Oral health education (advice and training) for people with seriousmental illness (Review)

This article will be made Open Access on the publisher's webpage (follow the DOI link) on the 8 September 2016.Background People with serious mental illness not only experience an erosion of functioning in day-to-day life over a protracted period of time, but evidence also suggests that they have a greater risk of experiencing oral disease and greater oral treatment needs than the general population. Poor oral hygiene has been linked to coronary heart disease, diabetes, and respiratory disease and impacts on quality of life, affecting everyday functioning such as eating, comfort, appearance, social acceptance, and self esteem. Oral health, however, is often not seen as a priority in people suffering with serious mental illness. Objectives To review the effects of oral health education (advice and training) with or without monitoring for people with serious mental illness. Search methods We searched the Cochrane Schizophrenia Group’s Trials Register (5November 2015), which is based on regular searches ofMEDLINE, EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the register. Selection criteria All randomised clinical trials focusing on oral health education (advice and training) with or without monitoring for people with serious mental illness. Data collection and analysis We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created ’Summary of findings’ tables using GRADE. Main results We included three randomised controlled trials (RCTs) involving 1358 participants. None of the studies provided useable data for the key outcomes of not having seen a dentist in the past year, not brushing teeth twice a day, chronic pain, clinically important adverse events, and service use. Data for leaving the study early and change in plaque index scores were provided. Oral health education compared with standard care When ’oral health education’ was compared with ’standard care’, there was no clear difference between the groups for numbers leaving the study early (1 RCT, n = 50, RR 1.67, 95%CI 0.45 to 6.24, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect was found. Although this was statistically significant and favoured the intervention group, it is unclear if it was clinically important (1 RCT, n = 40, MD - 0.50 95% CI - 0.62 to - 0.38, very low quality evidence).These limited data may have implications regarding improvement in oral hygiene. Motivational interview + oral health education compared with oral health education Similarly, when ’motivational interview + oral health education’ was compared with ’oral health education’, there was no clear difference for the outcome of leaving the study early (1 RCT, n = 60 RR 3.00, 95% CI 0.33 to 27.23, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect favouring the intervention group was found (1 RCT, n = 56, MD - 0.60 95% CI - 1.02 to - 0.18 very low-quality evidence). These limited, clinically opaque data may or may not have implications regarding improvement in oral hygiene. Monitoring compared with no monitoring For this comparison, only data for leaving the study early were available. We found a difference in numbers leaving early, favouring the ’no monitoring’ group (1 RCT, n = 1682, RR 1.07, 95% CI 1.00 to 1.14, moderate-quality evidence). However, these data are problematic. The control denominator is implied and not clear, and follow-up did not depend only on individual participants, but also on professional caregivers and organisations - the latter changing frequently resulting in poor follow-up, but not a good reflection of the acceptability of the monitoring to patients. For this comparison, no data were available for ’no clinically important change in plaque index’. Authors’ conclusions We found no evidence from trials that oral health advice helps people with serious mental illness in terms of clinically meaningful outcomes. It makes sense to follow guidelines and recommendations such as those put forward by the British Society for Disability and Oral Health working group until better evidence is generated. Pioneerin

Political masculinities, crisis tendencies, and social transition: Toward an understanding of change

This introduction to the special issue on “Political Masculinities and Social Transition” rethinks the notion of “crisis in masculinity” and points to its weaknesses, such as cyclical patterns and chronicity. Rather than viewing key moments in history as points of rupture, we understand social change as encompassing ongoing transitions marked by a “fluid nature” (Montecinos 2017, 2). In line with this, the contributions examine how political masculinities are implicated within a wide range of social transitions, such as nation building after war, the founding of a new political party in response to an economic crisis, an “authoritarian relapse” of a democracy, attempts at changing society through terrorism, rapid industrialization as well as peace building in conflict areas. Building on Starck and Sauer’s definition of “political masculinities” we suggest applying the concept to instances in which power is explicitly either being (re)produced or challenged. We distinguish between political masculinities that are more readily identified as such (e.g., professional politicians) and less readily identified political masculinities (e.g., citizens), emphasizing how these interact with each other. We ask whether there is a discernible trajectory in the characteristics of political masculinities brought about by social transition that can be confirmed across cultures. The contributors’ findings indicate that these political masculinities can contribute to different kinds of change that either maintain the status quo, are progressive, retrogressive, or a mixture of these. Revolutionary transitions, it seems, often promote the adherence to traditional forms of political masculinity, whereas more reformatory transition leaves discursive spaces for argument

Monitoring oral health of people in Early Intervention for Psychosis (EIP) teams: the extended Three Shires randomised trial

Background: The British Society for Disability and Oral Health guidelines made recommendations for oral health care for people with mental health problems, including providing oral health advice, support, promotion and education. The effectiveness of interventions based on these guidelines on oral health-related outcomes in mental health service users is untested. Objective:To acquire basic data on the oral health of people with or at risk of serious mental illness. To determine the effects of an oral health checklist in routine clinical practice. Design: Clinician and service user-designed cluster randomised trial. Settings and Participants: The trial compared a simple form for monitoring oral health care with standard care (no form) for outcomes relevant to service use and dental health behaviour for people with suspected psychosis in Mid and North England. Thirty-five teams were divided into two groups and recruited across 2012-3 with one year follow up. Results: 18 intervention teams returned 882 baseline intervention forms and 274 outcome sheets one year later (31%). Control teams (n=17) returned 366 baseline forms. For the proportion for which data were available at one year we found no significant differences for any outcomes between those allocated to the initial monitoring checklist and people in the control group (Registered with dentist (p=0.44), routine check-up within last year (p= 0.18), owning a toothbrush (p= 0.99), cleaning teeth twice a day (p=0.68), requiring urgent dental treatment (p=0.11). Conclusion: This trial provides no clear evidence that Care Co-ordinators (largely nursing staff) using an oral health checklist improves oral health behaviour or oral health state in those thought to be at risk of psychosis or with early psychosis

Smoking cessation advice for people with serious mental

Background People with a serious mental illness are more likely to smoke more and to be more dependent smokers than the general population. This may be due to a wide range of factors that could include a common aetiology to both smoking and the illness, self medication, smoking to alleviate adverse effects of medications, boredom in the existing environment, or a combination of these factors. It is important to undertake this review to facilitate improvements in both the health and safety of people with serious mental illness who smoke, and to reduce the overall burden of costs (both financial and health) to the smoker and, eventually, to the taxpayer. Objectives To review the effects of smoking cessation advice for people with serious mental illness. Search methods We searched the Cochrane Schizophrenia Group Specialized Trials Register up to 2 April 2015, which is based on regular searches of CENTRAL, BIOSIS, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and trial registries. We also undertook unsystematic searches of a sample of the component databases (BNI, CINHAL, EMBASE, MEDLINE, and PsycINFO), up to 2 April 2015, and searched references of all identified studies Selection criteria We planned to include all randomised controlled trials (RCTs) that focussed on smoking cessation advice versus standard care or comparing smoking cessation advice with other more focussed methods of delivering care or information. Data collection and analysis The review authors (PK, AC, and DB) independently screened search results but did not identify any trials that fulfilled the inclusion criteria of this review. Main results We did not identify any RCTs that evaluated advice regarding smoking cessation for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to smokers with serious mental illness is possible. Authors’ conclusions People with serious mental illness are more likely to smoke than the general population. Yet we could not find any high quality evidence to guide the smoking cessation advice healthcare professionals pass onto service users. This is an area where trials are possible and needed