Impact of the Brush Day & Night Programme on Well-Being, Plaque, and Dental Caries in Children

Objectives: Poor oral hygiene can have an adverse effect on quality of life. School-based interventions can establish positive behaviours that reduce the likelihood of dental caries later in life. The Brush Day & Night programme aims to encourage good oral health behaviour and improve oral health and quality-of-life outcomes. In this article, we report the effect of the programme on well-being and oral hygiene measured by plaque levels at 3, 8, and 24 weeks and dental caries at 24 weeks after programme start date. Methods: This was a superiority cluster randomised trial of children 6-12 years of age from Indonesia (N = 2021) and Nigeria (N = 2104). All children were provided with toothpaste and a toothbrush. Children in the intervention group received the 21-day Brush Day & Night programme, whereas those in the control group did not. Children completed a questionnaire addressing the objectives at all time points. Their oral hygiene was assessed using the Oral Hygiene Index-Simplified (OHI-S). Additionally, at baseline and 24 weeks their caries status was recorded using the decayed, missing, and filled teeth (DMFT) index. Results: In Indonesia, after participation in the programme children demonstrated a 45% increased probability of no worsening in the occurrence of decayed, missing, or filled teeth. In Nigeria, children had a 71% higher probability of having confidence in their smile and the proportion of children with good oral hygiene doubled from 40% to 80% at 24 weeks. Conclusions: The Brush Day & Night programme was successful in improving well-being and oral hygiene in children in Nigeria and reduced the likelihood of worsening in the occurrence of decayed, missing, or filled teeth in children in Indonesia.This article is published as part of a supplement sponsored by Unilever. Medical writing assistance, in the form of preparation and revision of the manuscript, as well as support of the conduct of the research, was supported financially by Unilever

Impact of the Brush Day & Night Programme on Oral Health Knowledge and Behaviour in Children

Objectives: School-based interventions can establish positive behaviours that reduce the likelihood of oral diseases later in life. The Brush Day & Night (BDN) programme is a 21-day school-based educational programme to promote good oral health behaviours. This study aims to evaluate the effect of the BDN programme on oral health knowledge and behaviour outcomes in children after the intervention as compared to a control group over 24 weeks. Methods: This was a superiority cluster randomised trial of children aged 6-12 years from Indonesia (N = 2021) and Nigeria (N = 750). All children were provided with toothpaste and a toothbrush, and the intervention groups (N = 1107 and 439, respectively) received the 21-day BDN programme. Children were followed up at Weeks 3, 8, and 24 after the programme start date and completed a questionnaire addressing the objectives at all timepoints. Improvement in oral health knowledge and behaviour was calculated based on the percentage of positive change in answers and analysed based on a conditional logistic approach for each evaluation timepoint, compared with control, with a 95% CI. Results: After 24 weeks, Indonesian children following the BDN programme presented with a 30% and 60% additional probability, respectively, of adequate timing of toothbrushing and of being aware of the importance of adequate toothbrushing frequency compared with control. In Nigeria, after 24 weeks, children following the BDN programme had a 92% and 73% higher probability of adequate toothbrushing frequency and of using fluoride toothpaste, respectively, compared with control. Conclusions: The BDN programme is effective at improving children's knowledge and behaviour compared with a control population.This article is published as part of a supplement sponsored by Unilever. Medical writing assistance, in the form of preparation and revision of the manuscript, as well as support of the conduct of the research, was supported financially by Unilever

Brush Day & Night Phase III to Phase IV: ensuring that good oral health habits are sustainable

Over the past 10 years, the FDI-Unilever Brush Day & Night partnership has significantly influenced the life of children worldwide through the implementation of school programmes for oral health education and prevention. This article reports the key facts and outcomes of Phase III of the partnership, and announces the launch of Phase IV. During Phase III, the expert advisors of the Brush Day & Night partnership conducted a longitudinal study to evaluate the impact of the '21 Day' programme in almost 8,000 children in 10 countries. Analysis revealed the effectiveness of the 21 Day programme in sustainably educating children to brush their teeth twice a day, with the greatest impact observed in children aged 7-9 years. With the launch of Phase IV, the Brush Day & Night partnership will continue to deliver its oral health school programme for 7-9 year-old children with a strengthened methodology, including randomized sampling and control groups. The scope of the evaluation will be broadened to include oral health-related quality of life indicators, and monitoring of the oral health knowledge of children's parents/carers.The work presented in this article was made possible through an unrestricted grant from Unilever Oral Care. All authors are grateful to Mr Sean Taylor for his editorial review of this article

Thermoelectric response of Fe1+y_{1+y}Te0.6_{0.6}Se0.4_{0.4}: evidence for strong correlation and low carrier density

We present a study of the Seebeck and Nernst coefficients of Fe$_{1+y}$Te$_{1-x}$Se$_{x}$ extended up to 28 T. The large magnitude of the Seebeck coefficient in the optimally doped sample tracks a remarkably low normalized Fermi temperature, which, like other correlated superconductors, is only one order of magnitude larger than T$_c$. We combine our data with other experimentally measured coefficients of the system to extract a set of self-consistent parameters, which identify Fe$_{1+y}$Te$_{0.6}$Se$_{0.4}$ as a low-density correlated superconductor barely in the clean limit. The system is subject to strong superconducting fluctuations with a sizeable vortex Nernst signal in a wide temperature window.Comment: 4 pages including 4 figure

Endogenous fantasy and learning in digital games.

Many people believe that educational games are effective because they motivate children to actively engage in a learning activity as part of playing the game. However, seminal work by Malone (1981), exploring the motivational aspects of digital games, concluded that the educational effectiveness of a digital game depends on the way in which learning content is integrated into the fantasy context of the game. In particular, he claimed that content which is intrinsically related to the fantasy will produce better learning than that which is merely extrinsically related. However, this distinction between intrinsic and extrinsic (or endogenous and exogenous) fantasy is a concept that has developed a confused standing over the following years. This paper will address this confusion by providing a review and critique of the empirical and theoretical foundations of endogenous fantasy, and its relevance to creating educational digital games. Substantial concerns are raised about the empirical basis of this work and a theoretical critique of endogenous fantasy is offered, concluding that endogenous fantasy is a misnomer, in so far as the "integral and continuing relationship" of fantasy cannot be justified as a critical means of improving the effectiveness of educational digital games. An alternative perspective on the intrinsic integration of learning content is described, incorporating game mechanics, flow and representations

Electron-impact excitation of X 1Sigma_g⁺(v[double-prime]=0) to the a[double-prime] 1Sigma_g⁺, b 1Piu, c3 1Piu, o3 1Piu, b[prime] 1Sigma_u⁺, c₄^[prime] 1Sigma_u⁺, G 3Piu, and F 3Piu states of molecular nitrogen

Measurements of differential cross sections (DCSs) for electron-impact excitation of the a[double-prime] 1Sigmag+, b 1Piu, c3 1Piu, o3 1Piu, b[prime] 1Sigmau+, c4[prime] 1Sigmau+, G 3Piu, and F 3Piu states in N2 from the X 1Sigmag+(v[double-prime]=0) ground level are presented. The DCSs were obtained from energy-loss spectra in the region of 12 to 13.82 eV measured at incident energies of 17.5, 20, 30, 50, and 100 eV and for scattering angles ranging from 2° to 130°. The analysis of the spectra follows a different algorithm from that employed in a previous study of N2 for the valence states [Khakoo et al. Phys. Rev. A 71, 062703 (2005)], since the 1Piu and 1Sigmau+ states form strongly interacting Rydberg-valence series. The results are compared with existing data

The effectiveness of the Brush Day and Night programme in improving children's toothbrushing knowledge and behaviour

Background: Regular twice‐daily toothbrushing with a fluoridated toothpaste is widely recommended for schoolchildren. The ‘21‐day Brush Day and Night (BDN) programme’ includes an educational approach for children and school staff, with a consistent practice of toothbrushing at school for 3 weeks. Objective: This study aims to evaluate the improvement in oral hygiene knowledge and behaviour in schoolchildren involved in BDN, the sustainability of this after 6–12 months, and if any particular age group was more receptive to it than others. Materials and methods: Ten countries and 7,991 children, 2–12 years old, participated in this longitudinal study, with two BDN interventions at the beginning and 6–12 months afterward. Data were collected via a self‐reported questionnaire at baseline/first intervention (T0), 21 days after first intervention (T0D21), at the second intervention (T1), and 21 days after second intervention (T1D21). Improvement in knowledge and behaviour was compared using the chi‐square test with an alpha level of 5%. The final data sample of 5,148 schoolchildren was evaluated, and the analysis revealed that 25% more of the schoolchildren brushed their teeth twice a day after the first intervention. The programme was more effective among the 7–9 years age group. The BDN intervention increased brushing‐frequency in children at the first intervention, and this was sustained after 6–12 months. Therefore, this programme illustrated a sustainable approach to improve children's oral health knowledge and behaviour.The work presented in this article was made possible through an unrestricted grant from Unilever Oral Care. All authors are grateful to Mr Sean Taylor for his editorial review of this article

A realistic evaluation : the case of protocol-based care

Background 'Protocol based care' was envisioned by policy makers as a mechanism for delivering on the service improvement agenda in England. Realistic evaluation is an increasingly popular approach, but few published examples exist, particularly in implementation research. To fill this gap, within this paper we describe the application of a realistic evaluation approach to the study of protocol-based care, whilst sharing findings of relevance about standardising care through the use of protocols, guidelines, and pathways. Methods Situated between positivism and relativism, realistic evaluation is concerned with the identification of underlying causal mechanisms, how they work, and under what conditions. Fundamentally it focuses attention on finding out what works, for whom, how, and in what circumstances. Results In this research, we were interested in understanding the relationships between the type and nature of particular approaches to protocol-based care (mechanisms), within different clinical settings (context), and what impacts this resulted in (outcomes). An evidence review using the principles of realist synthesis resulted in a number of propositions, i.e., context, mechanism, and outcome threads (CMOs). These propositions were then 'tested' through multiple case studies, using multiple methods including non-participant observation, interviews, and document analysis through an iterative analysis process. The initial propositions (conjectured CMOs) only partially corresponded to the findings that emerged during analysis. From the iterative analysis process of scrutinising mechanisms, context, and outcomes we were able to draw out some theoretically generalisable features about what works, for whom, how, and what circumstances in relation to the use of standardised care approaches (refined CMOs). Conclusions As one of the first studies to apply realistic evaluation in implementation research, it was a good fit, particularly given the growing emphasis on understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalise it and some of the challenges. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about using standardised care approaches in practice