unethical mass medication (Colquhoun 1990: Diesendorf 1986: Diesendorf et al 1997).More recently, however, there have been important questions raised regarding the continuing benefit of CWF over and above that produced by the widespread use of other sources of fluoride (toothpaste. mouth rinses. varnish and other professionally applied fluorides). Generally, dental caries has declined steeply in the last thirty years and many have observed that dental caries has also reduced in parts of Australia and other countries where there has never been CWF or where it has ceased. It has been suggested that because of the current low population levels of dental caries and the increase in alternate sources of fluoride, CWF no longer offers the benefits it may have in the past. Given this notion, together with the concerns of a minority subgroup of the population regarding the safety of CWF, it is valuable to examine current evidence to answer the question: Is there still a role for CWF in Australia?This paper will firstly examine the history of water fluoridation and its mechanisms of action. Secondly. trends in dental decay experience over the last three decades with particular emphasis on social and geographical inequities in Australia will be described. We also review the current state of scientific evidence for the benefits of CWF including the contribution it makes to the reduction of oral health inequalities. In light of this we will provide a response to the question posed above.<br /

A Service Evaluation of V Heart Health

Introduction: The aim of this work was to conduct an evaluation of V Heart Health, a digital cardiac rehabilitation programme for patients with multimorbidity. Whilst the traditional (face-to-face) cardiac rehab programme is considered the ‘gold standard’ it is important that there is a menu of options available for patients and V Heart Health seems well placed to form part of this. Methods: Quantitative and qualitative methods of data collection were utilised including adherence (usability) data, routinely collected clinical data and patient satisfaction feedback. A staff focus group was conducted to explore staff perceptions with regards to the delivery of V Heart Health. Results: The collection of routine clinical data was successful where data were collected by clinicians via phone or video call. Where the onus was on patients to complete and return questionnaires and feedback forms there were some missing data. It is important that this is addressed as completeness of data and patient feedback are essential to ensure service development and improvement. The feedback from patients with regard to the programme content and the staff involved in the delivery was positive. Findings from the focus group indicated that staff felt the programme was successful and they were keen to continue developing and improving the service. They reported keeping patients at the heart of all future decisions and emphasized that V Heart Health should continue to form part of a suite of options for patients. Some of the issues described in this early rollout phase included challenges securing an appropriate venue (during COVID 19 lockdown), awareness and knowledge of wider team about V Heart Health and concerns about digital literacy within the county. Factors perceived as facilitators included staff development, IT support and teamwork. There were technology and connectivity issues described by patients that need to be explored and addressed as a priority going forward. Conclusion: it is important to offer patients choice, to include site based, home, online or blended programmes on an equitable basis with the aim to improve uptake across a range of patient groups. There are areas for development of V Heart Health described within this report which are already being explored as the programme is continuously evolving in response to feedback and staff are becoming more confident and competent in its delivery. V Heart Health has the potential to form part of the menu of programme options for patients living in Lincolnshire. This initial evaluation demonstrates preliminary proof of concept and acceptability data for V Heart Health, however further evaluation and research is warranted

Mental health emergencies attended by ambulances in the United Kingdom and the implications for health service delivery: A cross-sectional study

Objective: In the context of increasing demand for ambulance services, emergency mental health cases are among the most difficult for ambulance clinicians to attend, partly because the cases often involve referring patients to other services. We describe the characteristics of mental health emergencies in the East Midlands region of the United Kingdom. We explore the association between 999 (i.e. emergency) call records, the clinical impressions of ambulance clinicians attending emergencies and the outcomes of ambulance attendance. We consider the implications of our results for optimizing patient care and ambulance service delivery. Methods: We conducted a retrospective observational study of records of all patients experiencing mental health emergencies attended by ambulances between 1 January 2018 and 31 July 2020. The records comprised details of 103,801 ‘999’ calls (Dispatch), the preliminary diagnoses by ambulance clinicians on-scene (Primary Clinical Impression) and the outcomes of ambulance attendance for patients (Outcome). Results: A multinomial regression analysis found that model fit with Outcome data was improved with the addition of Dispatch and Primary Clinical Impression categories compared to the fit for the model containing only the intercept and Outcome categories (Chi-square = 18,357.56, df = 180, p < 0.01). Dispatch was a poor predictor of Primary Clinical impression. The most common predictors of Outcome care pathways other than ‘Treated and transported’ were records of respiratory conditions at Dispatch and anxiety reported by clinicians on-scene. Conclusions: Drawing on the expertise of mental health specialists may help ‘999’ dispatchers distinguish between physical and mental health emergencies and refer patients to appropriate services earlier in the response cycle. Further investigation is needed to determine if training Dispatch operatives for early triage and referral can be appropriately managed without compromising patient safety

Disparities in spatial accessibility to public dental services relative to estimated need for oral health care among refugee populations in Victoria

Objectives To examine the spatial accessibility to public dental services (PDS) relative to the estimated oral health needs of refugee populations within the state of Victoria, Australia. Methods The study employed enhanced two-step floating catchment area method to measure spatial accessibility to PDS by driving and public transit modes at statistical area level 2 (SA2). Principal component analysis of select census-derived socioeconomic variables specific to the refugee population was conducted to derive an area-based indicator of refugee oral health needs, also at SA2 level. Individual indices were then developed for each of these components using standardized z-scores. Finally, an integrated need-accessibility index was developed to identify low-accessibility areas associated with high needs. Results The results show clear contrast in spatial accessibility to PDS for the refugee populations between metropolitan and rural areas as well as between driving and public transit modes. There are critical limitations in accessibility for refugees living in the rural areas and those dependent on public transit mode for travel. Also, there is evident disparity between the estimated oral health needs of refugees in metropolitan and rural areas. Overall, approximately 29% of all SA2s with refugee population are in the 'High' needs category, which comprise 19.8% of the total Victorian refugee population. Integrating accessibility and oral health needs measures revealed that about 30% and 18% of refugee population are identified as under-serviced, when considering driving and public transit modes respectively. Conclusion The findings provide implications for researchers and policy makers to address the inequalities in access to PDS among the refugee population in Victoria. The methodology outlined in this study provides a complementary approach in planning oral health service provision in the absence of population level data at a small-area scale on access to dental services or need for oral health care.</p

Developing participatory methods that meet the needs of rural communities: the Rural ECOH study

The international literature is replete with case studies of community participation in healthcare planning. Many have not been systematically or robustly evaluated. The Rural ECOH study, across six Australian communities, was designed to robustly evaluate the usefulness of 'Remote Service Futures', an evidence-based method of community participation. Using oral health as a focus, the theory was that services and local people would come together for evidenced-based discussions about oral health and would design costed strategies to address oral health challenges. Whilst 'Remote Service Futures' has been successfully used in the United Kingdom, in the Australian context, its translation has not been easy. Our findings reflect the dilemma of whether local organisations really want to delegate decision-making power to communities, and whether people want to participate in structured ways. We discuss the challenges that we encountered, and provide examples of the approaches that we have used to engage all stakeholders, including modifications to ethics processes, using social media, community conversations, working with existing community and social groups, and extensive work with community champions. Our findings have implications for policy and practice. Whilst internationally, policy promotes the active engagement of citizens and health service providers in health planning, service design and evaluation, there is little guidance on how this can be achieved. Our recommendations provide clear direction for enacting participation policy at a service and community level

A rural-urban comparison of self-management in people living with cancer following primary treatment: A mixed methods study

Objective To investigate and compare self-management in people living with cancer following treatment, from rural and urban areas in the United Kingdom where there is a significant evidence gap. Methods A cross-sectional explanatory sequential mixed methods design. This involved a self-completion questionnaire that collected data on demographics, self-management using the PAM-13 and rural-urban residence and 34 in-depth interviews that aimed to explore and compare the barriers and facilitators to self-management in rural and urban settings. Results 227 participants completed the questionnaire: mean age 66.86 (±11.22). Fifty-two percent (n = 119) were female and 48% (n = 108) were male. Fifty-three percent (n = 120) resided in urban areas and 45 % (n = 103) in rural areas. Participants had a range of different types of cancer but the three most common were breast (n = 73), urological (n = 53), upper and lower gastrointestinal (n = 41). Rural respondents (63.31 ± 13.66) were significantly (p < 0.05) more activated than those in urban areas (59.59 ± 12.75). The barriers and facilitators to self-management identified in the interviews were prevalent in both rural and urban settings but some barriers were more explicit in rural settings. For example, there was a lack of bespoke support in rural areas and participants acknowledged how travelling long distances to urban centres for support groups was problematic. Equally, there were barriers and facilitators that were not necessarily unique to either geographic setting. Conclusion Whilst the active treatment phase can present considerable challenges for people living with cancer in rural areas the findings suggest that the rural environment has the potential to increase engagement with self-management in the transition to survivorship. The rigorous mixed methods design has led to different and complementary conclusions that would not have been possible had either quantitative or qualitative methods been used in isolation

The knowledge and practice of pediatricians in children’s oral health: a scoping review

Background Dental caries is a significant public health problem and one of the most common chronic conditions affecting children. The potential for the non-dental workforce to improve children’s oral health is well documented. For well over a decade, there have been calls for pediatricians to address children’s oral health, but the incorporation of oral health screening, referral, and oral healthcare in pediatric practice remains underdeveloped. Developing action to strengthen the role of pediatricians’ in children’s oral health requires an understanding of their current knowledge and practice. In this scoping review, we aimed to comprehensively map what is known about the knowledge and practice of pediatricians regarding children’s oral health. Methods Arksey & O’Malley’s five-stage review process was used to comprehensively map studies undertaken on pediatrician’s knowledge and practice regarding children’s oral health. Key search terms were developed and a total of 42 eligible articles are included in the review. Results The studies were conducted in 19 countries. The majority (41/42) were quantitative, with over 90% using self-reported surveys. Only four studies used previously validated survey tools, with most adapting questions from previous studies. Observational designs were used in two studies and one used qualitative methods. Sample size ranged from 15 to 862. Oral health knowledge amongst pediatricians was reported to be mostly poor, with many gaps in key areas including age for first dental visit, dental caries and oral health risk assessments. Studies on the translation of oral health knowledge to practice were limited, with wide variation in rates of assessment. Few studies assessed actual practice. Conclusions This scoping review highlights growing international interest in the role of pediatricians in children’s oral health. Findings demonstrate that pediatricians have limited knowledge and understanding in critical areas, including; initial clinical signs of dental caries, recommended age for first dental visit, etiology of dental caries and recommended use of fluorides. Barriers for pediatricians include inadequate education and training, time constraints in practice and lack of referral pathways. Development of a validated tool to assess knowledge and practice is needed. This review provides a starting point to guide future research and areas for systematic reviews

Mental health emergencies and COVID-19: the impact of ‘lockdown’ in the East Midlands of the UK.

Background: The most immediate response of the research community to COVID-19 has been a focus on understanding the effects, treatment and prevention of infection. Of equal and ongoing importance is elucidating the impact of mitigation measures, such as lockdown, on the wellbeing of societies. Research about mental health and lockdown in the UK has predominately involved large surveys that are likely to encounter self-selection bias. Further, self-reporting does not constitute a clinical judgement. Aims: To 1) compare the age, gender and ethnicity of patients experiencing mental health emergencies prior, compared to during lockdown, 2) determine whether the nature of mental health emergencies has changed during compared to before lockdown, 3) explore the utility of EMS data for identifying vulnerability to mental health emergencies in real-time during a pandemic. Methods: 32,401 clinical records of ambulance paramedics attending mental health emergencies in the East Midlands of the UK between March 23rd and July 31st 2020 and the same period in 2019 were analysed using binary logistic regression. Results: People of younger age, male gender and South Asian and Black ethnicity are particularly vulnerable to acute mental health conditions during lockdown. Acute cases of anxiety have increased during lockdown while suicide and intentional drug overdose have decreased. Conclusions: Self-reported data may underrepresent the true impact of lockdown on male mental health and ethnic minority groups. Emergency medical data can be used to identify vulnerable communities in the context of the extraordinary circumstances surrounding the current pandemic, as well as under more ordinary circumstances

An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds: a protocol paper for Teeth Tales

Introduction: Inequalities are evident in early childhood caries rates with the socially disadvantaged experiencing greater burden of disease. This study builds on formative qualitative research, conducted in the Moreland/Hume local government areas of Melbourne, Victoria 2006–2009, in response to community concerns for oral health of children from refugee and migrant backgrounds. Development of the community-based intervention described here extends the partnership approach to cogeneration of contemporary evidence with continued and meaningful involvement of investigators, community, cultural and government partners. This trial aims to establish a model for child oral health promotion for culturally diverse communities in Australia.&lt;p&gt;&lt;/p&gt; Methods and analysis: This is an exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds. Families from an Iraqi, Lebanese or Pakistani background with children aged 1–4 years, residing in metropolitan Melbourne, were invited to participate in the trial by peer educators from their respective communities using snowball and purposive sampling techniques. Target sample size was 600. Moreland, a culturally diverse, inner-urban metropolitan area of Melbourne, was chosen as the intervention site. The intervention comprised peer educator led community oral health education sessions and reorienting of dental health and family services through cultural Competency Organisational Review (CORe).&lt;p&gt;&lt;/p&gt; Ethics and dissemination: Ethics approval for this trial was granted by the University of Melbourne Human Research Ethics Committee and the Department of Education and Early Childhood Development Research Committee. Study progress and output will be disseminated via periodic newsletters, peer-reviewed research papers, reports, community seminars and at National and International conferences.&lt;p&gt;&lt;/p&gt