Successful ageing and oral health: incorporating dental professionals into aged care facilities

Population projections by the Australian Bureau of Statistics indicate a rapid increase in the proportion of the population aged 65 years and older from 14% in 2012 to 22% in 2061 and 25% in 2101. Older people in residential aged care facilities (RACFs) have limited access to appropriate oral health systems, preventative dental care and other dental services. Research indicates that many older people are in urgent need of oral health care when they enter aged care facilities. An increasing dependency on care, coupled with inadequate oral care after entering facilities, can also lead to further deterioration in this group’s oral health. There are also a number of barriers to the provision of adequate oral care in Australian residential aged care facilities including insufficient resources, ambivalent attitudes from health professionals and carers to providing oral care, lack of oral health knowledge and inadequate training of carers, including non-dental health professionals. Cultural issues and different lived experiences of carers can play an important role in knowledge of and comfort with dental services. There is a need for greater collaboration across dental health services, dental professionals, dental associations, pharmaceutical agencies and dental technician industries to enhance the promotion of better oral health in RACFs. Studies support a shift from a service delivery oriented model of oral care to a more collaborative, team-based, inter-professional approach. Also, there is an increasing trend to engage both dentists and other dental professionals in providing oral health services in residential aged care environments. Dental hygienists already provide dental care to aged care residents in Japan, Sweden and the United States. An Australian study investigating the dental examination and referral capability of dental hygienists found that there ‘was excellent agreement between the dentist and the dental hygienist regarding the decision to refer residents to a dentist for treatment. Currently dental care for older adults in various types of residential aged care in Australia is often conducted on an ad hoc basis with little structure to such services. Many aged care residents do not receive adequate oral hygiene or any dental services. In the current system, when delivering dental care to residents in aged care facilities, dentists work most often in isolation from other health care teams, often without adequate or any links to the primary health care team of the resident. Ageing Australians with high dental treatment needs have been recognised as a concern in terms of poor access to services that would improve quality of life. The limited number of geriatric-specialised dental services in Australia adds to poor oral health outcomes for older persons. The oral health status of older adults can decline with failing health, systemic diseases and medical treatment for comorbidities, with a profound effect on nutritional status and quality of life. Most previous studies into oral health in RACFs have approached the issue from the perspective of adapting current dental services and adding more care responsibilities for residential aged care staff. This project recognised that the incorporation of the dental professional into the primary health care team was a major factor required to achieve the adequate oral health care of residents in aged care facilities and investigated the perceptions of the stakeholders involved (dental professionals, non-dental health professionals and carers) of the barriers and enablers they faced and that dental professionals face in providing oral care to residents in aged care facilities.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Oral health in Indigenous adults: Perceptions and beliefs about oral health and dental care

Current models of care are not reducing oral health disparities between Aboriginal and non-Aboriginal Australians. Poor oral health in Aboriginal Australians remains a significant concern. Evidence suggests that, despite dental caries being largely (theoretically) preventable, Australian Aboriginal people have worse periodontal disease, more decayed teeth and untreated dental caries than non-Aboriginal Australians. Current health care delivery systems need reviewing for their effectiveness in providing services that are culturally appropriate and understand the issues that many Aboriginal people face including marginalisation, racism and socio-economic disadvantage. Knowledge of Aboriginal perspectives of oral health and dental services is integral to developing responsive and appropriate oral health services that focus on upstream approaches such as preventing disease as well as providing tertiary dental care. The original concept of this project was suggested by a Noongar elder and developed over time through conversations with Community, Aboriginal health colleagues with leadership roles and with an Aboriginal co-investigator. Exploring perceptions is critical as they form the basis of health behaviour. There are a number of theories in relation to epidemiology, health promotion and behaviour change that investigate stages of change in terms of healthy behaviours and the impact of influences over a lifetime. Designed to respond to a pressing need to generate new knowledge and identify practical solutions to improve the provision of adequate primary oral health care to Aboriginal people, it was anticipated that project findings would provide evidence of how Aboriginal people perceive oral health and dental services, including barriers and enabling factors that can inform policy and practice development and future research projects. Aboriginal Australians living in rural and remote Australia face similar disparities in oral health which are multifactorial and multigenerational stemming from the legacy of colonisation and loss of culture and identity, but which are compounded by socioeconomic and geographical disadvantage. The maldistribution of the dental workforce and difficulties in retaining and attracting staff in remote areas makes providing dental services in this context an ongoing challenge. Using volunteers to extend dental care to the remote Kimberley region of Western Australia is a novel approach to address the issue. A secondary aim of this project was to understand the potential role volunteers may play in improving oral health outcomes for remote Australian Aboriginal communities. The study explored values and attitudes towards volunteering and the volunteers’ perceptions of oral health in remote Aboriginal communities. Aims Explore the issues, perceptions and attitudes regarding oral health among Aboriginal adults in the Perth metropolitan area. Explore the barriers and enablers to support oral health for Aboriginal adults in the Perth metropolitan area. Determine attitudes towards oral health among professionals who work with Aboriginal adults in the Perth metropolitan area. Understand the potential role volunteers play in improving oral health outcomes for remote Australian Aboriginal communities. Explore participants’ values and attitudes towards volunteering and their perceptions of barriers and enablers regarding oral health in rural and remote Aboriginal communities.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Are women with major depression in pregnancy identifiable in population health data?

BACKGROUND: Although record linkage of routinely collected health datasets is a valuable research resource, most datasets are established for administrative purposes and not for health outcomes research. In order for meaningful results to be extrapolated to specific populations, the limitations of the data and linkage methodology need to be investigated and clarified. It is the objective of this study to investigate the differences in ascertainment which may arise between a hospital admission dataset and a dispensing claims dataset, using major depression in pregnancy as an example. The safe use of antidepressants in pregnancy is an ongoing issue for clinicians with around 10% of pregnant women suffer from depression. As the birth admission will be the first admission to hospital during their pregnancy for most women, their use of antidepressants, or their depressive condition, may not be revealed to the attending hospital clinicians. This may result in adverse outcomes for the mother and infant. METHODS: Population-based de-identified data were provided from the Western Australian Data Linkage System linking the administrative health records of women with a delivery to related records from the Midwives’ Notification System, the Hospital Morbidity Data System and the national Pharmaceutical Benefits Scheme dataset. The women with depression during their pregnancy were ascertained in two ways: women with dispensing records relating to dispensed antidepressant medicines with an WHO ATC code to the 3rd level, pharmacological subgroup, ‘N06A Antidepressants’; and, women with any hospital admission during pregnancy, including the birth admission, if a comorbidity was recorded relating to depression. RESULTS: From 2002 to 2005, there were 96698 births in WA. At least one antidepressant was dispensed to 4485 (4.6%) pregnant women. There were 3010 (3.1%) women with a comorbidity related to depression recorded on their delivery admission, or other admission to hospital during pregnancy. There were a total of 7495 pregnancies identified by either set of records. Using data linkage, we determined that these records represented 6596 individual pregnancies. Only 899 pregnancies were found in both groups (13.6% of all cases). 80% of women dispensed an antidepressant did not have depression recorded as a comorbidity on their hospital records. A simple capture-recapture calculation suggests the prevalence of depression in this population of pregnant women to be around 16%. CONCLUSION: No single data source is likely to provide a complete health profile for an individual. For women with depression in pregnancy and dispensed antidepressants, the hospital admission data do not adequately capture all cases

The impact of low input DNA on the reliability of DNA methylation as measured by the Illumina Infinium MethylationEPIC BeadChip

DNA methylation (DNAm) is commonly assayed using the Illumina Infinium MethylationEPIC BeadChip, but there is currently little published evidence to define the lower limits of the amount of DNA that can be used whilst preserving data quality. Such evidence is valuable for analyses utilizing precious or limited DNA sources. We used a single pooled sample of DNA in quadruplicate at three dilutions to define replicability and noise, and an independent population dataset of 328 individuals (from a community-based study including US-born non-Hispanic Black and white persons) to assess the impact of total DNA input on the quality of data generated using the Illumina Infinium MethylationEPIC BeadChip. We found that data are less reliable and more noisy as DNA input decreases to 40ng, with clear reductions in data quality; and that low DNA input is associated with a reduction in power to detect EWAS associations, requiring larger sample sizes. We conclude that DNA input as low as 40ng can be used with the Illumina Infinium MethylationEPIC BeadChip, provided quality checks and sensitivity analyses are undertaken

Aboriginal Health Worker perceptions of oral health: a qualitative study in Perth, Western Australia

Background: Improving oral health for Aboriginal Australians has been slow. Despite dental disease being largely preventable, Aboriginal Australians have worse periodontal disease, more decayed teeth and untreated dental caries than other Australians. Reasons for this are complex and risk factors include broader social and historic determinants such as marginalisation and discrimination that impact on Aboriginal people making optimum choices about oral health. This paper presents findings from a qualitative study conducted in the Perth metropolitan area investigating Aboriginal Health Workers’ (AHWs) perceptions of barriers and enablers to oral health for Aboriginal people. Methods: Following extensive consultation with Aboriginal stakeholders, researchers conducted semi-structured interviews and focus groups across 13 sites to investigate AHWs’ perceptions of barriers and enablers to oral health based on professional and personal experience. Responses from 35 AHWs were analysed independently by two researchers to identify themes that they compared, discussed, revised and organised under key themes. These were summarised and interrogated for similarities and differences with evidence in the literature. Results: Key findings indicated that broader structural and social factors informed oral health choices. Perceptions of barriers included cost of services and healthy diets on limited budgets, attending services for pain not prevention, insufficient education about oral health and preventing disease, public dental services not meeting demand, and blame and discrimination from some health providers. Suggested improvements included oral health education, delivering flexible services respectful of Aboriginal people, oral health services for 0–4 year olds and role modelling of oral health across generations. Conclusion: Reviewing current models of oral health education and service delivery is needed to reduce oral health disparities between Aboriginal and non-Aboriginal Australians. Shifting the discourse from blaming Aboriginal people for their poor oral health to addressing structural factors impacting on optimum oral health choices is important. This includes Aboriginal and non-Aboriginal stakeholders working together to develop and implement policies and practices that are respectful, well-resourced and improve oral health outcomes

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Using social practice theory to examine parenting: A scoping review

Practice theory-based research has been established theoretically as an answer to health and social problems, but its use in empirical research is still emerging. We conducted a scoping review in accordance with JBI guidelines for evidence synthesis to identify methodological characteristics of practice theory-based research concerning parenting. A total of 2681 abstracts were identified, with 214 retained for full text screening. A total of 33 articles were included in the review. The included studies in the review focussed on a range of practices relating to parenting including meal preparation and cooking, mobility and transport, homework and school engagement. Major findings from this scoping review identified the use of multiple methods to draw on different aspects of practice and a high variety of time frames for data collection. The tailoring of practice theory approaches was highly varied, and some studies also combined practice theory with alternate theory and concepts. The results reveal significant diversity in the use of social practice theory, the range of methodological approaches used and the application of a high variety of methods. All studies used some form of interview to investigate practices and ethnography was a main methodological approach adopted. Across the studies there were recommendations for expanding sampling and recruitment strategies. Given the call to adopt new approaches to parenting and child development research, our review serves as a mapping of the multitude of ways practice theory-based research can provide can be used to examine parenting