Quality Improvement Through Evidence-Based Education: Advancing Obesity Awareness and Clinical Management Strategies for People Living with Mental Disorders

People living with mental disorders (PLWMDs) are at an increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the general-population obesity rate is 36% compared to more than 50% for PLWMDs. Mental health professionals (MHPs), focused on addressing psychiatric conditions, seldom recognize and clinically manage obesity. Furthermore, this population is socioeconomically disadvantaged with poor dietary habits while consuming psychiatric medications that stimulate hunger, further exacerbating the risk for obesity. The Promoting Action on Research Implementation in Healthcare Services (PARISHS) framework guided this quality improvement project to improve obesity awareness and management for PLWMD at a large state psychiatric hospital. An evidence-based education intervention was implemented to positively impact obesity awareness and clinical management or MHPs. The evaluation used a validated instrument with a pre- and posttest design. Paired t test was used to analyze multiple constructs from the MHP participants (N = 50). Overall, the pretest indicated 76% of MHPs were not involved in helping obese PLWMDs manage their weight; however, the posttest data (at 90-days) revealed that 90% were involved in this activity. This represents a positive shift in obesity perceptions and management knowledge. Future research needs to evaluate the impact of the perceptions on process measures and clinical outcomes. This project led to positive social change as MHPs are more likely to address obesity in PLWMD due to their increased awareness and knowledge. This project has broader implications as the program can be duplicated in other psychiatric hospitals

Relationship between obesity and oral diseases

Objective: The aim of this study was to determine the relationship between obesity and periodontal status and dental caries experience of a group of Nigerian dental patients.Materials and Methods: Participants were selected from patients attending dental outpatient clinics of the University of Benin Teaching Hospital, Benin City, Nigeria. Their weight and height were measured and body mass index (BMI) estimated in kg/m2, gingival health assessed using bleeding on probing index, oral hygiene estimated using the simplified oral hygiene index (OHI‑S), periodontal health estimated using the basic periodontal examination (BPE) and caries experience was estimated with the decayed, missing, and filled teeth (DMFT) index.Results: A few participants (3.8%) were underweight, 52.6% fell within the normal BMI range, 28.2% preobese, 12.2% obese class I and 3.2% obese class II. The mean OHI‑S score was 2.16 ± 1.13 among the overweight participants and 2.05 ± 1.13 among those who are not (P = 0.543). The mean DMFT score was 3.03 ± 4.25 among the overweight participants and 2.32 ± 3.01 among those who are not (P = 0.223). Sixty‑five percent of participants with BPE score of 0, considered to signify periodontal health, had normal BMI while all the participants with the worst BPE score recorded belong to the obese 1 group (P = 0.070). The binary logistic regression revealed that the likely predictor of gingival bleeding in the study is BMI between 35.0 and 39.9 (obese class 2) (P = 0.046, odds ratio = 0.07, 95% confidence interval = 0.01-0.96).Conclusion: It can be concluded from this study that there is no statistically significant relationship between obesity and periodontal status and dental caries experience in the studied group of dental patients. Increased BMI may however be a predictor of gingival bleeding.Keywords: Dental caries, obesity, periodontal diseas

THE DISPROPORTIONALITY OF AFRICAN AMERICAN CHILDREN IN THE CHILD WELFARE SYSTEM: A COMMUNITY PERSPECTIVE

African American communities have been subject to institutional and societal inequalities for much of our nation’s history. A review of the literature has shown that these families have unequal access to resources and opportunities, especially in the comparison to the rest of the population. These factors may contribute to African American children having higher rates of substantiated cases of abuse and neglect, as well as the amount of time that these children spend in the foster care system. A qualitative study was conducted in the form of focus groups. The study examined the African American community’s perspective of the child welfare system and the social workers they may have come in contact with in the scope of their possible child welfare experience. Common themes that emerged included a lack of understanding of both the system and services provided, a sense of mistrust between the community and government agencies, and the need for more resources specifically for the African American community. Proposed solutions to alleviate the disproportionality problems in child welfare included social workers teaming with families, mentorships between African Americans, and collaborations with other agencies

Nutrition And Oral Health

There is an interdependent relationship between nutrition and health of oral tissues. The well-being of the oral tissues, the quantity and quality of saliva and the dimension of taste depend on the intake of nutrients. Oral health determines the type of food consumed and ultimately the nutritional level. A review of literature was to outline this interdependent relationship

Factors Influencing The Selection Of Dental Nursing As A Profession

Objective: To provide a current description of dental nursing students and to assess the reasons for choosing the dental nursing career. Methods: Between 2008 and 2009, a questionnaire survey was administered to 85 dental nursing students from 3 Colleges of Health Technology undergoing external clinical posting in University of Benin Dental Clinic. The questionnaire requested information on age, gender, place of residence, type of school attended, previous employment, reason for choosing dental nursing as a career, career plans, parents' highest level of education and parents' occupations. Results: The mean age of the respondents was 23 ± 4.4 years and the male: female ratio of was 1:7.5. Three-quarter (75.3%) of the respondents attended government secondary school and 87.1% were products of mixed school. Teaching was the commonest job among 27.1% of the respondent that had previous employment. Three-quarter (75.6%) of the respondents attested that their education was being sponsored by their parents. Caring for the health of others was the main reason for pursuing dental nursing career. The decision to study dental nursing was taken by 44.7% of the respondents after their secondary education and 50.6% were influenced in their choice of the career with parent being a strong force. More than half (56.5%) plan to work in Teaching hospital on completion of their training. The educational backgrounds of parents varied widely with mothers being reported to have less formal education than fathers. Three-quarter (75.3%) and one-third (35.3%) respondents' mother and father were traders respectively. Conclusion: The study findings provide relevant information on the students' characteristics, factors influencing the selection of dental nursing career and will serve as a template, on which changes in the social composition of dental nursing students can be compared with over time. Key words: Factors, selection, dental nursing, professio

Nigerian dental students? compliance with the 4As approach to tobacco cessation

Objective. To assess the Nigerian dental students? present effort at tobacco cessation assistance using the simple stepwise 4As model. Methods. A cross-sectional survey of all the final level dental students in the Nigerian premier dental schools was carried out using a pretested self administered questionnaire. Results. The response rate was 98.9%. Majority (95.6%) of the respondents routinely take history of tobacco use. A total of 93.9% of the respondents routinely advice patient who smoke to quit but only 46.1% actually counsel patient on how to quit. Sixtenth of the respondents knew about nicotine replacement therapy but only 36.1% knew the role antidepressant therapy in tobacco cessation. Majority (87.2%) want cigarette sales to adolescents banned, 73.9% want adverts of cigarettes prohibited, 81.1% want cigarette smoking banned in public areas and only 2.8% will permit smoking in a dental office. Conclusions. The survey revealed deficiency in compliance to the 4As approach to tobacco cessation among Nigerian dental students. The incorporation of proper tobacco counseling cessation protocol, with emphasis on the pharmacological therapy, into the dental curriculum is therefore desirable. Dental professionals at all levels should be involved effectively with tobacco cessation to significantly reduce the morbidity and mortality of tobacco use

Oral Assessment and Nursing Interventions among Nigerian Nurses-Knowledge, Practices and Educational Needs

Background: Assessment of oral condition, oral care, and informing the attending doctor of unusual oral findings for possible consultation or referral to a dentist are the advocated roles of hospital nurses. The objective of the study was thus to assess the roles of Nigerian nurses in the assessment of oral conditions of hospitalized patients.Methods: This questionnaire-based cross-sectional survey of all nurses caring for hospitalized patients in the University of Benin Teaching Hospital was conducted in the first half of 2010.Results: Of the 384 studied participants, 94.3% considered oral care as an important aspect of nursing care and 73.4% had oral health component in their nursing school curriculum. A total of 80.7% reported suspicious and abnormal findings in hospitalized patients to the attending doctor. Amongst the respondents, 38.0% reported ability to conduct good oral tissue examination. Only 28.1% demonstrated good knowledge of common oral diseases. Three-quarters (73.4%) thought that it is compulsory for nurses to assess the oral condition of hospitalized patients. The 67.7% and 21.9% of the respondents did the assessment on admission and discharge respectively. The majority (90.1%) desired training on oral care of hospitalized patients.Conclusion: There is a need to improve the skill and competence of nurses in the assessment of oral condition to make them a substantive partner in the oral care of hospitalized patients.Keywords: hospitalized patients, nurses, oral condition, role

Misconceptions about oral health among a group of Nigerian primary school teachers

Objective: To identify the various misconceptions that still exist among teachers about oral health practices and their incorrect ideas about dental conditions. Method: The study was a descriptive cross-sectional study carried out between May and September 2008 among 640 primary school teachers in Oredo Local Government area of Benin City, Nigeria. Data collection was by the use of self –administered questionnaire. Result: More than a third of the respondents (39.6%) felt that tooth decay is caused by worms, 0.3% felt it is caused by black magic. While 11.9% felt gingival bleeding is caused by worms. Tooth loss was considered a natural process by 43% of the respondents and 53.1% did not feel it is possible to keep all the teeth in the dentition for life. In addition, 23.2% did not consider tooth loss a serious health problem. Traditional medicine was used for toothache and gingival bleeding in 5.0% and 2.6% of cases respectively, while 6.5% reported self medication. Improvement of oral hygiene by toothbrushing was considered ineffective in the prevention of gum disease by 15.3% of the respondents. Conclusion: This survey revealed that a few misconceptions still exist among teachers about what constitutes appropriate oral health practices and correct knowledge of oral diseases and remedies. These misconceptions should be corrected to prevent the teachers form impacting incorrect knowledge on the children they teach. In service training of the teachers in the area of oral health is therefore recommended.Keywords: Oral health, misconception, teachersNig Dent J Vol 20 No. 1 Jan - June 201

Hand hygiene amongst dental professionals in a tertiary dental clinic

Objective: To evaluate hand washing attitude and practices among Dentists and Dental Students treating patients in a Nigerian Tertiary Dental Clinic. Materials and Methods: A cross-sectional survey of Dentists and Dental Students treating patients in University of Benin Teaching Hospital was conducted between February and March 2010. Data collection tool was a 28-item, self-administered questionnaire, which elicited information on demography, handwashing practices, material used for handwashing, methods ofdrying hands after washing, attitudes towards prevention of spread of infection by handwashing measures in dental practice, barrier to regular hand washing, information need on handwashing and mode in which they would desire to receive the needed information. Results: One-quarter (25.7%) of the respondents washes their hands before wearing gloves and 98.1% wash their hands when they are visibly soiled. Less than half (46.7%) washed their hand when the worn gloves are torn. Majority strongly agreed that hand washing helps to prevent transmission of infection to patients (91.4%), health workers (92.4%) and health workers family members (89.5%). The main barriers to regular hand hygiene were inadequate facilities, forgetfulness and lack of time. About 69.5% desired more information on hand hygiene with the most indicated area of information needs being the indications and steps in hand washing in form of seminars and pamphlets. Conclusion: This study revealed positive attitude to hand washing, inadequate hand washing practices and poor monitoring of hand hygiene in the health institution. The studied dental professionals however know that hand washing plays an important role in the prevention of cross infection.Keywords: hand hygiene, dental professionals, tertiary, dental clinic, infection contro

Salivary Lactoferrin Levels, Disease Severity and Correlates in Patients with Chronic Periodontitis Presenting to a Tertiary Health Facility in Nigeria.

Objective: This study compared the concentration of salivary lactoferrin in patients with and without chronic periodontitis and investigated correlations with clinical variables of the disease. Methods: The study included 102 participants (51 cases and 51 controls) who presented at the Periodontology Clinic of University of Benin Teaching Hospital and met the selection criteria of ‘4mm and above’ periodontal probing depths (PPD) and positive bleeding on probing (BOP) using community periodontal index (CPI) probe. Healthy participants (controls) were patients that had PPD less than or equal to 3mm, absence of BOP and simplified oral hygiene index (OHI-S) not more than 1.2. Baseline OHI-S and CPI scores were recorded. Saliva samples were collected and analyzed using enzyme-linked immunosorbent assay. All data were analyzed with the Statistical Package for Social Sciences (SPSS) version 22.0. Results: There was a statistically significant difference between the mean (SD) lactoferrin concentration of control participants 5.27(0.59) mg/l and case participants 6.74(0.61) mg/l (p<0.001). Participants with probing pocket depths (PPD) of 6mm or more had a significantly higher mean concentration [6.85(0.06) mg/l] than that of those with PPD 4-5mm [6.71(0.67) mg/l] (p < 0.001) Lactoferrin levels were highest in participants with ‘poor’ oral hygiene [6.85(0.60) mg/l] and lowest in those with ‘good’ oral hygiene [6.65(0.83) mg/l]. Conclusion: Salivary lactoferrin levels were higher among participants with chronic periodontitis than those without chronic periodontitis and correlates positively with the main clinical characteristics of the diseas