Do Right, Be Bright: A Protocol on the Development of an Inter-Professional Health Intervention Model for Pre-School Children Through a Community-Based Service-Learning Initiative.

An inter-professional project with a collaborative endeavor between the programs of Dentistry, Nutrition and Medicine was carried out with the aim to emphasise oral health maintenance, making the right nutritional choices and effective hand washing among pre-school children. The purpose of this paper is to share a detailed description of the design, development process, implementation, and planned evaluation of an interprofessional school-based health promotion intervention model "Do Right, Be Bright". This model is part of a quasi-experimental study, targeting pre-school children as the "Targets of Change" through the empowerment of school teachers as the "Agents of Change". The program design was based on Bartholomew's Intervention Mapping Approach, which proposes a direction for developing a theory-based health promotion intervention and on the most extensively applied theories of health behavior, the Health Belief Model. Therefore, based on a thorough literature review and needs assessment, three key areas of needs were identified for the targeted preschool children: oral hygiene, hand hygiene and nutrition. The efficacy of this model will be pilot tested in a preschool in Kuala Lumpur Malaysia.

Emotional Intelligence, Depression, Stress and Anxiety Amongst Undergraduate Dental Students During the COVID-19 Pandemic.

Objectives: This study aimed to measure depression, anxiety and stress (DAS) among undergraduate dental students during the COVID-19 pandemic, identify key contributing factors of stress and explore the association of emotional intelligence to DAS. Methods: A multi-centre, cross-sectional study was conducted across four universities in Malaysia. The study administered a questionnaire consisting of the validated Depression Anxiety Stress Scale (DASS), Dental Environment Stress (DES), Emotional Intelligence Scale (EI) and 10 statements assessing COVID-19 specific potential stressor factors. Results: Participants included 791 students across four universities. Abnormal levels of DAS were identified in 60.6%, 66.8% and 42.6% of the study participants, respectively. "Pressure of performance," "Faculty administration" and "Self-efficacy belief" were the highest rated stressors. On-time graduation was the main COVID-19 specific stressor factor. EI was negatively correlated with DAS scores (p < 0.001). Conclusion: The levels of DAS during COVID-19 pandemic in this population is high. However, participants with higher EI presented with lower DAS suggesting that EI may be a form of coping resource and should be enhanced in this population.

A randomized controlled trial of 6-month dental home visits on 24-month caries incidence in preschool children.

OBJECTIVES: This paper reports on the effect of 6-month dental home visits compared to no dental home visits on 24-month caries incidence in 5- to 6-year-olds. METHODS: 5- to 6-year-olds attending kindergartens were randomized to receive either 6-month dental home visits and education leaflets (Intervention group) or education leaflets alone (Control group) over 24 months. To detect a 15% difference in caries incidence with a significance level of 5% and power of 80%, 88 children were calculated to be needed in the Intervention group and 88 in the Control. Baseline clinical data included oral examinations at the kindergartens. Follow-up visits were made on the 6th, 12th and 18th month. At the end of the 24 months, both the Intervention and Control groups were visited for oral examinations. The primary outcome was caries incidence, measured by the number and proportion of children who developed new caries in the primary molars after 24 months. The secondary outcome was the number of primary molars that developed new caries (d-pms). Frequency distributions of participants by baseline socio-demographic characteristics and caries experience were calculated. The chi-square test was used to test differences between the caries experience in the Intervention and Control groups. The t test was used to compare the mean number of primary molars developing new caries between the Intervention Group and the Control Group. The number of children needed to treat (NNT) was also calculated. RESULTS: At the 24-month follow-up, 19 (14.4%) developed new caries in the Intervention Group, compared to 60 (60.0%) in the Control Group (p = .001). On average, 0.2 (95% CI = 0.1-0.3) tooth per child in the Intervention Group was observed to have developed new caries compared to 1.1 (95% CI = 0.8-1.3) tooth per child in the Control Group (p = .001). The number of children needed to treat (NNT) to prevent one child from developing new caries was 2.2. CONCLUSIONS: The present study has demonstrated that 6-month home visits to families of 5- to 6-year-olds are effective in caries prevention in 5- to 6-year-olds of low-income families in a middle-income country where access to health services, including oral health promotion services, is limited.

Phenomenological insight into the motivation to quit smoking.

INTRODUCTION: Quitting tobacco is often viewed as a difficult experience as the dependence includes sets of behavioral, cognitive, social, and physiologic phenomena that prevent most smokers from having a successful first attempt of quitting. The aim of this qualitative study was to gain insight into and understand the motivation for attempts to quit smoking in relation to the stages of the behavior change model. METHOD: The study team based this qualitative study on Alfred Schütz's social phenomenology framework. The study team planned for fourteen in-depth interviews with patients registered at a Quit Smoking Clinic. Each in-depth session lasted 45-60 min and we audio recorded them with consent. Following full verbatim transcription, the study team carried out detailed thematic analysis using Nvivo software. RESULTS: Out of a total of 14 patients, 10 agreed to participate (response rate 71.4%). Seven participants (70%) had successfully quit smoking, while the remaining 30% relapsed after the first quit attempt. The study team extracted from the data three key themes with eight child nodes: barriers to quitting smoking, reasons for quit attempt, and how to quit. Unsuccessful attempts were related to tobacco addiction and successful attempts were based on the need to improve one's health and family. The study explored two intrinsic (self-realization and healthy lifestyle) and two extrinsic motivations (family's health and role model for children) for attempting to quit. CONCLUSION: The study highlights the importance of psychological support in successful quit attempts. Treatment providers should encourage behavior change through intrinsic goals, as such goals, compared to extrinsic goals, have a long-term and positive impact because they can activate autonomous motivation.

Role of family functioning and health-related quality of life in pre-school children with dental caries: a cross-sectional study.

BACKGROUND: The aim of this cross-sectional study was to evaluate the effect of family functioning on oral health related quality of life (OHRQoL) and dental caries status among 4- to 6-year-old Chinese pre-school children in Malaysia. METHODOLOGY: This study was approved by the institutional Joint Research and Ethics Committee, International Medical University, Malaysia (number 373/2016); consisted of 180 eligible pre-school children from a private school. Study tools included demographic, clinical oral health data form, the Early Childhood Oral Health Impact Scale (ECOHIS) and family functioning-12-item general functioning subscale. Written consent was sought prior to data collection. Data were analysed by SPSS v.22.0; descriptive statistics for socio-demographic details, clinical information, HRQoL and FAD scores. The parametric tests included independent sample t test and ANOVA to evaluate the associations between the dependent variable. Binary logistic regression models were applied to assess the impacts on OHRQoL (P value < 0.05). RESULTS: A response rate of 80.5% was achieved. Sample means for FAD-GF12 scores ranged < 2, indicating normal family functioning. The ECOHIS scores mean was 0.52 (SD = 0.68). In the children impact section the highest score of impacts 20 was noted followed by family impact section with the score of 12. It was observed that children with dental caries had a significant (P = 0.014) negative impact on OHRQoL (mean 0.72, SD = 0.50) as compared to children with no caries (mean 0.34 SD = 0.39). The bivariate regression analysis after getting adjusted indicated three predictors associated to poor HRQoL: having two or more siblings (OR = 4.73, P = 0.013), relationship (mother) of the respondent to the child (OR = 2.86, P = 0.013) and having dental caries (OR = 8.12, P ≤ 0.001). CONCLUSION: Findings of this study indicates that number of siblings, relationship of the respondent to the child and dental caries status are independently associated with health-related quality of life. However, family functioning does not mediate poor HRQoL in association to dental caries.

Antimicrobial and self-crosslinking potential of experimentally developed dioctadecyldimethyl ammonium bromide and riboflavin dentin adhesive.

The aim of the study is to investigate a new formulation, based on dioctadecyldimethyl ammonium-bromide (QA) and riboflavin (RF), combining antimicrobial activities and protease inhibitory properties with collagen crosslinking without interference to bonding capabilities in a rabbit model. Quaternary ammonium riboflavin (QARF) experimental adhesives modified with dioctadecyldimethyl ammonium-bromide and riboflavin were bonded (0.5/1.0/2.0%) to rabbit dentin to investigate for pulpal-histology, interfacial-morphology, transmission electron microscopy, mechanical properties, collagen crosslinking, micro-Raman analysis, antimicrobial, and anti-protease activities. Collagen type-I molecules were generated using molecular-docking. Odontoblasts appeared with normal histology, were seen in controls with no inflammatory cells detected in 0.5% specimens at day 7 and mild inflammatory response at day 30. In QARF 2.0%, inflammatory cells were not detected at day 7 and 30 (p < .05). Dentinal tubules are seen with intact collagen surface in 1% specimens. Resin penetrated inside 1% adhesive specimens with few irregularly funnel-shaped tags. Transmission electron microscopy showed thinner collagen in all specimens except 1% QARF specimens. Biofilms were influenced by QARF adhesives. Elastic moduli were significantly higher in 1.0% and 2.0% QARF adhesive specimens with a significant increase in total crosslinks. Stable amide groups with anti-protease activity was observed in QARF groups. Charged residues were seen in the triple helix hCOL3A1, Gly489-Gly510 after stabilisation with formulation. The 1% QARF modified adhesives improved biochemical and biomechanical properties of rabbit dentin.

An Overview on Betel Quid and Areca Nut Practice and Control in Selected Asian and South East Asian Countries.

Background: Areca nut (AN) and betel quid (BQ) chewing are ancient practices followed by an extensive proportion of the world's population. These practices are endemic in larger parts of South and Southeast Asia and selected Western Pacific countries. The prevalence of these habits varies across regions, age, gender, cultural practice, and socioeconomic status groups. Considerable variations exist between countries with respect to prevention/intervention programs, and policy guidelines of BQ usage. Objectives: (1) To provide an overview of the BQ chewing prevalence, practices, preventive interventions and policies in selected Asian and Western Pacific countries. (2) To explore the different terminologies associated with BQ use. Method: A narrative review of the current literature related to BQ, AN, and oral cancer was conducted by searching PUBMED, CINAHL, and GOOGLE databases. Results: The literature review revealed that the prevalence of BQ was found to be highest in Papua New Guinea, followed by Bangladesh, India, Pakistan, Myanmar and Sri Lanka. While, Cambodia, Malaysia, Indonesia and Taiwan had comparatively lower prevalence. Smokeless tobacco, BQ with tobacco, BQ without tobacco, AN were some of the terminologies used for BQ in various studies. Conclusions: The prevalence, and the interventional policies related to BQ and AN chewing habits varies widely among the selected countries. With the increasing awareness and association of BQ with oral cancer, there is a need to have better awareness, prevention and interventional strategies in place. We also found considerable variation in the use of terminologies associated with BQ.

Comparison of End Tidal Carbon Monoxide Levels between Conventional Cigarette, Electronic Cigarette and Heated Tobacco Product among Asiatic Smokers.

BACKGROUND: Electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs) are noncombustible tobacco products which have been found to generate aerosols containing lower levels of Harmful and Potentially Harmful Constituents (HPHCs) in comparison to conventional cigarettes. Objective: This quasi experimental study measured and compared the end tidal carbon monoxide (eCO) levels of participants after use of ENDS, HTPs and conventional cigarettes. Methods: In total 45 smokers, each smoking at least 10 conventional cigarettes per day for 5 years participated in the study. Based on their preference, participants used only one of the tobacco products (ENDS, HTPs, or conventional cigarette) and were briefed about the product use based on manufacturer's instructions. The eCO levels were obtained at baseline, followed by 5, 10, 15, 30 and 45 min respectively after the product use. Results: There was significant increase in eCO levels for conventional cigarettes as compared to other modes. Peak eCO levels of 20.2 ± 0.86 ppm, 8.8 ± 1.56 ppm and 6.0 ± 1.36 ppm was achieved at 30 min, 15 min and 10 min for conventional cigarettes, ENDS and HTPs respectively. However, the levels were significantly lower in ENDS and HTPs. Conclusion: Even though ENDS and HTPs may have produced significantly lower eCO than conventional cigarettes, the significantly increasing levels over time from baseline which was not shown before is a cause of concern. As of now, their use as an alternate to cigarettes needs to be considered under regulatory framework.

Current state of knowledge of basic life support in health professionals of the largest city in Pakistan: a cross-sectional study.

BACKGROUND: Basic Life Support (BLS) is the recognition of sudden cardiac arrest and activation of the emergency response system, followed by resuscitation, and rapid defibrillation. According to WHO, Pakistan has one of the highest mortality rates from accidental deaths therefore assessment and comparison of BLS knowledge in health professionals is crucial. We thereby aim to assess and compare the knowledge of BLS in doctors, dentists and nurses. METHODS: A multi-centric cross-sectional survey was conducted in Karachi at different institutions belonging to the private as well as government sector from January to March 2018. We used a structured questionnaire which was adapted from pretested questionnaires that have been used previously in similar studies. Descriptive statistics were analyzed using SPSS v22.0, where adequate knowledge was taken as a score of at least 50%. P < 0.05 was considered as significant. Logistic regression was used to identify the factors affecting the knowledge regarding BLS in health care professionals. RESULTS: The responders consisted of 140 doctors, nurses and dentists each. Only one individual (dentist) received a full score of 100%. In total, 58.3% of the population had inadequate knowledge. Average scores of doctors, dentists and nurses were 53.5, 43.3 and 38.4% respectively. Doctors, participants with prior training in BLS and those with 6 to 10 years after graduation were found to be a significant predictor of adequate knowledge, on multivariate analysis. CONCLUSION: Even though knowledge of BLS in doctors is better than that of dentists and nurses, overall knowledge of health care professionals is extremely poor. Present study highlights the need for a structured training of BLS for health care workers.

Quality of life associated factors in head and neck cancer patients in a developing country using the FACT-H&N.

Health-related quality of life (HRQoL) associated factors are vital considerations prior to treatment decision-making for head and neck cancer patients. The study aimed to identify potential socio-demographic and clinical prognostic value of HRQoL in head and neck cancer patients in a developing country. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N)-V4 in Urdu language was administered among 361 head and neck cancer patients. Data were statistically tested through multivariate analysis of variance (MANOVA) and regression modeling to identify the potentially associated factors. Treatment status, tumor stage and tumor site had the strongest negative impact on patients HRQoL, with a statistically significant decrement in FACT summary scales (effect size >0.15). Moderate associated factors of HRQoL included treatment type, marital status, employment status and age (effect size range 0.06-0.15). Weak associated factors of HRQoL with a small effect size (>0.01-0.06) included tumor size and type, gender, education level and ethnicity. This study reports 12 socio-demographic and clinical variables that have a significant impact on HRQoL of head, and neck cancer patients, and that should be considered during treatment decision-making by multidisciplinary teams and also in future HRQoL studies conducted in other developing countries.

The use of the FACT-H&N (v4) in clinical settings within a developing country: a mixed method study.

In the last decade there has been an increasing awareness about 'quality of life' (QOL) of cancer survivors in developing countries. The study aimed to cross-culturally adapt and validate the FACT-H&N (v4) in Urdu language for Pakistani head and neck cancer patients. In this study the 'same language adaptation method' was used. Cognitive debriefing through in-depth interviews of 25 patients to assess semantic, operational and conceptual equivalence was done. The validation phase included 50 patients to evaluate the psychometric properties. The translated FACT-H&N was easily comprehended (100%). Cronbach's alpha for FACT-G subscales ranged from 0.726 - 0.969. The head and neck subscale and Pakistani questions subscale showed low internal consistency (0.426 and 0.541 respectively). Instrument demonstrated known-group validity in differentiating patients of different clinical stages, treatment status and tumor sites (p < 0.05). Most FACT summary scales correlated strongly with each other (r > 0.75) and showed convergent validity (r > 0.90), with little discriminant validity. Factor analysis revealed 6 factors explaining 85.1% of the total variance with very good (>0.8) Kaiser-Meyer-Olkin and highly significant Bartlett's Test of Sphericity (p < 0.001). The cross-culturally adapted FACT-H&N into Urdu language showed adequate reliability and validity to be incorporated in Pakistani clinical settings for head and neck cancer patients.

Dental anxiety among adult patients and its correlation with self-assessed dental status and treatment needs.

OBJECTIVE: To evaluate the dental anxiety levels and to assess its correlation with self-assessed dental status and treatment needs of patients. METHODS: The study was conducted at the Out Patient Department of Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Karachi. Using non-probability quota sampling, the study included the first 32 patients between 18 and 35 years of age, visiting the facility. Over a period of one month (22 working days) 704 patients comprised the study population. They were interviewed using a structured questionnaire to self-assess their dental anxiety levels, oral health status and treatment needs. The data was analysed using SPSS 17.0 with descriptive frequencies and chi-square test. RESULTS: Of the total participants, 650 (92.32%) patients provided consent. Average dental anxiety scale score was 12.46, representing high anxiety score. There were 174 (26.8%) smokers; only 234 (36%) had visited a dentist less than a year ago; 385 (59.2%) considered their dental health to be satisfactory; 306 (47.1%) thought of their treatment needs to be 'little'; 222 (34.2%) brushed their teeth twice daily. Dental anxiety was statistically significant with treatment needs and dental status. Relation of tooth-brushing with last dental visit and treatment needs was also found to be significant. CONCLUSION: A high level of dental anxiety was observed among the study population. The dental professionals should seek ways to help dentally anxious individuals.

Perceptions and myths regarding oral health care amongst strata of low socio economic community in Karachi, Pakistan.

OBJECTIVES: To determine the prevalence of dental myths and perceived knowledge regarding oral healthcare practices and its associations with levels of education amongst low socioeconomic strata in Karachi, Pakistan. METHODS: The cross-sectional study was conducted in January 2011. Two-staged random sampling was conducted to achieve a sample size of 576 participants from 8 union councils of Gadap Town, Karachi, Pakistan. An interview-based questionnaire was used to determine the participants' perceptions towards oral health and hygiene practices as well as the prevalence of common dental myths. The subjects were interviewed through a formulated questionnaire that was cross-translated into Urdu language. RESULTS: Response rate from the participants was 550 (95.48%). Of the total, 270 (47%) respondents believed in the myth of tooth extraction affecting the eye vision. This was significantly associated with the socio-demography of the respondents. Besides, 421 (73%) thought that tooth extraction is not the ultimate remedy for pain relief and it was statistically significant with age and educational status of the participants. Those who considered bleeding while brushing to be normal were 144 (25%), and it was significantly associated with age and education level. Impact of oral health on general health was positively responded by 392 (68%), while 418 (72.5%) respondents did not think that the retention of baby teeth is important. Both these perceptions were significantly associated with age and level of education. CONCLUSION: Pakistani population has considerable belief in myths and false perceptions regarding oral health issues. Various stakeholders should be involved to develop policies towards healthy attitudes and beliefs within the community towards their oral healthcare.