Organizational Readiness to Implement System Changes in an Alaskan Tribal Dental Care Organization.

INTRODUCTION: Tribal health care systems are striving to implement internal changes to improve dental care access and delivery and reduce health inequities for American Indian and Alaska Native children. Within similar systems, organizational readiness to implement change has been associated with adoption of system-level changes and affected by organizational factors, including culture, resources, and structure. OBJECTIVES: The objectives of this study were to assess organizational readiness to implement changes related to delivery of evidence-based dental care within a tribal health care organization and determine workforce- and perceived work environment-related factors associated with readiness. METHODS: A 92-item questionnaire was completed online by 78 employees, including dental providers, dental assistants, and support staff (88% response rate). The questionnaire queried readiness for implementation (Organizational Readiness for Implementing Change), organizational context and resources, workforce issues, organizational functioning, and demographics. RESULTS: Average scores for the change commitment and change efficacy domains (readiness for implementation) were 3.93 (SD = .75) and 3.85 (SD = .80), respectively, where the maximum best score was 5. Perceived quality of management, a facet of organizational functioning, was the only significant predictor of readiness to implement change (B = .727, SE = .181, P < .0002) when all other variables were accounted for. CONCLUSION: Results suggest that when staff members (including dentists, dental therapists, hygienists, assistants, and support staff) from a tribal health care organization perceive management to be high quality, they are more supportive of organizational changes that promote evidence-based practices. Readiness-for-change scores indicate an organization capable of institutional adoption of new policies and procedures. In this case, use of more effective management strategies may be one of the changes most critical for enhancing institutional behaviors to improve population health and reduce health inequities. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by clinicians and other leaders implementing changes within dental care organizations. To promote organizational readiness for change and, ultimately, more expedient and efficient adoption of system-level changes by stakeholders, consideration should be given to organizational functioning generally and quality of management practices specifically.

Investigation and control of a cluster of cases of Legionnaires disease in western Sydney.

Three cases of Legionella pneumophila infection were identified in Sydney's west in November 1998. Epidemiological investigations identified an association with one workplace. Environmental sampling revealed that the cooling towers in the workplace, and at 2 other premises within a 1 km radius of the workplace, were positive for L. pneumophila serogroup 1 (LP1) which was indistinguishable from clinical isolates of 2 of the cases on DNA fingerprinting. Our report highlights limitations of the current control program for Legionella in cooling towers, including the finding of unregistered cooling towers, cooling towers positive for LP1 despite satisfactory results on inspection, and cooling towers potentially linked to disease with counts of LP1 below the current protocol requirements for immediate decontamination.

Can non-prosecutory enforcement of public health legislation reduce smoking among high school students?

BACKGROUND: Smoking by adolescents has been identified as a major public health issue. Raising the legal age of cigarette purchase from 16 to 18 years has attempted to address the issue by restricting adolescents' access. METHODS/STRATEGY: A prospective study evaluating the impact of non-prosecutory enforcement of public health legislation involving 'beat police' was conducted in the Northern Sydney Health region. Secondary students, aged 12 to 17 years, from both intervention and control regions were surveyed about cigarette smoking habits by means of a self-completed questionnaire administered pre- and post-intervention. RESULTS: 12,502 anonymous questionnaires were completed. At baseline, 19.3% of male students and 21.2% of female students indicated they were current smokers. Age and sex stratified chi-squared analysis revealed significantly lower post-intervention smoking prevalence for year 8 and 10 females and year 7 males among the intervention group. Higher post-intervention smoking prevalences were demonstrated for year 7 and 9 females and year 8 males among the intervention group and in year 10 males and year 11 females among the control group. The analysis of combined baseline and follow-up data from coeducational schools with logistic regression techniques demonstrated that the intervention had a significant effect in reducing smoking prevalence among year 7 students only (OR = 0.54). CONCLUSION: Our study demonstrates the difficulties in restricting high school students' access to cigarettes. Isolated non-prosecutory strategies are likely to only have a limited impact on reducing smoking prevalence among high school students.

Health problems and service use by parents of normal infants in the first 6 months of life.

A retrospective descriptive study was carried out on residents of the northern Sydney health area who delivered normal, full term, singleton infants at three large maternity units. A sample population of 1199 was sent a postal questionnaire when their infants reached the age of 6 months, and a 65% response rate was obtained. Problems encountered, with ratings of severity and difficulty of management, were reported in five categories: acute and persistent or recurrent illness, daytime and night-time behaviour problems and feeding problems. Forty-seven per cent of parents reported at least one problem which they rated severe or very difficult to manage, and 19.7% reported two or more, particularly in the areas of behaviour and feeding difficulties. Traditional services such as those provided by general practitioners and specialists were not often helpful for these problems, while baby health services and specialized support services were more helpful. However, a significant number of respondents found no service helpful, representing an area of unmet need.

Seasonal variation of birthweight in Bangladesh.

Analysis of birthweights of 1772 singleton babies born alive at Kumudini Hospital in rural Bangladesh over 2 consecutive years, 1983 and 1984, showed a consistent seasonal variation. The highest birthweights occurred in the period March to May (summer) and the lowest in the September to November period (autumn). This could not be correlated with differences in maternal age or parity, but was correlated with seasonal availability of food and changes in children's nutritional status as recorded in the hospital under-5s clinic. It is concluded that poor maternal nutrition in the last trimester of pregnancies in mothers delivered in the September to November period is the main factor, and recommendations for health education are made accordingly.

Introduction of neonatal care in a rural Bangladesh hospital: an analysis of the first year's operation.

A neonatal care unit was introduced into a rural hospital in Bangladesh. Emphasis was on simple care to prevent hypothermia, hypoglycaemia and infection, and on involving mothers in caring for their infants as much as possible. The mean birthweight was found to be only 2.44 kg, so that the level of low birthweight requiring special care was fixed at 2.0 kg. At this level, during the first year of operation, 193 low birthweight babies were attended, approximately 20% of total deliveries. Of these, 80% were above 1.5 kg and had a mortality of 25%. Those below 1.5 kg fared worse, and 83% either died or were discharged against medical advice. The main problems were an initial lack of enthusiasm from the nursing staff, high incidence of sepsis (related to poor hygiene of mothers) and difficulty in persuading mothers to keep very low birthweight babies in hospital. However, with minimal expenditure and equipment, appropriate neonatal care saved the lives of many low birthweight infants. Establishing breastfeeding and educating the mothers reduced the subsequent high mortality of low birthweight infants in the first year of life.