Caries experience by socio-behavioural characteristics in HIV-1-infected and uninfected Ugandan mothers – a multilevel analysis

Objectives To assess caries experience in Ugandan mothers according to HIV status, socio-behavioural-characteristics, gingival bleeding status and to examine whether HIV status impacts the association of socio-behavioural characteristics with caries experience. Third, using multilevel analysis, this study assessed to what extent surface-specific caries experience varied between and within individuals. Materials and methods Caries experience was recorded using the World Health Organization’s Decayed, Missed and Filled Teeth/Surfaces indices from a cohort of 164 HIV-1-infected Ugandan mothers and a cross sectional comparison group of 181 negative controls. Mixed-effects logistic regression was conducted with surface-specific caries experience as the outcome variable. Results The prevalence of caries in HIV-1-infected and uninfected mothers was 81% and 71%, respectively. Significant associations occurred between caries experience at surface level and women’s increasing age (odds ratio [OR] = 1.8, 95% confidence interval [CI]: 1.1–2.8) and presence of gingival bleeding (OR = 2.0, 95% CI: 1.2–3.2). Intra-class correlation (ICC) coefficient amounted to 0.54 (95% CI 0.48‒0.59). Conclusions Caries prevalence was higher in HIV-1 infected than in uninfected mothers and increased with age and gingival bleeding. ICC indicated that 54% of the variance was attributable to variation between individuals. Socio-demographic differences in dental caries did not vary by HIV-1 status.publishedVersio

The prevalence and socio-behavioural and clinical covariates of oral health related quality of life in Ugandan mothers with and without HIV-1

Background There is limited evidence regarding oral health related quality of life of HIV positive populations in sub-Saharan Africa. Focusing HIV positive- and HIV negative Ugandan mothers, this study assessed the influence of HIV status on oral health related quality of life in terms of oral impacts on daily performances, whilst adjusting for clinical- and socio-behavioural factors. We also examined whether any association of clinical and socio-behavioural factors with oral impacts on daily performances vary according to mothers’ HIV status. Methods This cross-sectional study used data from a trial (n = 164) and a comparison group (n = 181). The trial comprised of mothers with HIV-1 participating in the ANRS 121741-PROMISE-PEP-trial (NCT00640263) conducted between 2009 and 2013 and from the ANRS 12341-PROMISE-PEP-M&S follow-up study conducted in 2017. The comparison group comprised of HIV negative mothers recruited in 2017. Interviews and clinical oral examinations were performed. The oral health related quality of life was assessed using the oral impacts on daily performances frequency scale. Caries experience and gingival bleeding were assessed using the World Health Organization’s Decayed, Missed and Filled teeth indices and community periodontal index. Logistic and negative binomial regression analyses were performed. Results 29% of HIV-1 positive and 32% among the comparison reported any oral impact on daily performance. In adjusted logistic regression analysis, HIV status was not significantly associated with oral impacts on daily performances. Mother’s self-reported oral health, caries experience, gingival bleeding and oral health related quality of life of their children were independently associated with oral impacts on daily performances. Corresponding prevalence ratios and 95% confidence intervals were: 0.3 (0.2–0.6), 1.8 (1.0–3.2), 1.1 (1.0–1.1), and 2.1 (1.1–4.3). No significant interaction between HIV status and covariates were observed. Conclusions Oral health related quality of life was substantially impaired in Ugandan mothers but did not discriminate between HIV positive and negative participants. Mothers with impaired oral health related quality of life were more likely to have dental caries and children with impaired oral health related quality of life. HIV positive and negative mothers in Uganda deserve special attention regarding their oral disease and quality of life status

Innføring av nye og effektive legemidler for pasienter med diabetes mellitus type 2 og samtidig kardiovaskulær sykdom og/eller nyresykdom

Tema/problemstilling: Forekomsten av diabetes type 2 (DM2) er økende, med samtidig økt risiko for utvikling av hjerte- og nyresykdom (CVD og CKD). SGLT2-inhibitorer (SGLT2-I) og GLP1 reseptor agonister (GLP1-RA) utgjør nye og effektive legemidler som raskt endrer behandlingen av DM2. Dette skyldes dokumenterte gevinster på komplikasjoner ved DM2. Kunnskapsbaserte retningslinjer gir risikostratifiserte anbefalinger om oppstart hos pasienter med DM2 og samtidig CVD og/eller CKD. Sengeposter ved medisinsk avdeling ved Lovisenberg Diakonale Sykehus (LDS) er mikrosystemet i prosjektet, med støtte fra Endokrinologisk poliklinikk, som i stor grad tatt i bruk den nye retningslinjen. Vi ønsker med dette prosjektet å sikre at alle aktuelle pasienter innlagt på medisinsk avdeling får tilbud om ny og effektiv behandling, slik at retningslinjen blir implementert i sykehusets praksis. Kunnskapsgrunnlag: Etter utforming av PICO-spørsmålet, ble det gjennomført et pyramidesøk i McMaster PLUS, hvor vi fant en retningslinje fra 2021 i BMJ. Retningslinjen møter standarder for kunnskapsbaserte retningslinjer, baserer seg på ny og omfattende forskning, og gir klare anbefalinger for oppstart av SGLT2-I eller GLP1-RA ved DM2 og samtidig CVD og/eller CKD. Tiltak/kvalitetsindikator: Våre forbedringstiltak er utvikling og godkjenning av lokal fagprosedyre med oppdaterte anbefalinger i digitale formater, informasjon og internundervisning samt systematisk klinisk vurdering for oppstart av SGLT2-I eller GLP1- RA på sengepost. Dette skal skje gjennom identifisering av innlagte pasienter i målgruppen gjennom daglige tavlemøter. Våre valgte kvalitetsindikatorer er prosessindikatorene «antall pasienter som blir vurdert for behandling» og «andel forskrivninger av SGLT2-I eller GLP1-RA» hos pasienter med DM2 og samtidig CVD og/eller CKD i henhold til anbefalingene og kunnskapsgrunnlaget i retningslinjen. Dette inkluderer forventet ulik grad av etterlevelse av anbefalingene, med mål om at 90% av pasienter med både CVD og CKD blir forskrevet behandling (sterk anbefaling) og et mål om at majoriteten av pasienter med enten CVD eller CKD blir forskrevet behandling (svak/ betinget anbefaling), basert på at alle pasientene får tilbud om behandling fortrinnsvis gjennom samvalg. Ledelse/organisering: Prosjektet struktureres etter kvalitetsforbedringsmodell basert på Demings sirkel. En prosjektgruppe bestående av leger og sykepleiere og helsesekretær med tilhørighet til medisinsk avdeling og endokrinologisk poliklinikk vil sørge for planlegging, strukturering og oppfølging av prosjektet. Prosessen kontrolleres underveis. Prosjektgruppen er faglig ansvarlig for prosjektet og utgjør den sentrale forankring for å lykkes, dersom det oppstår motstand mot endring. Vi ser for oss prosjektvarighet på inntil et år. Konklusjon: Vi ønsker å implementere de nye retningslinjene slik at pasienter med DM2 og samtidig CVD og/eller CKD blir tilbudt vurdering for oppstart av nye og effektive legemidler med dokumentert nytte på reduksjon av død, CVD og CKD

Caries experience by socio-behavioural characteristics in HIV-1-infected and uninfected Ugandan mothers – a multilevel analysis

Objectives To assess caries experience in Ugandan mothers according to HIV status, socio-behavioural-characteristics, gingival bleeding status and to examine whether HIV status impacts the association of socio-behavioural characteristics with caries experience. Third, using multilevel analysis, this study assessed to what extent surface-specific caries experience varied between and within individuals. Materials and methods Caries experience was recorded using the World Health Organization’s Decayed, Missed and Filled Teeth/Surfaces indices from a cohort of 164 HIV-1-infected Ugandan mothers and a cross sectional comparison group of 181 negative controls. Mixed-effects logistic regression was conducted with surface-specific caries experience as the outcome variable. Results The prevalence of caries in HIV-1-infected and uninfected mothers was 81% and 71%, respectively. Significant associations occurred between caries experience at surface level and women’s increasing age (odds ratio [OR] = 1.8, 95% confidence interval [CI]: 1.1–2.8) and presence of gingival bleeding (OR = 2.0, 95% CI: 1.2–3.2). Intra-class correlation (ICC) coefficient amounted to 0.54 (95% CI 0.48‒0.59). Conclusions Caries prevalence was higher in HIV-1 infected than in uninfected mothers and increased with age and gingival bleeding. ICC indicated that 54% of the variance was attributable to variation between individuals. Socio-demographic differences in dental caries did not vary by HIV-1 status