Developing and piloting the Grinnin’ Up Mums & Bubs model of care to promote oral health among Aboriginal and Torres Strait Islander pregnant women : a mixed-methods study

Women are at greater risk for poor oral health during pregnancy, which is linked to adverse birth outcomes and an increased risk of early childhood caries. In Australia, Aboriginal and Torres Strait Islander communities experience higher rates of adverse maternal and early childhood oral health outcomes compared to other Australians. The Midwifery Initiated Oral Health (MIOH) program, an integrated model of care capacity building midwives to promote oral health, was developed to address the oral health needs of pregnant women in Australia. Although the MIOH program was found to be effective in improving maternal oral health outcomes, it was not developed to address the needs of Aboriginal and Torres Strait Islander pregnant women, many of whom may prefer not to access mainstream antenatal services. Currently, there is limited knowledge on the oral health perspectives of Aboriginal and Torres Strait Islander women and Aboriginal health staff about maternal oral health. The underlying motivation of this PhD, therefore, was to adapt the MIOH model of care to capacity build Aboriginal health staff to deliver culturally appropriate oral health promotion to Aboriginal and Torres Strait Islander pregnant women. This study thus fills an important gap in the current literature, and is clinically important, as this intervention could lead to better outcomes for Aboriginal and Torres Strait Islander mothers and their children. The aim of this embedded sequential mixed-methods study was to develop and pilot test a culturally appropriate model of care (Grinnin’ Up Mums & Bubs) in Greater Western Sydney, Australia, to promote oral health among Australian Aboriginal and Torres Strait Islander pregnant women by capacity building Aboriginal health staff. The findings from the pilot suggest that the model could be effective in capacity building Aboriginal Health Workers and influencing change in practice. Using an approach where the Aboriginal Health Workers could meaningfully drive the research resulted in a model of care that was useful, relevant, culturally appropriate and built on the Aboriginal Health Workers’ existing strengths. The initial findings from this research also highlight the need for further evaluation of the model of care to determine the impact on the oral health of Aboriginal and Torres Strait Islander pregnant women and the effectiveness of the model over time. Over the long term, there is also the need for changes in oral health policy to ensure that all Aboriginal and Torres Strait Islander women can access timely, affordable, and culturally safe dental care

Patient perceptions of oral health care following stroke : a qualitative study

Background: Stroke is a serious cerebrovascular disease and is one of the world’s leading causes of disability. Maintaining good oral health is a challenge among those hospitalised after stroke. A multidisciplinary approach to oral care involving non-dental professionals can be beneficial in improving oral health outcomes for patients. The aim of this study was to understand the perceptions of stroke survivors regarding oral healthcare across acute and rehabilitation settings. Methods: A descriptive qualitative approach was used. Face-to-face semi-structured interviews were conducted. A framework analysis was employed to analyse the data. Patients who had recently experienced a stroke were purposively recruited across both acute and rehabilitation settings, at two metropolitan hospitals in Sydney, Australia. In total, 11 patients were interviewed. Results: Although participants recognised the importance of oral health, few understood the link between oral and general health. Regular oral hygiene practices varied since having stroke, with a few receiving oral care assistance from nurses. Time, cost and lack of information were some barriers to accessing dental services, while supportive measures such as coordination of oral care, financial subsidy and nurse assistance were strategies proposed to support oral care practices amongst stroke survivors. Conclusions: There is scope to improve current models of oral care in stroke. While stroke survivors understand the importance of oral care, an integrated oral health model with a multidisciplinary approach could improve health outcomes

Integrative analysis workflow for the structural and functional classification of C-type lectins

<p>Abstract</p> <p>Background</p> <p>It is important to understand the roles of C-type lectins in the immune system due to their ubiquity and diverse range of functions in animal cells. It has been observed that currently confirmed C-type lectins share a highly conserved domain known as the C-type carbohydrate recognition domain (CRD). Using the sequence profile of the CRD, an increasing number of putative C-type lectins have been identified. Hence, it is highly needed to develop a systematic framework that enables us to elucidate their carbohydrate (glycan) recognition function, and discover their physiological and pathological roles.</p> <p>Results</p> <p>Presented herein is an integrated workflow for characterizing the sequence and structural features of novel C-type lectins. Our workflow utilizes web-based queries and available software suites to annotate features that can be found on the C-type lectin, given its amino acid sequence. At the same time, it incorporates modeling and analysis of glycans - a major class of ligands that interact with C-type lectins. Thereafter, the results are analyzed together with context-specific knowledge to filter off unlikely predictions. This allows researchers to design their subsequent experiments to confirm the functions of the C-type lectins in a systematic manner.</p> <p>Conclusions</p> <p>The efficacy and usefulness of our proposed immunoinformatics workflow was demonstrated by applying our integrated workflow to a novel C-type lectin -CLEC17A - and we report some of its possible functions that warrants further validation through wet-lab experiments.</p

Collaborative Tagging of Phenotypic Data for Clinical and Translational Sciences

To fully understand results derived from genetic research, a patient’s genotype data must be integrated with other information about the individual (vital signs, height/weight, lab values, disease history – the phenotype of the patient) that can be obtained through clinical records. Within the clinical and translational sciences awards (CTSA), significant effort has been supported to expand translational research through the creation and mining of a phenotypic data warehouse (i2b2) that can be further linked to genotype data. However, this is just a first step towards meaningful use of the available information. Much of the information in electronic clinical records is trapped in unstructured free text, and inaccessible. Transforming this information into usable data has great potential to improve personalized healthcare and enhance the scientific enterprise. We are using “collaborative tagging,” a newer web 2.0 phenomenon used to structure information for accessibility online in which groups of individuals can add any word or phrase as a tag to identify an object (a weblog entry, a picture, etc.). Because taggers create whatever they deem as the most important tags, and are not required to select from a complex tree of predetermined tags, folksonomies can be a more palatable form of data entry than selected from a complex, predetermined list of tags. We will present our results on tagging of clinical notes by UMMS and community-based providers. This presentation was part of the retreat mini-symposium entitled: Data-Driven Approaches for Health Informatics

The codesign of implementation strategies for children's growth assessment guidelines in the dental setting

Background: Considering the interdisciplinary role dental staff can play in addressing overweight and obesity in childhood, this study aimed to codesign guideline implementation strategies for children’s growth assessment and dietary advice guidelines in the dental setting. Methods: This qualitative study utilised principles of codesign and appreciative inquiry through a series of four, two hour focus groups with dental staff and parents. Focus groups were analysed using content analysis. Results: Discussion fell into two main themes, engaging patients throughout their care journey and supporting staff to engage with the guidelines. Six strategies were developed within these themes: (1) providing growth assessment information to patients and families before appointments, (2) providing refresher training to staff, (3) involving dental assistants in the growth assessment, (4) keeping dental staff updated regarding referral outcomes, (5) culturally appropriate information resources for patients and families, and (6) enabling longitudinal growth tracking in patient information systems. Conclusions: This study successfully designed six implementation strategies for children’s growth assessment guidelines in the dental setting. Further research is required to determine their impact on guideline adherence

Long-term effectiveness of the midwifery initiated oral health-dental service program on maternal oral health knowledge, preventative dental behaviours and the oral health status of children in Australia

Background The Midwifery Initiated Oral Health-Dental Service was developed to train midwives to promote maternal oral health, and a large trial showed it substantially improved the oral health, knowledge and behaviours of pregnant women. Aim Evaluate the long-term effectiveness of the program (post-trial) on maternal oral health knowledge, dental behaviours, and early childhood caries in offspring. Methods A prospective cohort study involving 204 women and children 3–4 years (followed after trial) was conducted in Sydney, Australia from 2017 to 2019. Results The program did not have a significant impact on the study measures. Mothers who received the program did have comparatively better knowledge around preventative behaviours to reduce early childhood caries and significantly more mothers were engaging in a key behaviour of using a cup to feed their child. Overall maternal oral health knowledge and level of education did have a protective effect on the dental decay of children. Higher knowledge and levels of education reduced the odds of having a dmft of one or more by over half (OR 0.473), and almost 80% (OR 0.212) respectively. Conclusions Although the MIOH-DS program was not effective, there is still value in exploring other complementary interventions to improve maternal oral health, especially for disadvantaged families. Future research should focus on co-designing an antenatal and postnatal oral health intervention and exploring its long-term impact on the oral health of children

Oral health in residential aged care : perceptions of nurses and management staff

Aim: This study aimed to explore the perceptions of residential aged care nursing and management staff regarding oral care, to develop strategies to improve the oral health of aged care residents. Design: A qualitative approach was used. Methods: Two focus groups were conducted with nursing and management staff at two residential aged care facilities and transcripts were thematically analysed. Results: All staff had an awareness of the importance of oral health; however, they highlighted the significant challenges in the current system that affect implementation of oral health training and practice guidelines in the residential aged care facility. High staff turnover, time constraints, difficulties in accessing dental services and working together with residents, their families and external staff were barriers to providing oral health care. Staff highlighted the need for formalized clinical guidelines and processes and efficient dental referral pathways to create a more cohesive system of care

Oral health knowledge, attitudes and practices of people living with diabetes in South Asia : a scoping review

Diabetes increases the risk of oral health complications. This review aimed to synthesise the current evidence on the oral health knowledge, attitudes and practices of people living with diabetes in South Asian countries and provide recommendations on possible strategies for addressing the gaps in oral health care in this population, including the role of non-dental professionals. Using a scoping review framework, six electronic databases (Ovid Medline, CINAHL, ProQuest Central, Scopus, Web of Science and Embase) were searched to identify the relevant literature published between January 2000 and December 2021. The data were extracted into three main categories based on the review’s aims, and further refined into sub-categories. A total of 23 studies were included. The review identified that while people with diabetes living in South Asian countries had some level of awareness about oral health and limited care practices to maintain good oral health, there were gaps in knowledge, and there were areas where their oral health practices and attitudes could be improved. The findings suggest a need for developing targeted oral health policies as well as implementing integrated oral health care interventions involving non-dental professionals to improve the oral health outcomes of people with diabetes

Developing and pilot testing an oral health screening tool for diabetes care providers

Background: People with poorly managed diabetes are at greater risk of periodontal disease. Periodontal disease that is not effectively managed can affect glycaemic levels. Diabetes care providers, including general practitioners and diabetes educators, are encouraged to promote oral health of their clients. However, valid and reliable oral health screening tools that assess the risk of poor oral health, that are easy to administer among non-dental professionals, currently do not exist. Existing screening tools are difficult to incorporate into routine diabetes consultations due to their length. Thus, this study aimed to develop and pilot a short oral health screening tool that would identify risk of existing oral diseases and encourage appropriate referrals to the dental service. Methods: A three-item screening tool was developed after a comprehensive review of the literature and consensus from an expert panel. The tool was then piloted as part of a larger cross-sectional survey of 260 adults with diabetes who were accessing public diabetes clinics at two locations in Sydney, Australia. As part of the survey, participants completed the three-item screening tool and a 14-item validated tool, the Oral Health Impact Profile (OHIP-14), which has been used previously in the preliminary validation of screening tools. Sensitivity and specificity analyses were then undertaken comparing the results of the two tools. Results: A statistically significant correlation was found between the shorter screening tool and the OHIP-14 (rho = 0.453, p < 0.001), indicating adequate validity. The three-item tool had high sensitivity (90.5%, 95% CI 84.9%, 94.7%), with a specificity of 46.3% (95% CI 37.7%, 55.2%). The negative predictive value was 81.4% (95% CI 71.3, 89.3). No single item performed as well regarding sensitivity and negative predictive value when compared to the three items collectively. Conclusions: The three-item screening tool developed was found to be valid and sensitive in identifying risk of poor oral health, requiring oral health referrals, among people with diabetes in this pilot. This is a simple, accessible tool that diabetes care providers could incorporate into their routine consultations. Further validation against comprehensive dental assessments is needed to reassess the tool’s specificity and sensitivity in diverse settings

"Got to build that trust" : the perspectives and experiences of Aboriginal health staff on maternal oral health

Background: In Australia, models of care have been developed to train antenatal care providers to promote oral health among pregnant women. However, these models are underpinned by Western values of maternity care that do not consider the cultural needs of Aboriginal and Torres Strait Islander women. This study aimed to explore the perceptions and experiences of Aboriginal health staff towards oral health care during pregnancy. It is part of a larger program of research to develop a new, culturally safe model of oral health care for Aboriginal women during pregnancy. Methods: A descriptive qualitative methodology informed the study. Focus groups were convened to yarn with Aboriginal Health Workers, Family Partnership Workers and Aboriginal management staff at two antenatal health services in Sydney, Australia. Results: A total of 14 people participated in the focus groups. There were four themes that were constructed. These focused on Aboriginal Health Workers and Family Partnership Workers identifying their role in promoting maternal oral health, where adequate training is provided and where trust has been developed with clients. Yet, because the Aboriginal health staff work in a system fundamentally driven by the legacy of colonisation, it has significantly contributed to the systemic barriers Aboriginal pregnant women continue to face in accessing health services, including dental care. The participants recommended that a priority dental referral pathway, that supported continuity of care, could provide increased accessibility to dental care. Conclusions: The Aboriginal health staff identified the potential role of Aboriginal Health Workers and Family Partnership Workers promoting oral health among Aboriginal pregnant women. To develop an effective oral health model of care among Aboriginal women during pregnancy, there is the need for training of Aboriginal Health Workers and Family Partnership Workers in oral health. Including Aboriginal staff at every stage of a dental referral pathway could reduce the fear of accessing mainstream health institutions and also promote continuity of care. Although broader oral health policies still need to be changed, this model could mitigate some of the barriers between Aboriginal women and both dental care providers and healthcare systems