The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents : a systematic review

Background: Globally, oral health status of the geriatric population residing in nursing homes is poor. The integration of non-dental professionals is vital to monitor oral health, early identification and triaging of oral health problems, and timely referral to dental professionals. The aims of this systematic review were to provide a summary on the development and characteristics of oral health assessment instruments currently used by non-dental professionals for nursing home residents, and to perform a critical appraisal of their psychometric properties. Methods: This review was conducted as per the PRISMA guidelines. CINHAL (EBSCO), Medline (Ovid), and EMBASE (Ovid) were searched systematically. Two reviewers independently screened the title, abstract, and full text of the studies as per the eligibility criteria. Studies describing oral health assessment instruments used to assess oral health of nursing home residents by non-dental professionals were included. Using a methodological framework, each instrument was evaluated for purpose, content, and psychometric properties related to validity, reliability, feasibility, generalisability, and responsiveness. Additionally, the reporting quality assessment of each included study was performed according to the SURGE guidelines. Results: Out of the 819 screened articles, 10 studies were included in this review. The 10 identified instruments integrated 2 to 12 categories to assess oral health, which was scored on a 2 to 5-point scale. However, the measurement content varied widely, and none were able to comprehensively measure all aspects of oral health. Three measurement approaches were identified: performance- based assessment, direct inspection of the oral health status, and interview measures. Only eight instruments provided quality assessment on the basis of validity, reliability, feasibility and generalisability, whereas three instruments- Brief Oral Health Status Examination, Dental Hygiene Registration, and Oral Health Assessment Tool reported good methodological quality on at least one assessment criteria. Conclusions: None of the instruments identified in this review provided a comprehensive assessment of oral health, while three instruments appeared to be valid and reliable. Nonetheless, continuous development of instruments is essential to embrace the complete spectrum of oral health and address the psychometric gaps

The use of two-dimensional shear wave elastography in people with obesity for the assessment of liver fibrosis in non-alcoholic fatty liver disease

Obesity is associated with significant comorbidities, including non-alcoholic fatty liver disease (NAFLD). Given its potential to progress to advanced liver disease, monitoring the extent and progress of liver fibrosis and assessing its fibrosis stage are essential. Although liver biopsy is considered to be the gold standard for liver fibrosis staging, it is an invasive procedure with risk of complications. Considering the rising prevalence of obesity and NAFLD globally, developing non-invasive diagnostic methods is a priority. Transient elastography (TE) is increasingly being used to assess the severity of liver disease. However, in the presence of severe obesity, the increased thickness of subcutaneous adipose tissue and changes in anatomy may affect its diagnostic accuracy. Two-dimensional shear wave elastography (2D-SWE) assesses the liver stiffness in real time along with simultaneous anatomic B-mode ultrasound imaging and allows selection of the region of interest. This would suggest that 2D-SWE has several advantages over TE in patients with severe obesity. The purpose of this review is to examine the current literature addressing the use of 2D-SWE in the assessment of liver fibrosis in patients with NAFLD. This review also examines the evidence on the use of 2D-SWE in patients with obesity and NAFLD and compares it to TE as a novel and non-invasive method of assessing liver fibrosis

How do mothers living in socially deprived communities perceive oral health of young children? : a qualitative study

This qualitative study aims to explore and gain an in-depth understanding of the knowledge and perceptions of mothers living in Greater Western Sydney (GWS), one of Australia’s most socioeconomically disadvantaged regions, regarding the factors that influence oral health of young children. Mother–child dyads (n = 45) were purposively selected from a population-based cohort study in GWS. Semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and subsequently analyzed using thematic analysis. Five main themes emerged from the interviews: (1) beliefs about child oral health and first set of teeth; (2) awareness and attitudes towards oral health services; (3) identification of caries risk and protective factors; (4) broader cultural and social class influences on childhood oral health practices; and (5) the influence of parental self-confidence, self-efficacy, and perceived control. Overall, mothers reported having limited knowledge and awareness on the importance of baby teeth, child’s first dental visit, and seeking oral health care. Oral health and preventative practices in children were reported to be influenced by past dental experiences, culture and social class, and parental factors. The empirical findings of this study bring our attention to the critical factors that influence child oral health and the opportunities for co-creating child oral health promotion by targeting mothers

Improvement in eating disorder risk and psychological health in people with class 3 obesity : effects of a multidisciplinary weight management program

This study aimed to evaluate the risk of eating disorders, psychological distress, and healthrelated quality of life (HRQoL) in people with class 3 obesity (body mass index (BMI) ≥ 40 kg/m2 ), and the effect of multidisciplinary weight management over 12 months. This retrospective cohort study included all adults with class 3 obesity who enrolled in a weight management program from March 2018 to December 2019. Questionnaires included the Eating Disorder Examination Questionnaire Short (EDE-QS), Kessler Psychological Distress Scale (K10), and 36-Item Short Form Survey (SF-36) for HRQoL. Physical and Mental Component Summary scores (PCS and MCS) were derived from the SF-36. Of 169 participants who completed 12 months in the program, 65.7% (n = 111) completed questionnaires at baseline and 12 months, with 6.0 ± 6.8% weight loss over this period. Compared to baseline, there was significant improvement at 12 months in EDE-QS (15.7 ± 6.6 vs. 13.6 ± 6.2, p = 0.002), K10 (25.7 ± 9.7 vs. 21.2 ± 9.4, p < 0.001), PCS (29.4 ± 10.1 vs. 36.1 ± 10.9, p < 0.001), and MCS scores (40.2 ± 12.4 vs. 44.0 ± 13.4, p = 0.001). All, apart from EDE-QS scores, remained significant after adjusting for weight change. This study highlights the importance of multidisciplinary management in people with class 3 obesity to help reduce eating disorder risk and psychological distress, and improve HRQoL, in addition to weight loss

Enablers and barriers to implementing obesity assessments in clinical practice : a rapid mixed-methods systematic review

Objectives This systematic review aims to improve our knowledge of enablers and barriers to implementing obesity-related anthropometric assessments in clinical practice. Design A mixed-methods systematic review. Data sources Medline, Embase and CINAHL to November 2021. Eligibility criteria Quantitative studies that reported patient factors associated with obesity assessments in clinical practice (general practice or primary care); and qualitative studies that reported views of healthcare professionals about enablers and barriers to their implementation. Data extraction and synthesis We used randomeffects meta-analysis to pool ratios for categorical predictors reported in ≥3 studies expressed as pooled risk ratio (RR) with 95% CI, applied inverse variance weights, and investigated statistical heterogeneity (I2 ), publication bias (Egger’s test), and sensitivity analyses. We used reflexive thematic analysis for qualitative data and applied a convergent integrated approach to synthesis. Results We reviewed 22 quantitative (observational) and 3 qualitative studies published between 2004 and 2020. All had ≥50% of the quality items for risk of bias assessments. Obesity assessment in clinical practice was positively associated with patient factors: female sex (RR 1.28, 95% CI 1.10 to 1.50, I2 99.8%, mostly UK/USA), socioeconomic deprivation (RR 1.21, 95% CI 1.18 to 1.24, I2 73.9%, UK studies), non-white race/ ethnicity (RR 1.27, 95% CI 1.03 to 1.57, I2 99.6%) and comorbidities (RR 2.11, 95% CI 1.60 to 2.79, I2 99.6%, consistent across most countries). Obesity assessment was also most common in the heaviest body mass index group (RR 1.55, 95% CI 0.99 to 2.45, I2 99.6%). Views of healthcare professionals were positive about obesity assessments when linked to patient health (convergent with meta-analysis for comorbidities) and if part of routine practice, but negative about their role, training, time, resources and incentives in the healthcare system. Conclusions Our evidence synthesis revealed several important enablers and barriers to obesity assessments that should inform healthcare professionals and relevant stakeholders to encourage adherence to clinical practice guideline recommendations

Application of 2D shearwave elastography for screening of NAFLD in people with class 3 obesity

INTRODUCTION: Early and accurate detection of significant liver fibrosis allows timely management of cirrhosis and related comorbidities. Liver biopsy, the diagnostic gold standard, is invasive and risks complications. Non-invasive methods such as 2D Shear Wave Elastography (SWE) are increasingly being used, but the presence of severe obesity could lead to technical difficulties. This study aimed to assess the applicability of SWE in screening for non-alcoholic fatty liver disease (NAFLD) associated liver fibrosis in people with class 3 obesity. MATERIALS AND METHODS: This was a cross-sectional study conducted in a publicly funded, multidisciplinary weight management program in Sydney, Australia. All patients enrolled between February 2021 and February 2022, who had at least one physician appointment, were included. Participants were aged ≥ 18 years with body mass index (BMI) ≥ 40 kg/m2 and at least one weight-related medical comorbidity. A Fibrosis-4 (FIB-4) index score of 1.45 and AST to Platelet Ratio Index (APRI) score of 0.7 were considered as cut-off scores for significant fibrosis. SWE was performed by a single operator using Acoustic Radiation Force Impulse (ARFI) ultrasound system enabled with ElastPQ imaging (EQI) SWE. EQI liver stiffness values were calculated to estimate the likelihood of liver fibrosis, and 6.43 kPa was considered as cut-off score for significant fibrosis. RESULTS: The mean (SD) weight of participants (n = 50; age 47.9 (13.9) years; 59% females; 68% Caucasians; 56% Type 2 diabetes, 23% Hypertension, 6% known NAFLD) was 148.4 (29.7) kg with a BMI of 51.5 (8.7) kg/m2. A Liver EQI was obtained for all elastography scans in spite of their high BMI, with a reliability indicator (Liver EQI IQR/Med) below 30%, indicating that all tests were reliable for reporting. The mean Liver EQI Med value was 5.1 (1.2) kPa, mean FIB-4 score was 0.9 (0.5), and mean APRI score was 0.2 (0.1). Using SWE, 2/50 participants had a liver-stiffness value above cut-off score for significant fibrosis. There was a positive correlation between Liver EQI Med value and FIB-4 score (r = 0.451, p = 0.003) and APRI score (r = 0.337, p = 0.029). FIB-4 score had a statistically significant positive correlation with age (r = 0.671, p < 0.001) and APRI score (r = 0.618, p < 0.001). CONCLUSION: SWE is a feasible non-invasive technique for the assessment of liver fibrosis that can provide reliable results in the vast majority of people with class 3 obesity. SWE can be used to support the detection of significant fibrosis in addition to blood tests, thus limiting the need for liver biopsy only among those with suspected significant fibrosis