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Kamalabadi YM, Campbell MK, Gratton R, Jessani A. Oral Health Status and Dental Services Utilisation Among a Vulnerable Sample of Pregnant Women. Int Dent J 2024:S0020-6539(24)00203-X. [PMID: 39266400 DOI: 10.1016/j.identj.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/12/2024] [Accepted: 07/14/2024] [Indexed: 09/14/2024] Open
Abstract
INTRODUCTION AND AIMS Oral health conditions during pregnancy can negatively impact both mother and fetus, highlighting the importance of maintaining dental care. In Canada, significant disparities exist between general and dental healthcare access, with limited evidence on oral health status and dental care utilisation among pregnant women. This study aimed to provide initial insights into self-perceived oral health status and dental utilisation patterns among a vulnerable sample of pregnant women in southwestern Ontario. METHODS This cross-sectional study recruited a convenient sample of pregnant women referred to the Family Medicine and Obstetrics Clinic, serving those without a family physician. Data were collected using a self-administered questionnaire adapted from the Canadian Health Measure Survey, the Canadian Community Health Survey, and the Survey of Maternal Health. Andersen and Newman's framework for health service utilisation was used as the theoretical framework. Descriptive and univariable analyses were conducted, followed by a forward stepwise selection of variables with p-values < 0.1 from the univariable analyses. RESULTS One-hundred-fifty patients were approached and 130 (86.7%) completed the questionnaire. Of these, 96 (73.9%) reported their oral health as good/excellent while 34 (26.2%) reported having poor/fair oral health. Education level and quality of life were the strongest predictors of oral health status. While 101 (77.7%) visited a dentist within the last 2 years, only 35 (26.9%) had a dental visit during pregnancy. Toothbrushing frequency was the main predictor of time since last dental visit, with no other predictive factors once toothbrushing was considered. CONCLUSION The study sample showed relatively positive self-perceived oral health and dental visit patterns. However, the low rate of dental visits during pregnancy highlights the need for better integration of dental care into prenatal care. To ensure maternal and child health, pregnant women should be a high priority in policies aimed at improving access to dental care.
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Affiliation(s)
- Yasaman Mohammadi Kamalabadi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - M Karen Campbell
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Obstetrics/Gynecology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Robert Gratton
- Department of Obstetrics/Gynecology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Abbas Jessani
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Dentistry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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Chou R, Selph SS, Bougatsos C, Nix C, Ahmed A, Griffin J, Schwarz E. Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults: A Systematic Review for the US Preventive Services Task Force. JAMA 2023; 330:1780-1790. [PMID: 37934490 DOI: 10.1001/jama.2023.20685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Importance Dental caries and periodontal disease are common adult oral health conditions and potentially amenable to primary care screening and prevention. Objective To systematically review the evidence on primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force. Data Sources MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023. Study Selection Diagnostic accuracy studies of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions; cohort studies on primary care oral health screening and preventive intervention harms. Data Extraction and Synthesis One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Diagnostic accuracy data were pooled using a bivariate mixed-effects binary regression model. Main Outcomes and Measures Dental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy. Results Five randomized clinical trials, 5 nonrandomized trials, and 6 observational studies (total 3300 participants) were included. One poor-quality trial (n = 477) found no difference between oral health screening during pregnancy vs no screening in caries, periodontal disease, or birth outcomes. One study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity (0.42 and 0.56) and high specificity (0.84 and 0.87) for periodontal disease and with variable sensitivity (0.33 and 0.83) and high specificity (0.80 and 0.93) for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 (95% CI, 0.57-0.83) and specificity of 0.74 (95% CI, 0.66-0.82) for periodontal disease. For preventive interventions no study evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, -0.33 to -1.3) and decreased likelihood of new root caries lesion (2 trials; adjusted odds ratio, 0.4 [95% CI, 0.3-0.7]). No trial evaluated primary care-administered preventive interventions. Conclusions and Relevance Screening questionnaires were associated with moderate diagnostic accuracy for periodontal disease. Research is needed to determine benefits and harms of oral health primary care screening and preventive interventions.
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Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
- Division of General Internal Medicine; Oregon Health & Science University, Portland
| | - Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Christina Bougatsos
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Chad Nix
- School of Medicine; Oregon Health & Science University, Portland
| | - Azrah Ahmed
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Jessica Griffin
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Eli Schwarz
- School of Dentistry, Division of Dental Public Health, Oregon Health & Science University, Portland
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Spencer M, Idzik SK. Dental Screening and Referral during Prenatal Care. MCN Am J Matern Child Nurs 2023; 48:320-325. [PMID: 37840202 DOI: 10.1097/nmc.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Oral health is an important aspect of overall health and should be maintained during pregnancy. Due to complex physiological changes during pregnancy, the pregnant woman is at risk for developing periodontal disease and dental caries which are associated with poor birth outcomes including preterm births and low birthweight infants. Evidence-based guidelines developed by several professional organizations recommend oral screening be included in the first prenatal visit. The purpose of this quality improvement project was to implement a dental screening tool during prenatal care to identify pregnant patients with oral health needs and provide subsequent referrals to a dentist. METHODS The project was implemented over a 14-week period and included an oral health screening using a valid and reliable tool to identify oral health needs. Patients were screened and received a referral for dental care. RESULTS N = 826 pregnant women were screened. Of those screened 36.3% (n = 300) had not had their teeth cleaned in the past 12 months. More than 30% of pregnant patients (n = 316) reported some type of dental problem, 29.5% (n = 244) were screened during the first prenatal visit, and 36.7% (n = 303) were enrolled in Medicaid. At project completion, 74.6% (n = 616) of patients received dental referrals. CONCLUSION Conducting oral health screenings during the first prenatal visit is important for identifying pregnant women at risk for oral health problems and improving birth outcomes and allows the patient time to visit the dentist prior to birth. Integration of an oral health screening and referral process can be successfully implemented during prenatal care to meet the needs of childbearing women.
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George A, Poudel P, Kong A, Villarosa A, Calache H, Arora A, Griffiths R, Wong VW, Gussy M, Martin RE, Lau P. Developing and pilot testing an oral health screening tool for diabetes care providers. BMC PRIMARY CARE 2022; 23:202. [PMID: 35948883 PMCID: PMC9367124 DOI: 10.1186/s12875-022-01798-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Ajesh George
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, 1871, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, NSW, 1871, Australia.
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW, 2010, Australia.
- South Western Sydney Local Health District, Liverpool, NSW, 1871, Australia.
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC, 3552, Australia.
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Prakash Poudel
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, 1871, Australia
- South Western Sydney Local Health District, Liverpool, NSW, 1871, Australia
| | - Ariana Kong
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, 1871, Australia
| | - Amy Villarosa
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, 1871, Australia
| | - Hanny Calache
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, 1871, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC, 3552, Australia
- School of Health and Social Development, Faculty of Health, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia
- Melbourne Dental School, The University of Melbourne, Carlton, VIC, 3053, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, 2050, Australia
- Sydney Dental Hospital/Sydney Local Health District, Surry Hills, NSW, 2010, Australia
| | - Rhonda Griffiths
- School of Nursing & Midwifery, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Vincent W Wong
- South-Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, 2170, Australia
| | - Mark Gussy
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC, 3552, Australia
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, United Kingdom
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Rachel E Martin
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, 1871, Australia
- Melbourne Dental School, The University of Melbourne, Carlton, VIC, 3053, Australia
| | - Phyllis Lau
- Melbourne Dental School, The University of Melbourne, Carlton, VIC, 3053, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Department of General Practice, The University of Melbourne, Melbourne, VIC, 3010, Australia
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Park JJ, Corwin E, Dunlop AL, Yang I. Initial Psychometric Testing of a Brief Maternal Oral Symptom Survey. J Midwifery Womens Health 2022; 67:258-263. [DOI: 10.1111/jmwh.13343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 12/21/2022]
Affiliation(s)
- Joy JooHee Park
- Penn Nursing University of Pennsylvania Philadelphia Pennsylvania
| | | | - Anne L. Dunlop
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia
| | - Irene Yang
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia
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Knowledge, Attitude and Practices of Nurses and Midwives towards Oral and Dental Health Care during Pregnancy: A Cross Sectional Study. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.977546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kong A, Dickson M, Ramjan L, Sousa MS, Jones N, Srinivas R, Chao J, Goulding J, George A. Aboriginal Health Workers Promoting Oral Health among Aboriginal and Torres Strait Islander Women during Pregnancy: Development and Pilot Testing of the Grinnin' Up Mums & Bubs Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9576. [PMID: 34574506 PMCID: PMC8471975 DOI: 10.3390/ijerph18189576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND this study aimed to develop and pilot test the model of care, Grinnin' Up Mums & Bubs, to train Aboriginal Health Workers to promote oral health among Aboriginal and Torres Strait Islander pregnant women. METHODS Participatory Action Research was employed to develop the different components of the model (oral health promotion resources, training workshop, and a culturally safe referral pathway to dental services). The model was piloted (pre-post), using an embedded mixed-methods design, to determine the acceptability, satisfaction, and any recommendations made by seven Aboriginal Health Workers at an antenatal service in Western Sydney, Australia. RESULTS there was a high level of satisfaction with the components of the model of care among the participants, who believed that the model could be integrated into practice. The training showed some improvement in oral health knowledge and confidence. The participants recommended strategies for discussing oral health with Aboriginal and Torres Strait Islander pregnant women, and changes in public health dental policy to ensure that all women would be able to access affordable dental services through the referral pathway. CONCLUSION the findings suggest a high level of satisfaction with the model of care among the Aboriginal Health Workers. Further evaluation is needed to confirm the short and long-term impact of the model.
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Affiliation(s)
- Ariana Kong
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia; (L.R.); (M.S.S.); (R.S.); (A.G.)
- South Western Sydney Local Health District, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Michelle Dickson
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia;
| | - Lucie Ramjan
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia; (L.R.); (M.S.S.); (R.S.); (A.G.)
- Translational Health Research Institute, Campbelltown, NSW 2560, Australia
| | - Mariana S. Sousa
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia; (L.R.); (M.S.S.); (R.S.); (A.G.)
- IMPACCT—Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - Nathan Jones
- Aboriginal Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia;
| | - Ravi Srinivas
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia; (L.R.); (M.S.S.); (R.S.); (A.G.)
- Oral Health Services, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
- Faculty of Medicine and Health, School of Dentistry, University of Sydney, Camperdown, NSW 2006, Australia
| | - Jemma Chao
- The Poche Centre for Indigenous Health, University of Sydney, Camperdown, NSW 2006, Australia;
| | - Joanne Goulding
- Primary and Community Services, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia;
| | - Ajesh George
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia; (L.R.); (M.S.S.); (R.S.); (A.G.)
- South Western Sydney Local Health District, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Faculty of Medicine and Health, School of Dentistry, University of Sydney, Camperdown, NSW 2006, Australia
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Tannous KW, George A, Ahmed MU, Blinkhorn A, Dahlen HG, Skinner J, Ajwani S, Bhole S, Yaacoub A, Srinivas R, Johnson M. Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia. BMJ Open 2021; 11:e047072. [PMID: 34341045 PMCID: PMC8330572 DOI: 10.1136/bmjopen-2020-047072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures. DESIGN AND SETTING The evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years. PARTICIPANTS Data were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up. COST MEASURES Data included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach. OUTCOME MEASURES Utility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios. RESULTS Compared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only 'cost-effective' in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was 'cost-effective' in all scenarios except at 3 months scenario. CONCLUSIONS The midwives' only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives' and dentists' combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide. TRIAL REGISTRATION NUMBER ACTRN12612001271897; Post-results.
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Affiliation(s)
- Kathy W Tannous
- Translational Health Research Institute, Digital Health Cooperative Research Centre, Economics, Finance and Property, School of Business, Western Sydney University, Penrith, New South Wales, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Moin Uddin Ahmed
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Anthony Blinkhorn
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shilpi Ajwani
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Oral Health Services and Sydney Dental Hospital, Sydney Local Health District, Surry Hills, New South Wales, Australia
| | - Sameer Bhole
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Oral Health Services and Sydney Dental Hospital, Sydney Local Health District, Surry Hills, New South Wales, Australia
| | - Albert Yaacoub
- Oral Health Services, Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Ravi Srinivas
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Oral Health Services, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Maree Johnson
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Australian Catholic University, North Sydney, New South Wales, Australia
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Abuhaloob L, Helles N, Mossey P, Freeman R. An ADePT evaluation for incorporating the TIPPS periodontal health intervention into primary care antenatal programmes to enhance infant birth weight in Palestine: a feasibility study. Pilot Feasibility Stud 2021; 7:91. [PMID: 33795025 PMCID: PMC8015161 DOI: 10.1186/s40814-021-00827-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background A feasibility study was conducted to implement the Talk, Instruct, Practice, Plan and Support (TIPPS) intervention for pregnant women to enhance infant birth weight in a conflict area in Low- and Middle-Income Countries (LMIC). The decision tool, A process for Decision-making after Pilot and feasibility Trials (ADePT), examines the methodological factors identified in a feasibility study, that may require modification for a full trial. Thus, this study aimed to use the ADePT decision tool to evaluate if the feasibility study had achieved its objectives and to identify the need for intervention, clinical context and trial design modification. Methods A one-arm, pretest–posttest feasibility study recruited 25 pregnant women in their first trimester and clinic staff from a primary healthcare clinic located in Gaza City, Palestine. The TIPPS periodontal health intervention was delivered by antenatal care nurses to the pregnant women during their regular follow-up appointments. The ADePT framework was applied to evaluate the findings from the feasibility study. The ADePT checklist demonstrated sample size estimation, recruitment, consent, intervention adherence, intervention acceptability, costs and duration, completion and appropriateness of outcome assessments, retention, logistics, and synergy between protocol components. Results All recruited pregnant women (25, aged 16–35 years old) consented to participate in the study, and the adherence to the intervention was 88% (22 women). The TIPPS intervention was acceptable, but there was ambivalence over who should deliver it in the clinic. Only the cost of toothbrushing and TIPPS information materials was calculated, while the cost of nurses’ time was not included. The missing values of data were few (12% of gingival bleeding data and 22% from infant birth weight data). This intervention significantly reduced the mean percentage of plaque and bleeding scores after 3 months. The sample size for future randomised controlled trial was estimated around 400 participants. The participants stated the value of the intervention. The clinic staff voiced concerns regarding time and the cost of nurses providing the TIPPS intervention. This allowed suggestions to be made regarding the modification of trial design and context of implementation. Conclusions The ADePT evaluation showed it was possible to progress to full trial with modifications in the trial design.
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Affiliation(s)
- Lamis Abuhaloob
- Dental School and Hospital, University of Dundee, Park Place, Dundee, Scotland, DD1 4HN, UK.
| | - Nahla Helles
- Ministry of Health, Gaza Strip and West Bank, Palestine
| | - Peter Mossey
- Dental School and Hospital, University of Dundee, Park Place, Dundee, Scotland, DD1 4HN, UK
| | - Ruth Freeman
- Dental School and Hospital, University of Dundee, Park Place, Dundee, Scotland, DD1 4HN, UK
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Abstract
PurposeIntegrating preventive oral care into prenatal care is suggested as a strategy for reducing the burden of oral diseases among pregnant women and their offspring. This scoping review sought to synthesize available information and identify knowledge gaps on integrating oral health into prenatal care.Design/methodology/approachThe scoping review was conducted based on the Joanna Briggs Institute scoping review framework using the following databases: CINAHL, Cochrane Database of Systematic Reviews, Medline, ProQuest Dissertation and theses Global, Psychinfo and Web of Science®. No search limits were used. Content analysis of the included articles was performed to identify conceptual frameworks, types of integration used, study designs, study objectives and outcomes.FindingsOverall, 2,861 references were obtained from the databases search; and based on the inclusion and exclusion criteria 35 references were included in the final analysis. Of these 35 references, one document presented a conceptual model, six documents reviewed guidelines for integrating oral health in prenatal care, two were policy documents aimed at interprofessional collaboration for oral health during pregnancy, eight documents described programs focused on providing oral care during pregnancy, five of the references were literature reviews and the remaining 13 evaluated the impact of integration. Linkages between healthcare professionals were the most common type of integration used.Research limitations/implicationsDespite advances in understanding integrated care concepts for healthcare delivery, there is little evidence available on the impact of the various types of, and strategies for, integrating oral health into prenatal care. Future research to bridge the identified gaps is recommended.Originality/valueThe originality of this study is to provide evidence on integrated oral healthcare during pregnancy.
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Poudel P, Griffiths R, Wong VW, Arora A, Flack JR, Khoo CL, George A. Perceptions and practices of general practitioners on providing oral health care to people with diabetes - a qualitative study. BMC FAMILY PRACTICE 2020; 21:34. [PMID: 32054440 PMCID: PMC7020546 DOI: 10.1186/s12875-020-1102-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
Background Poorly controlled diabetes leads to multiple complications including oral health problems. General practitioners (GPs) are at the forefront of management of chronic diseases in primary health care. Diabetes guidelines encourage a proactive role for GPs in oral health complications management in people with diabetes, yet little is known about this area of care. This study aimed to explore current practices, perceptions and barriers of GPs towards oral health care for people with diabetes. Methods We employed a qualitative research method utilising telephone interviews. Purposive and snowball sampling were used to recruit 12 GPs from Greater Sydney region. A thematic analysis involving an inductive approach was used to identify and analyse contextual patterns and themes. Results A majority of participants were males (n = 10), working in group practices (n = 11) with a mean ± SD age of 55 ± 11.4 years and 25 ± 13.6 years work experience. Three major themes emerged: oral health care practices in general practice settings; barriers and enablers to oral health care; and role of diabetes care providers in promoting oral health. Most GPs acknowledged the importance of oral health care for people with diabetes, identifying their compromised immune capacity and greater risks of infections as risk factors. GPs reported 20–30% of their patients having oral health problems, however their current oral health care practices relating to education, risk assessment and referrals were reported as very limited. GPs identified several barriers including time constraints, absence of referral pathways, and limited knowledge and training in promoting oral health care. They also reported patient barriers including oral health care costs and lower oral health awareness. GPs perceived that resources such as education/training, a standardised assessment tool and patient education materials could support them in promoting oral health care. GPs also perceived that other diabetes care providers such as diabetes educators could play an important role in promoting oral health. Conclusions Despite current recommendations, GPs’ current oral health care practices among people with diabetes are limited. Further strategies including capacity building GPs by developing appropriate oral health training programs and simple risk assessment tools along with accessible referral pathways are needed to address the current barriers.
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Affiliation(s)
- Prakash Poudel
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, New South Wales (NSW), 2170, Australia. .,School of Nursing & Midwifery, Western Sydney University, Campbelltown, NSW, 2560, Australia. .,South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia. .,Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.
| | - Rhonda Griffiths
- School of Nursing & Midwifery, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Vincent W Wong
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.,Faculty of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University Campbelltown Campus, Campbelltown, NSW, 2751, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia
| | - Jeff R Flack
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia.,Faculty of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia.,Diabetes Centre Bankstown-Lidcombe Hospital, Bankstown, NSW, 2200, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Chee L Khoo
- Health focus Family Practice, Ingleburn, NSW, 2565, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, New South Wales (NSW), 2170, Australia.,School of Nursing & Midwifery, Western Sydney University, Campbelltown, NSW, 2560, Australia.,South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia.,University of Sydney, Camperdown, NSW, 2050, Australia
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12
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Ajwani S, Sousa MS, Villarosa AC, Bhole S, Johnson M, Dahlen HG, Hoolsema J, Blinkhorn A, Srinivas R, Yaacoub A, Milat A, Skinner J, George A. Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of dental professionals. Health Promot J Austr 2018; 30:333-343. [PMID: 30512207 DOI: 10.1002/hpja.224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 11/30/2018] [Indexed: 01/31/2023] Open
Abstract
ISSUE ADDRESSED All pregnant women should have a comprehensive oral health evaluation. Unfortunately, many pregnant women seldom seek dental care and some dentists are hesitant to treat during pregnancy. To address these issues, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in Australia. The aim of this study was to undertake a process evaluation and explore the perceptions of dental professionals involved in the program to determine the acceptability, feasibility and effectiveness of the program if it were to be upscaled. METHODS A qualitative approach using content analysis was conducted on data from two focus groups involving 12 dental professionals. RESULTS All participants were supportive of the MIOH-DS program. They thought pregnant women were receptive to their care, and reported markedly improved oral health. The provision of free dental care and the involvement of midwives were cited as major factors that improved the uptake of the program. Some of the challenges encountered were the prevailing misconceptions about the safety of dental treatment and pregnancy-related impairments. CONCLUSIONS Dental professionals found the MIOH-DS to be acceptable, feasible and effective in improving oral health of pregnant women and their uptake of dental services. However, some challenges need to be addressed as the MIOH-DS program is upscaled into a cost-effective model. SO WHAT?: Dental professionals are important stakeholders in the MIOH-DS model. The process evaluation of the successful dental intervention is necessary to understand how and why such interventions work, and is an important step in scaling up to a population-wide intervention.
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Affiliation(s)
- Shilpi Ajwani
- Sydney Local Health District Oral Health Services/Sydney Dental Hospital/University of Sydney, Sydney Research, Sydney, NSW, Australia
| | - Mariana S Sousa
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research/Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Ariana C Villarosa
- COHORT, Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research, Liverpool, NSW, Australia
| | - Sameer Bhole
- Sydney Local Health District Oral Health Services/Sydney Dental Hospital/University of Sydney, Sydney Research, Sydney, NSW, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University/Ingham Institute Applied Medical Research, Sydney, NSW, Australia
| | - Hannah G Dahlen
- School of Nursing & Midwifery, Western Sydney University/Ingham Institute Applied Medical Research, Parramatta, NSW, Australia
| | - Julia Hoolsema
- COHORT, Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research, Liverpool, NSW, Australia
| | | | - Ravi Srinivas
- COHORT, South Western Sydney Local Health District Oral Health Services, Western Sydney University/Ingham Institute Applied Medical Research/University of Sydney, Liverpool, NSW, Australia
| | - Albert Yaacoub
- Nepean Blue Mountains Local Health District Oral Health Services, Penrith, NSW, Australia
| | - Andrew Milat
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - John Skinner
- Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia
| | - Ajesh George
- COHORT, Western Sydney University/South Western Sydney Local Health District/University of Sydney/Ingham Institute Applied Medical Research, Translational Health Research Institute, Liverpool, NSW, Australia
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13
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Dahlen HG, Johnson M, Hoolsema J, Norrie TP, Ajwani S, Blinkhorn A, Bhole S, Ellis S, Srinivas R, Yaacoub A, Milat A, Skinner J, George A. Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of midwives in Greater Western Sydney, Australia. Women Birth 2018; 32:e159-e165. [PMID: 30025676 DOI: 10.1016/j.wombi.2018.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/29/2018] [Accepted: 06/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite links between poor maternal oral health, adverse pregnancy outcomes and early childhood decay there is limited emphasis on maternal oral health in Australia. To address this, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in collaboration with the Australian College of Midwives. AIMS To undertake a process evaluation and explore perceptions of midwives involved in the MIOH-DS program to determine its practicability, acceptability and feasibility if it were to be up-scaled and implemented into clinical practice. METHODS Qualitative content analysis was undertaken on data from three focus groups with 21 midwives. FINDINGS Midwives generally found the MIOH-DS to be acceptable and feasible with potential for widespread scalability. The trust women had in midwives was an important factor in gaining women's attention about oral health in pregnancy. The program assisted in increasing midwives' knowledge and awareness, though some felt it was outside their scope of practice. The oral health assessment tool was acceptable to midwives but some concerns were expressed about undertaking a visual oral inspection. Most midwives stated they were now confident with referring individuals to a dentist. Significant barriers to widespread implementation included the cost of dental care and the continued lack of awareness and misconceptions pregnant women had towards oral health. CONCLUSION Midwives found the MIOH-DS to be acceptable and feasible which are two important barriers to potential implementation at scale. Misconceptions over the importance of oral health by women and cost of accessing dental services still need resolving.
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Affiliation(s)
- Hannah G Dahlen
- School of Nursing & Midwifery, Western Sydney University, Ingham Institute Applied Medical Research, Parramatta 2150, Australia.
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Ingham Institute Applied Medical Research, Sydney 2060, Australia.
| | - Julia Hoolsema
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool 1871, Australia.
| | - Tiffany Patterson Norrie
- COHORT, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool 1871, Australia.
| | - Shilpi Ajwani
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney Research, Sydney 2010, Australia.
| | - Anthony Blinkhorn
- Faculty of Dentistry, University of Sydney, Sydney, 2006, Australia.
| | - Sameer Bhole
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney Research, Sydney 2010, Australia.
| | - Sharon Ellis
- Camden and Campbelltown Hospitals, South Western Sydney Local Health District, 2170, Australia.
| | - Ravi Srinivas
- South Western Sydney Local Health District Oral Health Services, COHORT, Western Sydney University, University of Sydney, Ingham Institute Applied Medical Research, Liverpool, Australia.
| | - Albert Yaacoub
- Nepean Blue Mountains Local Health District Oral Health Services, Penrith, Australia.
| | - Andrew Milat
- Centre for Epidemiology and Evidence, NSW Ministry of Health, University of Sydney, Australia.
| | - John Skinner
- Faculty of Dentistry, University of Sydney, Sydney, 2006, Australia.
| | - Ajesh George
- COHORT, Western Sydney University, South Western Sydney Local Health District, University of Sydney, Ingham Institute Applied Medical Research, Translational Health Research Institute, Liverpool 1871, Australia.
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14
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Villarosa AC, Villarosa AR, Salamonson Y, Ramjan LM, Sousa MS, Srinivas R, Jones N, George A. The role of indigenous health workers in promoting oral health during pregnancy: a scoping review. BMC Public Health 2018; 18:381. [PMID: 29558933 PMCID: PMC5859720 DOI: 10.1186/s12889-018-5281-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 03/08/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early childhood caries is the most common chronic childhood disease worldwide. Australian Aboriginal and Torres Strait Islander children are twice more likely to develop dental decay, and contributing factors include poor maternal oral health and underutilisation of dental services. Globally, Indigenous health workers are in a unique position to deliver culturally competent oral healthcare because they have a contextual understanding of the needs of the community. METHODS This scoping review aimed to identify the role of Indigenous health workers in promoting maternal oral health globally. A systematic search was undertaken of six electronic databases for relevant published literature and grey literature, and expanded to include non-dental health professionals and other Indigenous populations across the lifespan when limited studies were identified. RESULTS Twenty-two papers met the inclusion criteria, focussing on the role of Indigenous health workers in maternal oral healthcare, types of oral health training programs and screening tools to evaluate program effectiveness. There was a paucity of peer-reviewed evidence on the role of Indigenous health workers in promoting maternal oral health, with most studies focusing on other non-dental health professionals. Nevertheless, there were reports of Indigenous health workers supporting oral health in early childhood. Although some oral health screening tools and training programs were identified for non-dental health professionals during the antenatal period, no specific screening tool has been developed for use by Indigenous health workers. CONCLUSIONS While the role of health workers from Indigenous communities in promoting maternal oral health is yet to be clearly defined, they have the potential to play a crucial role in 'driving' screening and education of maternal oral health especially when there is adequate organisational support, warranting further research.
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Affiliation(s)
- Ariana C. Villarosa
- Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool BC, NSW 1871 Australia
- School of Nursing & Midwifery, Western Sydney University, Penrith, 2751 Australia
- South Western Sydney Local Health District, Liverpool, NSW Australia
- Ingham Institute for Applied Medical Research, Liverpool, 1871 Australia
| | - Amy R. Villarosa
- Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool BC, NSW 1871 Australia
- School of Nursing & Midwifery, Western Sydney University, Penrith, 2751 Australia
- South Western Sydney Local Health District, Liverpool, NSW Australia
- Ingham Institute for Applied Medical Research, Liverpool, 1871 Australia
| | - Yenna Salamonson
- School of Nursing & Midwifery, Western Sydney University, Penrith, 2751 Australia
- Ingham Institute for Applied Medical Research, Liverpool, 1871 Australia
- Centre for Applied Nursing Research (CANR), Liverpool, 1871 Australia
| | - Lucie M. Ramjan
- School of Nursing & Midwifery, Western Sydney University, Penrith, 2751 Australia
- Ingham Institute for Applied Medical Research, Liverpool, 1871 Australia
- Centre for Applied Nursing Research (CANR), Liverpool, 1871 Australia
| | - Mariana S. Sousa
- Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool BC, NSW 1871 Australia
- South Western Sydney Local Health District, Liverpool, NSW Australia
- Ingham Institute for Applied Medical Research, Liverpool, 1871 Australia
- Centre for Applied Nursing Research (CANR), Liverpool, 1871 Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, 2052 Australia
| | - Ravi Srinivas
- Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool BC, NSW 1871 Australia
- School of Nursing & Midwifery, Western Sydney University, Penrith, 2751 Australia
- South Western Sydney Local Health District, Liverpool, NSW Australia
- Ingham Institute for Applied Medical Research, Liverpool, 1871 Australia
- Faculty of Dentistry, University of Sydney, Camperdown, 2050 Australia
| | - Nathan Jones
- South Western Sydney Local Health District, Liverpool, NSW Australia
| | - Ajesh George
- Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool BC, NSW 1871 Australia
- School of Nursing & Midwifery, Western Sydney University, Penrith, 2751 Australia
- South Western Sydney Local Health District, Liverpool, NSW Australia
- Ingham Institute for Applied Medical Research, Liverpool, 1871 Australia
- Faculty of Dentistry, University of Sydney, Camperdown, 2050 Australia
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15
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George A, Dahlen HG, Blinkhorn A, Ajwani S, Bhole S, Ellis S, Yeo A, Elcombe E, Johnson M. Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial. Int J Nurs Stud 2018; 82:49-57. [PMID: 29605753 DOI: 10.1016/j.ijnurstu.2018.03.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/19/2018] [Accepted: 03/05/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Oral health care during pregnancy is important for the health of the mother and child. However, pregnant women have limited knowledge about maternal oral health and seldom seek dental care. Further, due to limited training antenatal care providers like midwives rarely discuss oral health with pregnant women. The Midwifery-Initiated Oral Health Dental Service program was developed to address current gaps in oral promotional interventions during pregnancy. OBJECTIVES To assess the effectiveness of a Midwifery-Initiated Oral Health Dental Service program in improving uptake of dental services, oral health knowledge, quality of oral health, oral health status and birth outcomes of pregnant women. DESIGN Multi-centre randomised controlled trial. SETTING Three large metropolitan public hospitals in Sydney, Australia. PARTICIPANTS Pregnant women attending their first antenatal appointment who were at least 18 years old and had a single low risk pregnancy between 12 and 20 weeks gestation. METHODS 638 pregnant women were allocated to three groups using block randomisation (n = 211) control group, intervention group 1 (n = 215), intervention group 2 (n = 212) and followed up till birth. Study investigators and data collectors were blinded to group allocation. Intervention group 1 received a midwifery intervention from trained midwives involving oral health education, screening and referrals to existing dental pathways. Intervention group 2 received the midwifery intervention and a dental intervention involving assessment/treatment from cost free local dental services. The control group received oral health information at recruitment. Primary outcome was uptake of dental services. Secondary outcomes included oral health knowledge, quality of oral health, oral health status and birth outcomes. RESULTS Substantial improvements in the use of dental services (20.2% Control Group; 28.3% Intervention group 1; 87.2% Intervention group 2; Odds Ratio Intervention group 2 vs Control Group = 29.72, 95% CI 15.02-58.53, p < 0.001), women's oral health knowledge (p = 0.03); quality of oral health (p < 0.001) and oral health outcomes (sulcus bleeding, dental plaque, clinical attachment loss, decayed/filled teeth- p < 0.001) were found in Intervention group 2. No difference in the rate of preterm or low-birth weight was found. CONCLUSIONS The Midwifery-Initiated Oral Health Dental Service program (Intervention group 2) improved the uptake of dental services and oral health of pregnant women and is recommended during antenatal care. A cause and effect relationship between this intervention and improved birth outcomes was not supported.
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Affiliation(s)
- Ajesh George
- Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Western Sydney University, South Western Sydney Local Health District Oral Health Services, University of Sydney, Ingham Institute Applied Medical Research, Liverpool 1871, Australia.
| | - Hannah G Dahlen
- School of Nursing & Midwifery, Western Sydney University, Ingham Institute Applied Medical Research, Parramatta 2150, Australia
| | | | - Shilpi Ajwani
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney 2010, Australia; Sydney Research, Sydney 2010, Australia
| | - Sameer Bhole
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney 2010, Australia; Sydney Research, Sydney 2010, Australia
| | - Sharon Ellis
- Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Campbelltown 2170, Australia
| | - Anthony Yeo
- School of Nursing & Midwifery, University of Western Sydney, Liverpool, 1871, Australia
| | - Emma Elcombe
- Western Sydney University, University of New South Wales, Ingham Institute Applied Medical Research, Liverpool 1871, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Sydney 2060, Australia; Ingham Institute Applied Medical Research, Liverpool 1871, Australia
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Barasinski C, Debost-Legrand A, Lemery D, Vendittelli F. Practices during the active second stage of labor: A survey of French midwives. Midwifery 2018; 60:48-55. [PMID: 29494852 DOI: 10.1016/j.midw.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE the principal objective of our study was to describe the practices reported by French midwives during the active second stage of labor (expulsion phase). DESIGN this cross-sectional Internet survey questioned French midwives who attended at least one childbirth in 2013. SETTING this open survey was posted on a website from June 15 through December 1, 2014. PARTICIPANTS 1496 midwives from 377 maternity units participated in the study. MEASUREMENTS AND FINDINGS the midwives most often reported suggesting horizontal positions during the active second stage (supine with footholds, lithotomy, lithotomy with knees turned in, or lateral positions). Non-horizontal positions were more often proposed by midwives in level I units (p<0.0001). Almost half the midwives responding (46.4%), especially those working in level III units (51.1%, p = 0.006), advised Valsalva pushing. The mean maximum pushing time was 35.3 minutes±12.8 minutes. Nearly all the midwives favored the 'hands on' technique at childbirth (91.4%), and 24% reported using warm compresses on the perineum at childbirth. KEY CONCLUSION most midwives advised horizontal positions for childbirth. The practices of French midwives differed as a function of where they worked. The midwives, especially those in level III facilities, reported that they cannot always ensure 'physiological childbirth'. IMPLICATIONS FOR PRACTICE the practices of French midwives must become more evidence-based. The development of professional guidelines for midwives in France appears essential. This study also helps to prioritise national training for midwives.
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Affiliation(s)
- Chloé Barasinski
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France.
| | - Anne Debost-Legrand
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France
| | - Didier Lemery
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique; et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France
| | - Françoise Vendittelli
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique; et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France
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Pranal M, Guttmann A, Ouchchane L, Parayre I, Rivière O, Leroux S, Bonnefont S, Debost-Legrand A, Vendittelli F. Do estimates of blood loss differ between student midwives and midwives? A multicenter cross-sectional study. Midwifery 2017; 59:17-22. [PMID: 29348050 DOI: 10.1016/j.midw.2017.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/15/2017] [Accepted: 12/21/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE the principal objective of this study was to assess the quality of blood loss estimates by midwives and student midwives. The secondary objectives were: to assess the intraobserver agreement of visual blood estimates and the rate of underestimation of blood loss by participants, and to estimate the sensitivity, specificity, and negative likelihood ratio of these estimates for clinically pertinent blood losses (≥ 500mL and ≥ 1000mL). DESIGN multicenter cross-sectional study. SETTING thirty-three French maternity units and 35 French midwifery schools participated in this study. PARTICIPANTS volunteer French midwifery students (n = 463) and practicing midwives (n = 578). INTERVENTION an online survey showed 16 randomly ordered photographs of 8 different simulated blood quantities (100, 150, 200, 300, 500, 850, 1000, and 1500mL) with a reference 50-mL image in each photo and asked participants to estimate the blood loss. The visual blood loss estimates were compared with Fisher's exact test. Intraobserver agreement for these estimates was assessed with a weighted kappa coefficient, and the negative predictive values (probability of no hemorrhage when visual estimate was negative) were calculated from prevalence rates in the literature. FINDINGS of the 16,656 estimates obtained, 34.1% were accurate, 37.2% underestimated the quantity presented, and 28.7% overestimated it. Analyses of the intraobserver reproducibility between the two estimates of the same photograph showed that agreement was highest (weighted kappa ≥ 0.8) for the highest values (1000mL, 1500mL). For each volume considered, students underestimated blood loss more frequently than midwives. In both groups, the negative predictive values regarding postpartum hemorrhage (PPH) diagnosis (severe or not) were greater than 98%. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE student midwives tended to underestimate the quantity of blood loss more frequently than the midwives. Postpartum hemorrhage (≥ 500mL) was always identified, but severe postpartum hemorrhage (≥ 1000mL) was identified in fewer than half the cases. These results should be taken into account in training both student midwives and practicing professionals.
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Affiliation(s)
- Marine Pranal
- Centre Hospitalier Universitaire de Clermont-Ferrand, Pôle Femme et Enfant, Clermont-Ferrand, France; CNRS, SIGMA Clermont, Institut Pascal, Clermont Université, Clermont-Ferrand, France.
| | - Aline Guttmann
- Centre Hospitalier Universitaire de Clermont-Ferrand, Service de Biostatistique, Informatique Médicale et Technologies de la Communication, Clermont-Ferrand, France; UMR CNRS 6284, ISIT, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- Centre Hospitalier Universitaire de Clermont-Ferrand, Service de Biostatistique, Informatique Médicale et Technologies de la Communication, Clermont-Ferrand, France; UMR CNRS 6284, ISIT, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Ines Parayre
- Ecole de sages-femmes, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Olivier Rivière
- AUDIPOG, Université Claude Bernard Lyon 1 - site Laennec, Lyon, France
| | - Sylvie Leroux
- Centre Hospitalier d'Annecy Genevois, Pôle gynécologie-obstétrique, Epagny Metz-Tessy, France
| | | | - Anne Debost-Legrand
- CNRS, SIGMA Clermont, Institut Pascal, Clermont Université, Clermont-Ferrand, France; Centre Hospitalier Universitaire de Clermont-Ferrand, Pôle de Santé Publique, Clermont-Ferrand, France
| | - Françoise Vendittelli
- Centre Hospitalier Universitaire de Clermont-Ferrand, Pôle Femme et Enfant, Clermont-Ferrand, France; CNRS, SIGMA Clermont, Institut Pascal, Clermont Université, Clermont-Ferrand, France; AUDIPOG, Université Claude Bernard Lyon 1 - site Laennec, Lyon, France; Centre Hospitalier Universitaire de Clermont-Ferrand, Pôle de Santé Publique, Clermont-Ferrand, France
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18
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Positions during the first stage and the passive second stage of labor: A survey of French midwives. Midwifery 2017; 56:79-85. [PMID: 29096283 DOI: 10.1016/j.midw.2017.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 09/11/2017] [Accepted: 10/15/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE the objective of our study was to describe the practices reported by French midwives during labor (first stage and passive phase of the second stage). DESIGN this cross-sectional internet questionnaire surveyed French midwives who attended at least one delivery in 2013. SETTING this open survey was posted on a website from June 15 through December 1, 2014. PARTICIPANTS 1496 midwives from 377 maternity units participated in the study. Nearly 93% of the midwives worked in an obstetric unit, 5.9% had a mixed practice, and 1.3% worked in private practice. MEASUREMENTS AND FINDINGS during the first stage of labor, midwives reported suggesting that women without epidural analgesia use a birthing ball (98.1%) and that they walk around (97.4%). For women with epidural analgesia, most suggested motion in horizontal positions. Epidural analgesia was proposed more often by midwives from level II (75.7%) and level III (73.5%) maternity wards than by those at level 1 units (57.7%) (p<0.0001). The midwives preferred a lateral position during the first stage for women with epidural analgesia and during the second stage for women both with and without it. Midwives in practice for 5 years or less suggested a kneeling position for women with epidural analgesia more often than more experienced midwives. KEY CONCLUSION the practices of French midwives vary with their place of practice and their experience. IMPLICATIONS FOR PRACTICE to promote normal labor, French midwives must reappropriate vertical positions and analgesic alternatives to epidurals.
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Poudel P, Griffiths R, Wong VW, Arora A, George A. Knowledge and practices of diabetes care providers in oral health care and their potential role in oral health promotion: A scoping review. Diabetes Res Clin Pract 2017; 130:266-277. [PMID: 28662464 DOI: 10.1016/j.diabres.2017.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/21/2017] [Accepted: 06/06/2017] [Indexed: 12/17/2022]
Abstract
AIM Oral health complications are common in people with diabetes yet very little is reported about the oral health care provided in diabetes care setting. This study reviewed global evidence on the oral health care knowledge and practices of diabetes care providers and the role of non-dental health professionals in oral health promotion. METHODS A systematic search of five databases was undertaken with key search terms using a scoping review framework. Relevant studies published till October 2016 in the English language were included (n=30) and no restrictions were placed on the study design, quality or setting. RESULTS Most diabetes care providers are not addressing oral health care with the main barriers being time constraints and limited oral health knowledge. Diabetes educators (DEs) could engage in oral health promotion with few studies showing this model of care can translate into improved patient outcomes. However, no appropriate oral health training programs and assessment tools exist for DEs. With proper training, non-dental professionals like nurses have successfully incorporated oral healthcare in other settings. CONCLUSIONS DEs are well placed to promote oral health in diabetes care setting. Further research is needed to identify barriers and oral health resources to support DEs in this role.
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Affiliation(s)
- Prakash Poudel
- Collaboration for Oral Health Outcomes, Research Translation and Evaluation (COHORTE) Research Group, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Locked Bag 7103, Liverpool 1871, Australia.
| | - Rhonda Griffiths
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797, Australia
| | - Vincent W Wong
- Diabetes and Endocrine Service, Liverpool Hospital, Liverpool Diabetes Collaborative Research Unit, Ingham Institute Applied Medical Research, South Western Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Amit Arora
- School of Science and Health, Western Sydney University, COHORTE Research Group, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Sydney Medical School, University of Sydney, Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Building 24.2.97, Campbelltown Campus, WSU, NSW 2560, Australia
| | - Ajesh George
- COHORTE Research Group, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, University of Sydney, Locked Bag 7103, Liverpool 1871, Australia
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George A, Ajwani S, Bhole S, Dahlen HG, Reath J, Korda A, Ng Chok H, Miranda C, Villarosa A, Johnson M. Knowledge, attitude and practises of dentists towards oral health care during pregnancy: A cross sectional survey in New South Wales, Australia. Aust Dent J 2017; 62:301-310. [DOI: 10.1111/adj.12505] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2017] [Indexed: 01/23/2023]
Affiliation(s)
- A George
- Collaboration for Oral Health Outcomes, Research Translation and Evaluation (COHORTE) Research Group; Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, University of Sydney; Liverpool New South Wales Australia
| | - S Ajwani
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney; Sydney New South Wales Australia
| | - S Bhole
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital/University of Sydney; Sydney New South Wales Australia
| | - HG Dahlen
- School of Nursing and Midwifery; Western Sydney University/Ingham Institute Applied Medical Research; Parramatta New South Wales Australia
| | - J Reath
- Peter Brennan Chair of General Practice, School of Medicine, Western Sydney University; Campbelltown New South Wales Australia
| | - A Korda
- Obstetrics and Gynaecology, School of Medicine, Western Sydney University; Campbelltown New South Wales Australia
| | - H Ng Chok
- Centre for Nursing Research and Practice Development; Western Sydney University/Nepean Blue Mountains Local Health District; Penrith New South Wales Australia
| | - C Miranda
- College of Professional Psychology; Crows Nest New South Wales Australia
| | - A Villarosa
- COHORTE Research Group; Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research; Liverpool New South Wales Australia
| | - M Johnson
- Faculty of Health Sciences; Australian Catholic University, Ingham Institute Applied Medical Research; Sydney New South Wales Australia
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Duff M, Dahlen HG, Burns E, Priddis H, Schmied V, George A. Designing an oral health module for the Bachelor of Midwifery program at an Australian University. Nurse Educ Pract 2017; 23:76-81. [PMID: 28273559 DOI: 10.1016/j.nepr.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 02/04/2017] [Accepted: 02/08/2017] [Indexed: 01/22/2023]
Abstract
Maternal oral health is important yet many pregnant women are unaware of its significance. Midwives are advised to promote oral health during pregnancy and are supported to do this in Australia through the Midwifery Initiated Oral Health training program. However, limited undergraduate education is being provided to midwifery students in this area. The objective of this paper is to describe how an innovative oral health education module for an undergraduate midwifery course in Australia was designed using a multidisciplinary approach. Midwives experienced in curriculum development and key investigators from the Midwifery Initiated Oral Health program designed the module using existing literature. Constructive alignment, blended learning and scaffolding were used in the design process. The draft module was then reviewed by midwifery academics and their feedback incorporated. The final module involves 4 h of teaching and learning and contains three components incorporated into first year course units. Each component is aligned with existing learning outcomes and incorporates blended learning approaches and tutorials/class activities as well as online quizzes and personal reflection. The module details key information (current evidence; basic anatomy/physiology; common oral conditions; and guidelines during pregnancy) that could better prepare students to promote oral health in clinical practice. This is the first time such an innovative, multidisciplinary approach has been undertaken embedding oral health in an undergraduate midwifery program in Australia.
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Affiliation(s)
- Margaret Duff
- School of Nursing & Midwifery, Western Sydney University, Sydney, NSW 2150, Australia
| | - Hannah G Dahlen
- School of Nursing & Midwifery, Western Sydney University, Ingham Institute Applied Medical Research, Sydney, NSW 2150, Australia
| | - Elaine Burns
- School of Nursing & Midwifery, Western Sydney University, Sydney, NSW 2150, Australia
| | - Holly Priddis
- School of Nursing & Midwifery, Western Sydney University, Sydney, NSW 2150, Australia
| | - Virginia Schmied
- School of Nursing & Midwifery, Western Sydney University, Sydney, NSW 2150, Australia
| | - Ajesh George
- Collaboration for Oral Health Outcomes, Research Translation and Evaluation (COHORTE) Research Group, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, University of Sydney, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
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