Risk factors for oral health in young, urban, Aboriginal and Torres Strait Islander children.

BACKGROUND: The caries process follows a strong social gradient which can commence in the first years of life. Yet data on young children remain limited. This study reports the potential risk factors and indicators in urban, Aboriginal and Torres Strait Islander children aged less than 5 and estimates the prevalence of caries. METHODS: Demographic and risk factor and risk indicator data were collected at baseline in a cohort study of children attending a health clinic in north Brisbane. Dentulous children received a basic oral examination to explore the presence of decayed, missing and filled teeth (dmft). Descriptive analyses were performed. A backwards stepwise logistic regression model was performed to identify potential associations with dmft status. RESULTS: In this study, 180 children enrolled: 111 children received the oral examination, of whom 14 (12.6%) (mean age 35 months) were estimated to have dmft >0. There was a high prevalence of socio-economic, dietary and behavioural risk factors/indicators present for children. Due to the small sample size, planned regression was not performed. CONCLUSIONS: Overall, the prevalence of risk factors and risk indicators for caries in the study population is high. More culturally appropriate resources that support preventive care need to be invested before children are school aged.

Lung disease in indigenous children.

Children in indigenous populations have substantially higher respiratory morbidity than non-indigenous children. Indigenous children have more frequent respiratory infections that are, more severe and, associated with long-term sequelae. Post-infectious sequelae such as chronic suppurative lung disease and bronchiectasis are especially prevalent among indigenous groups and have lifelong impact on lung function. Also, although estimates of asthma prevalence among indigenous children are similar to non-indigenous groups the morbidity of asthma is higher in indigenous children. To reduce the morbidity of respiratory illness, best-practice medicine is essential in addition to improving socio-economic factors, (eg household crowding), tobacco smoke exposure, and access to health care and illness prevention programs that likely contribute to these issues. Although each indigenous group may have unique health beliefs and interfaces with modern health care, a culturally sensitive and community-based comprehensive care system of preventive and long term care can improve outcomes for all these conditions. This article focuses on common respiratory conditions encountered by indigenous children living in affluent countries where data is available.

Achieving cardiovascular health through continuing interprofessional development.

In order to achieve cardiovascular health for all Canadians, the ACHIC (Achieving Cardiovascular Health in Canada) partnership advocates that health promotion for healthy lifestyles be incorporated into practice, and that the consistent messages and professional skills required to motivate patients and the public be acquired through interprofessional education and development. Professional education specialists are essential members of health care promotion teams with expertise to develop educational interventions that impact behaviours of health professionals and subsequent patient outcomes. Continuing medical education (CME) is in evolution to continuing professional development (CPD), and then to continuing inter-professional development (CID). Providers of health promotion, public health, and health care can work with health educators to complete the cascade of learning, change in practice, and improvement in patient outcomes. The Canadian health care system can empower Canadians to achieve cardiovascular health, the most important health challenge in the 21st century.

From death and disability to patient empowerment: an interprofessional partnership to achieve cardiovascular health in Canada.

This paper proposes a paradigm shift in health care from a focus on death and disability to one on health empowerment resulting in improved cardiovascular lifestyles for all Canadians. It describes a national interprofessional initiative to achieve this new vision in the area of cardiovascular health promotion. Achieving Cardiovascular Health in Canada (ACHIC) is a partnership of health professional associations and other health advocate groups whose vision is to promote optimal cardiovascular health (including cerebrovascular health) for all Canadians through interprofessional partnership initiatives and support systems. ACHIC's objectives are to: 1) identify system barriers and supports to cardiovascular health; 2) develop strategies that will have a positive impact on the practices of health professionals/educators in the promotion of cardiovascular health; 3) develop an interprofessional national approach to support strategies to achieve cardiovascular health in Canada; and 4) support the development and delivery of consistent, evidence-based messages by health professionals/educators for promotion of cardiovascular health.

Mobilizing physicians for clinical tobacco intervention in Canada: evaluating a national and provincial partnership.

This paper examines the activities of the 'Mobilizing Physicians for Clinical Tobacco Intervention' project, a multi-partner project established in 1995 to provide resources to physicians to help them counsel patients about smoking. The evaluation was a multi-level case study which used a variety of national and provincial data sources, including surveys and document review. Findings from each of the partners are presented, and their implications for future tobacco control projects discussed. The study also discusses problems encountered in implementation and their solutions, and assesses the implications for those planning or conducting large scale, multi-centre evaluations.

Qualitative evaluation of the Canadian Medical Association's counselling guidelines for HIV serologic testing.

OBJECTIVE: To evaluate the face and content validity of the CMA's counselling guidelines for HIV serologic testing in order to prepare a revised edition. DESIGN: Qualitative evaluation by structured focus groups in September and October 1994 to assess the relevance, clarity and practicality of the guidelines, followed by content analysis of the discussions. SETTING: Vancouver, Winnipeg, Toronto, Montreal, Quebec City and St. John's. PARTICIPANTS: Primary care physicians randomly selected from the CMA database and nonrandomly selected from the Canadian Medical Directory who had limited experience with HIV testing and counselling and who provided an appropriate mix of characteristics in terms of practice type (solo and group), setting (urban and rural), age and sex. A total of 1247 physicians were approached for the study; a convenience sample of 68 were recruited, of whom 56 participated. The average size of each focus group was eight physicians. OUTCOME MEASURES: Clinical experience and information sources with respect to HIV testing, reactions to the counselling guidelines, and suggestions for revisions and improvements to the guidelines. RESULTS: Most (96% [54/56] of the participants had ordered HIV serologic testing for patients in the 6 months preceding the focus groups, and about half of them (52% [28/54]) had at least one patient with a positive test result. Many (59% [33/56]) of the participants had a copy of the guidelines at the time of recruitment; 19 (58%) of them had used the guidelines in the months before the focus groups. The parts of the guidelines most often read were the checklists and inset boxes. Recommendations for revisions in content were for more information on legal and ethical issues, information on new issues (e.g., rapid testing) and guidelines on how best to tell a patient about a positive test result; recommendations for revisions in format included more tables, algorithms, bulleted points and white space, less text, larger type and plainer language. CONCLUSIONS: The focus groups provided detailed, credible and consistent information about the face and content validity of the HIV counselling guidelines. They are a useful qualitative method for evaluating the relevance, clarity and practicality of clinical practice guidelines at the inception or revision stage.

The role of distinctive features in articulation errors.

Articulation errors of 1,077 children of various ages, etiologies, and sexes were taken from several standardized articulation tests. The Singh and Singh (1976) distinctive feature system was used to produce profiles for each subgroup for consonant phonemes in the initial, medial, and final word positions. Distinctive features were used with different degrees of importance causing hierarchial orders among the features. The hierarchy of features established in this study was consistent with those found in previous studies. It was more pronounced for the initial position than for the medial and final positions, and for the younger age groups as compared with the older groups. In addition, the feature hierarchy for the articulation-disordered group was more distinct than that for the language group. Females revealed a generally superior performance to males, but this superiority was in general not statistically significant. Findings are discussed as to their relevance in the overall application of a phonological theory to speech production strategies.

Markedness of features in the articulatory substitutions of children.

This study concerns an analysis of articulatory substitutions of 801 students using markedness theory and a distinctive feature model (Singh & Singh, 1976). The 556 male and 245 female students ranged in age from 3--7 years and were diagnosed as evidencing an articulatory disorder or a linguistic delay. Significantly more feature substitutions moved from marked to unmarked values than from unmarked to marked values (p less than .05, binomial distribution). The study proposed a hierarchy of distinctive features in terms of markedness rather than in terms of features per se. The applications of articulatory and acoustic data to phonological theory and the implications of the findings to speech treatment are discussed.