Identifying potential catalysts to accelerate the achievement of Sustainable Development Goals (SDGs) among adolescents living in Nigeria.

Investing in adolescents in Africa holds great promise for the development of the continent. The steps involved in identifying factors linked to interventions that may accelerate the attainment of multiple SDGs for adolescents in Nigeria are described. Data from a survey to investigate the well-being of 1800 adolescents aged 10-19 years in Southwest Nigeria was analysed. A four-step process was employed: 1) Mapping of variables deemed as suitable proxies for SDG targets; 2) Mapping hypothesised protective factors (accelerators) from the study instruments. Consequently, SDG targets related to elimination of hunger, good health, gender equality and peace; and seven accelerators (safe schools, parenting support, good mental health, no survival work, food security, stable childhood, and regular physical activity) were identified; 3) evaluating associations using bivariate analysis and multivariable logistic regression, 4) calculating adjusted probabilities. The mean age of the adolescents was 15.02 ± 2.27 years (48.6% female). Good mental health, not doing survival work, safe schools, stable childhood and parental support were significantly associated with at least two SDG targets. For example, food security was significantly associated with the highest number of SDG outcomes: one SDG target related to child survival (no substance use: x2 = 3.39, p = <0.001); three SDG targets related to educational outcomes (school progression: x2 = 5.68, p = 0.017, ability to concentrate in school: x2 = 26.92, p = <0.001, and school attendance: x2 = 25.89, p = <0.001); and four SDG targets related to child protection (no risky sexual behaviours: x2 = 16.14, p = <0.001, no perpetration of violence: x2 = 15.74, p = <0.001, no community violence: x2 = 39.06, p =<0.001, and no sexual abuse: x2 = 7.66, p = 0.006). Interventions centred around good mental health, not doing survival work, safe schools, small family size, stable childhood and parental support are potential accelerators for the attainment of SDG outcomes by adolescents living in Nigeria.

Accelerating progress towards the sustainable development goals for adolescents in Ghana: a cross-sectional study.

Since the adoption of the sustainable development goals (SDGs) by the United Nations (UN), the search has been on to identify interventions that have effects on multiple SDG-targets simultaneously. Like other developing countries, Ghana has a youthful population and would require creative, urgent, youth-focused interventions to be able to attain the SDGs by 2030. This paper describes the application of the accelerator model on data from a sample of Ghanaian adolescents to identify potential accelerators towards selected SDG targets involving youth. The data for 944 adolescents, 10-19 years (mean age 12.31 ± 3.51 years), extracted from two cross-sectional surveys on children and adolescents aged 6-19 years in Kumasi, Ghana, were analysed in this paper. Variables considered suitable proxies for SDG targets and potential accelerators were identified from the study instruments. Consequently, four aligned SDG targets (good mental health, access to ICT, school completion and no open defaecation) and five accelerators (cognitive stimulation, no relative poverty, low student-teacher ratio, high caregiver education and safe water) were extracted. Associations between accelerators and SDG targets were assessed using multivariable logistic regression adjusting for sociodemographic covariates and multiple testing. Cumulative effects were tested by marginal effects modelling. The three hypothesised accelerators identified were cognitive stimulation, low student-teacher ratio, and no relative poverty. A combination of all three accelerators was associated with a higher likelihood of adolescents having access to Information and Communication Technology (ICT) by +73% (CI 0.72-0.74), no open defecation by +44% (CI 0.43-0.46), school completion by +27% (CI 0.26-0.27) and good mental health by +9% (CI 0.08-0.10). Three hypothesized accelerators showed association across all four SDG aligned targets. The accelerator model has been further validated in this dataset from Ghana. Robust interventions designed around these accelerators may represent an opportunity for achieving the SDGs in Ghana.

A protocol for early childhood caries diagnosis and risk assessment.

The global Early Childhood Caries (ECC) burden is of concern to the World Health Organisation (WHO), but the quantification of this burden and risk is unclear, partly due to difficulties in accessing young children for population surveys and partly due to diagnostic criteria for ECC experience. The WHO criterion for caries diagnosis is the late stage event of dentine cavitation. Earlier stages of the caries lesion are clinically detectable and should be registered earlier in the life of children and arrested/remineralized before lesions progress to the cavitation stage. A protocol for ECC diagnosis is proposed to guide those engaged in clinical dentistry in their characterization of the ECC lesion. As management of early lesions is a critical step to reduce risk of their progression to later stage lesions, a practical method for assessing ECC risk is proposed also. Risk assessment is very important because it determines (a) urgency for interventions aimed to arrest lesion progression; (b) the frequency of such interventions and (c) the need to enhance the primary prevention of ECC. The guidelines are set out separately for ECC diagnosis for ongoing clinical care and for epidemiologic purposes. Similarly, guidelines are set out for ECC risk assessment and ongoing monitoring.

Acyclic Linear SEMs Obey the Nested Markov Property.

The conditional independence structure induced on the observed marginal distribution by a hidden variable directed acyclic graph (DAG) may be represented by a graphical model represented by mixed graphs called maximal ancestral graphs (MAGs). This model has a number of desirable properties, in particular the set of Gaussian distributions can be parameterized by viewing the graph as a path diagram. Models represented by MAGs have been used for causal discovery [22], and identification theory for causal effects [28]. In addition to ordinary conditional independence constraints, hidden variable DAGs also induce generalized independence constraints. These constraints form the nested Markov property [20]. We first show that acyclic linear SEMs obey this property. Further we show that a natural parameterization for all Gaussian distributions obeying the nested Markov property arises from a generalization of maximal ancestral graphs that we call maximal arid graphs (MArG). We show that every nested Markov model can be associated with a MArG; viewed as a path diagram this MArG parametrizes the Gaussian nested Markov model. This leads directly to methods for ML fitting and computing BIC scores for Gaussian nested models.

Marginal log-linear parameters for graphical Markov models.

Marginal log-linear (MLL) models provide a flexible approach to multivariate discrete data. MLL parametrizations under linear constraints induce a wide variety of models, including models defined by conditional independences. We introduce a subclass of MLL models which correspond to Acyclic Directed Mixed Graphs (ADMGs) under the usual global Markov property. We characterize for precisely which graphs the resulting parametrization is variation independent. The MLL approach provides the first description of ADMG models in terms of a minimal list of constraints. The parametrization is also easily adapted to sparse modelling techniques, which we illustrate using several examples of real data.

Screening for caries in targeted schools in the Blue Mountains and Hawkesbury districts, New South Wales, Australia: an evaluation of the School Assessment Program.

AIM: To determine if the school dental screening program in New South Wales, the School Assessment Program, achieved its aim of being the key entry point for high-risk children to receive care. METHODS: A secondary analysis was conducted on epidemiological data gathered in 16 primary schools in New South Wales (10 for the School Assessment Program and six for the non-School Assessment Program) in 2003. The validity of the School Assessment Program targeting criteria in identifying high-risk schools was determined. Post-screening treatment outcomes were evaluated from the assessment of treatment ratios. RESULTS: There were negligible differences in the caries experience and proportions of high-risk children, irrespective of their School Assessment Program status. Sensitivity and specificity values were approximately 60% and 40%, respectively, using various case definitions of high risk applied to both children and schools. Deciduous dentition treatment ratios for School Assessment Program and non-School Assessment Program children with decayed, missing, and filled teeth (dmft) ≥1 ranged from 0.48 to 0.79 and from 0.47 to 0.73, respectively. Respective permanent dentition treatment ratios for School Assessment Program and non-School Assessment Program children with Decayed, Missing, and Filled Teeth (DMFT) ≥1 were 0.49-0.82 and 0.64-1.08. CONCLUSION: The School Assessment Program failed to identify schools with high caries-risk children or confer post-screening caries treatment benefits.

Dental caries in children: a comparison of one non-fluoridated and two fluoridated communities in NSW.

AIM: The aim of the Child Dental Health Survey in Lithgow was to establish the oral health status of primary schoolchildren to assist the local council in deciding whether to fluoridate the water and to provide a baseline for future monitoring of changes in caries rates. METHODS: All six primary schools in Lithgow were invited to participate, and 653 children aged 6-12 years were clinically examined for dental caries. World Health Organization criteria were used, whereby a decayed tooth is defined as a cavity into the dentine. Caries prevalence was measured as the mean number of decayed, missing and filled teeth (primary: dmft; secondary: DMFT). Significant caries indices were calculated to categorise children with the mean dmft/DMFT score of the highest 30 percentage (SiC) and the highest 10 percentage (SiC(10)) of caries. Data for Lithgow were compared with school dental service data for the socioeconomically comparable fluoridated townships of Bathurst and Orange. RESULTS: The primary dentition caries estimates (dmft, SiC and SiC(10)) in Lithgow children aged 6 years were 0.92, 2.72 and 5.81, respectively; the estimates for permanent dentition caries (DMFT, SiC and SiC(10)) in Lithgow children aged 12 years were 0.69, 2.05 and 6.41, respectively. The caries prevalence in the permanent dentition of Lithgow children was significantly higher than that in children living in the fluoridated towns of Bathurst and Orange. No significant differences were observed in the estimates for primary teeth. CONCLUSION: Although the mean levels of dental caries in schoolchildren in Lithgow were low, oral health inequalities exist between children residing in non-fluoridated Lithgow and the fluoridated locations of Orange and Bathurst. The local council decided that Lithgow will have fluoridated water by December 2010.

Role transitions for new clinical leaders in perinatal practice.

New clinical leaders are transitioning to their roles in a demanding and short-staffed profession where change is constant and finances are uncertain. For successful role transition in the specialty of perinatal nursing, both new leaders and their mentors must understand the attributes of potential leaders, the role of mentoring, and the need for clearly articulated expectations. This article discusses these processes in the context of the considerable skill set required for leadership in nursing today. The similarities and differences between the roles of manager and leader are discussed.