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

BackgroundOral 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.ObjectivesTo 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.DesignMulti-centre randomised controlled trial.SettingThree large metropolitan public hospitals in Sydney, Australia.ParticipantsPregnant 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.Methods638 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.ResultsSubstantial 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.ConclusionsThe 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.     

创建以人为本的产科新模式:孕期全程服务

目的探索新的以人为本的产科服务模式,改善医患关系,优化妊娠结局。方法取2000年1月至12月的产前门诊1 200名孕妇为实验组,选择一对一孕期全程服务,取1999年1月至12月产前门诊1000名孕妇为对照组,常规检查,将两组孕妇分娩结局进行统计学比较。结果两组的产检率、高危管理率,围产儿死亡率、患者投诉及患者满意度经卡方检验,均差异有统计学意义(P<0.05)。结论孕期全程服务模式能改善妊娠结局。     

助产士角色认知与工作体验的质性研究

目的 深入了解和探索助产士的角色认知和工作体验.方法 采用质性研究中的现象学研究法,对10名助产士进行深入访谈,并采用类属分析法对资料进行分析.结果 本研究提炼了3个主题:助产士的多重角色、助产士所应具备的能力和特质、正负双向的助产工作体验.结论 管理者应采取人性化的管理策略帮助助产士充分发挥职业角色,获得积极的工作体验.也提示我国助产教育和助产管理体系有待进一步完善,以促进助产专业的发展.     

Perceptions of nurses towards oral health in palliative care: A qualitative study

BackgroundOral health problems among people receiving palliative care are common and can significantly affect quality of life. Nurses are at the frontline of palliative care in Australia. However, how optimal oral health care is addressed in clinical practice by palliative nurses is not known.AimTo explore the perceptions of nurses working in Australian palliative care settings to determine the acceptability, challenges and recommendations that need to be considered to develop and implement an oral health care model in palliative care settings.MethodsTwo focus groups were conducted with community (n = 8) and inpatient nurses (n = 10) working in urban palliative care settings.FindingsFour main themes were developed through consensus: 1) Oral health is important in the palliative care setting; 2) Additional training could enhance what nurses already do; 3) Barriers to receiving oral care: a structural issue; 4) Exploring alternative pathways to dental services.DiscussionNurses recognised the importance of oral health in palliative care; however, the paucity of set protocols based on existing guidelines meant that oral care was often unstructured. Systemic factors reduced the number of available options for people receiving palliative care to access professional dental treatment. Although alternative solutions, including teledentistry services, were explored, there were some constraints.ConclusionA palliative care oral health model of care would need to integrate existing formal guidelines into a comprehensive framework specific for palliative care nurses and develop palliative care oral health training for them taking into consideration existing barriers for people to receive professional dental treatment.     

Perceptions of cardiac care providers towards oral health promotion in Australia

Background

There is increasing evidence linking poor oral health with cardiovascular disease and it is recommended that health professionals managing people with cardiac disease (cardiac care providers) promote oral health in their practice. However, the current perceptions of cardiac care providers regarding this aspect of clinical practice are unknown in Australia.

Designing an oral health module for the Bachelor of Midwifery program at an Australian University

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.     

The role of nurses and midwives in the governance of local health networks

Current health reforms in Australia will establish local health networks of public hospitals each with a governing body. The establishment of these governing bodies, particularly in states like NSW where these entities do not currently exist within the public hospital system, provides opportunities for nurses, midwives and other clinicians to seek appointment to them. The policy and discussion papers on the establishment of the local health networks promise that local clinicians will be appointed to these governing bodies. Debate within the nursing and midwifery profession seems focused on the management of nursing and midwifery services within the new local health networks and not on the role of nurses and midwives on governing bodies. Nurses and midwives undoubtedly have a role to play on these governing councils, however there are a range of issues that should be considered on the role that nurses, midwives (and other clinicians) will play when appointed to the governing councils to ensure that they can appropriately undertake the role of a council member. The role of governance differs from that of management and clinicians who aspire to appointment of these governing bodies should be aware of the difference in these roles.     

A qualitative study of mild to moderate psychological distress during pregnancy

Background

Psychological distress is common in the antenatal period. In England, psychological distress is classified as mild, moderate or severe but only those who suffer severe psychological distress are referred to the specialist mental health services. Those who suffer mild to moderate psychological distress are managed by the primary care services. However, little is know about the psychosocial experiences of pregnant women who suffer from mild-moderate psychological distress.

Objective

This study explored the experiences of pregnant women who self-reported mild to moderate psychological distress during antenatal care.

Design

A qualitative study. Data were collected using digitally recorded, face-to-face, semi-structured interviews. Data were analysed using framework analysis.

Setting

A large teaching maternity hospital in North West England.

Participants

Twenty-four pregnant women who self-reported mild to moderate psychological distress to their midwife during routine antenatal care.

Results

Three main themes emerged: the causes of, impact of, and ways of controlling self-reported mild to moderate psychological distress. A range of experiences caused psychological distress including past life and childbearing experiences, and current pregnancy concerns. Mild to moderate psychological distress took over the lives of these pregnant women. The strategies used to control mild to moderate psychological distress included both positive and negative coping elements.

Conclusions

Psychological distress that is categorised as mild to moderate can be extremely debilitating for pregnant women. Identification of these women in clinical practice is crucial so that effective interventions can be targeted appropriately. Screening criteria that has the efficacy to identify depression and anxiety is needed. We recommend that a multidisciplinary approach to the management of care is developed to address the range of experiences that pregnant women who suffer mild to moderate prenatal psychological distress may have.     

Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study

Objective

To identify elements of the physiotherapist–patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings.

Design

A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach.

Setting

Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain).

Participants

Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries.

Results

Patients based their evaluations of quality of care on their assessment of physiotherapists’ willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist–patient interaction emerged under all these themes, except for friendly and respectful communication.

Conclusion

This study identified which elements of the physiotherapist–patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients’ experiences of the physiotherapist–patient interaction in rehabilitation services to provide empirical and quantitative evidence.     

Assessing oral health literacy of university nursing students: A cross-sectional exploratory study

AimResearch has proven a link between oral health and numerous chronic systemic diseases. To achieve better health outcomes, there is a need to involve interprofessional primary health care providers, such as nurses to raise awareness and promote oral health. Nurses have regular contact with patients which provides a unique opportunity to impart disease-specific information and technical skills for patients to self-manage their oral health conditions. However, the baseline oral health literacy of undergraduate nursing students at the University of Sydney is not known. Before creating a targeted curriculum to improve oral health literacy amongst nursing students, it is essential to assess the baseline oral health knowledge of these students. This study aimed to assess the oral health literacy level among undergraduate nursing students of the University of Sydney, Australia.DesignAn exploratory research approach was used.MethodsA cross-sectional survey study was conducted using the validated Comprehensive Measure of Oral Health Knowledge (CMOHK) instrument. A univariate general linear model was used to explore the association of CMOHK total score with demographic and educational variables.ResultsA total number of 197 nursing students participated in the survey, with a mean CMOHK score of 15.48, SD 3.27. 72% were categorized as having good, 16% fair and 12% poor oral health knowledge. The analysis from the six individual knowledge domains of the CMOHK revealed lower percentages of correct responses in the periodontal disease and oral cancer knowledge domains. Students with English as their second language, on average, scored 2 fewer correct responses (p <.001) than students whose first language was English. Low socioeconomic status was not associated with a low level of oral health literacy.ConclusionThe baseline results show a good level of general oral health knowledge as measured by the CMOHK. However, periodontal disease and oral cancer were identified as the particular domains where a knowledge gap exists. These findings may help to map and design an oral health education intervention to improve oral health literacy amongst nursing students. Culturally responsive pedagogy may need to be considered for students with English as their second language. This baseline survey data may potentially facilitate integrating oral health in nursing education and practice.     

Enhancing oral health for better mental health: Exploring the views of mental health professionals

The association between oral health, self‐esteem and quality of life is well established yet there is limited research on the impact of addressing the poor oral health of people living with mental health disorders. Greater consideration is warranted on how enhancing oral health in the course of mental healthcare might reduce the burden of a person's ill health. The role of mental health professionals is important in this regard yet uncertainty persists about the role these providers can and should play in promoting oral health care for people with mental health disorders. This qualitative study explored the issue of oral health and mental health with community based mental health professionals in Perth, Western Australia. It examined their views on the oral health status and experiences of their clients, and the different and alternative ways to improve access to care, knowledge and preventative regimens. Findings indicated participants’ ambivalence, reluctance and lack of training in raising oral health issues, despite its acknowledged importance, indicating a siloed approach to care. Findings offer an opportunity to reflect on whether a more integrated approach to oral health care for people with mental health disorders would improve health outcomes.     

Current practice and knowledge of oral care for cancer patients: a survey of supportive health care providers

Background The Oral Care Study Section of the Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) conducted a survey on clinical practices of oral/dental management of cancer patients among supportive health care providers. The main purpose was to evaluate the knowledge and current practice for preventing and managing oral side effects associated with intensive chemotherapy (ICT), hematopoietic cell transplant (HCT), and radiation therapy to the head and neck (H&N RT).Materials and methods A questionnaire designed and pretested was sent to 212 MASCC/ISOO members around the world with different dental and medical backgrounds.Main results Seventy-four individuals (35%) responded. The majority of respondents were aware of possible oral complications and provided patients with clinical strategies and recommendations although there was considerable variability among the respondents. Approximately 75% stated that patients were referred for oral/dental care prior to H&N RT and ICT including HCT. However, integrated dental and medical services were reported available in only about 25% of the institutions, and most patients were referred to community-based dental professionals.Main conclusions The survey represents a first review of current, international oral care practices. It suggests a need to develop evidence-based clinical guidelines to support effective oral/dental interventions and management strategies for this population. Furthermore, strategies for implementation of oral care protocols and better integration of dental and medical services should be developed. Caution in interpreting these findings is urged due to the limited response rate.For the Oral Care Study Section of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology. Chairs: Dr. Fred K. L. Spijkervet and Dr. Philip C. Fox.     

1350名儿童口腔保健知识与行为的调查分析

目的 了解就诊儿童的口腔保健知识和行为，为口腔保健知识的宣传提供基线资料。方法 对就诊的1350名儿童进行口腔健康问卷调查。结果 2-6岁组儿童口腔健康行为的平均发生率为36．4％。7～12岁组为53．3％，2组间差异存在显著性（P〈0．05）；2～6岁组饮食不良行为平均发生率为16．06％，7～12岁组为13．43％，2组间差异无显著性（P〉0．05）12～6岁组口腔保健知识平均知晓率为24．41％，7～12岁组为40．95％，2组间差异有显著性（P〈0．05）。结论 2组儿童口腔健康行为和口腔保健知识知晓率都较低。今后应加强时儿童及其母亲的口腔健康知识的宣传，以降低龋病的发病率。     

The effect of oral care using honey as an additional topical agent on oral health status of intubated patients in the intensive care unit

BackgroundPatients using endotracheal tubes are at high risk of oral health status dysfunction due to impaired natural airway defence, oral flora composition changes and protective substances of the teeth, medication causing xerostomia. Oral care has not been enough to manage oral mucosal dryness, so an additional topical agent is needed to protect oral mucosa to maintain oral health. Honey is one of the recommended topical agents.ObjectiveThis study aims to identify the effect of oral care with honey as topical agents on the oral health status of patients using endotracheal tube in the Intensive Care Unit.MethodsThis was an experimental study with a randomized pretest and posttest design. The sample was adult intubated patients, consisting of 36 patients. The data were analysed using the parametric test, and dependent and independent t-test.ResultsThe oral health score in the control group was found to be pre & post mean score11.94 and 13.28 (p = .004) respectively, while in the intervention group 11.89 and 8.33 (p < .001). Mean differences in both groups were 4.95 (p < .001) and the BOAS subscale differences were seen on the lips, gums & mucosa, and tongue (p < .05).ConclusionOral care with honey as a topical agent can improve the oral health status of intubated patients on the lips, gum, mucosa, and tongue subscale. Therefore, honey as an additional topical agent can be a moisturizer to maintain the oral mucosa for intubated patients in the Intensive Care Unit. Furthermore, good mucosal health will help prevent the infection and colonization of microorganisms.