Effectiveness of an oral health curriculum in reducing dental caries increment and improving oral hygiene behaviour among schoolchildren of Ernakulam district in Kerala, India: study protocol for a cluster randomised trial.

INTRODUCTION: Children's learning abilities suffer when their oral health is compromised. Inadequate oral health can harm children's quality of life, academic performance, and future success and achievements. Oral health problems may result in appetite loss, depression, increased inattentiveness, and distractibility from play and schoolwork, all of which can lower self-esteem and contribute to academic failure. An oral health curriculum, in addition to the standard school curriculum, may instil preventive oral hygiene behaviour in school students, enabling them to retain good oral health for the rest of their lives. Because most children attend school, the school setting is the most effective for promoting behavioural change in children. A 'health-promoting school' actively promotes health by enhancing its ability to serve as a healthy place to live, learn and work, bringing health and education together. Making every school a health-promoting school is one of the joint objectives of the WHO and UNICEF. The primary objective of this proposed study is to assess the effectiveness of an oral health curriculum intervention in reducing dental caries incidence and improving oral hygiene behaviour among high school children in grades 8-10 of the Ernakulam district in Kerala, India. If found to be effective in changing children's behaviour in a positive way, an oral health curriculum may eventually be incorporated into the school health curriculum in the future. Classroom interventions can serve as a cost-effective tool to increase children's oral health awareness. METHODS AND ANALYSIS: This protocol presents a cluster randomised trial design. It is a parallel-group comparative trial with two arms having a 1:1 distribution-groups A and B with oral health curriculum intervention from a dental professional and a schoolteacher, respectively. High schools (grades 8-10) will be selected as clusters for the trial. The minimum cluster size is 20 students per school. The total sample size is 2000 high school children. Data will be collected at three time points, including baseline, after 1 year (mid-term) and 2 years (final), respectively. The outcome measures are Decayed, Missing and Filled Teeth Index; Oral Hygiene Index-Simplified; and knowledge, attitude and behaviour. Data collection will be done by clinical oral examination and questionnaire involving oral health-related knowledge, attitude and behaviour items. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Institutional Ethics Committee of Amrita Institute of Medical Sciences and Research Centre (dated 19 July 2022, no: IEC-AIMS-2022-ASD-179). TRIAL REGISTRATION NUMBER: Clinical Trial Registry of India (CTRI/2022/09/045410).

Development and validation of cultural competence assessment tool for healthcare professionals, India.

Culture influences an individual's perception of "health" and "sickness". Therefore, cultural competence assessment of healthcare professionals is very important. Existing assessment scales have limited application in India due to the nation's rich cultural diversity and heterogeneous healthcare streams. This study was undertaken to develop and validate a cultural competence assessment tool for healthcare professionals in India. A cross-sectional study using convenience sampling was conducted following all standard steps among 290 healthcare professionals in India. Item reduction was followed by estimation of validity and reliability. Responses were recorded on a five-point Likert scale, ranging from strongly disagree to strongly agree. The resultant tool, named Cultural Competence Assessment Tool-India (CCT-I) showed an acceptable internal consistency (Cronbach's alpha =0.734). Inter-rater agreement was 81.43%. Face, content, and construct validity were demonstrated. There was no statistically significant difference in cultural competence between the healthcare streams based on years of clinical experience. There was statistically significant difference between streams of healthcare (p-value =0.009) and also between dentistry and Ayurveda groups (p-value = 0.003). This comprehensive tool can be used as the first step toward designing cultural competence training of healthcare manpower and the establishment of culturally sensitive healthcare organizations.

Comparative evaluation of implant stability using bone expanders and conventional osteotomy.

Aim: The purpose of this study was to compare the implant stability and bone implant contact obtained using bone expanders to conventional osteotomy. Materials and methods: In this multiphasic study, the first phase was conducted on ex vivo porcine models to standardize the procedure and to check its feasibility. The second phase was conducted as human clinical trial. Phase I: A total of 10 implants were placed in the premolar region on five exvivo porcine models in randomized sequence using conventional osteotomy drills and bone expanders/screw spreaders. Implant stability was measured using resonance frequency analyser on the day of implant placement. Radiological analysis was done using micro-CT in two sectional block specimens randomly selected from each study groups. Phase II: Implants were placed on ten patients fulfilling the inclusion criteria. Implants were placed after randomizing the osteotomy sites. Bone expanders were used in 5 sites and conventional osteotomy technique was used in 5 other sites. Implant stability was measured on the day of implant placement and after three months in pre-loaded state using resonance frequency analyser. Results: Phase I: Average implant stability quotient for bone expanders were 71.2% ± 3.8% and 66.4% ± 1.3% for conventional osteotomy respectively. Bone to implant contact ratio values for bone expanders were 84.7% ± 7.9% and conventional osteotomy drills were 66.3% ± 13.6%. Phase II: Average primary stability at the day of surgery was 71.4 ± 1.3 for bone expanders and 65.6 ± 2.4 for conventional osteotomy drills. After three months (per-loaded state), average primary stability of bone expanders were 74.8 ± 1.1 and conventional osteotomy drills were 71.8 ± 2.5. Conclusion: The bone expanders used when indicated can enhance implant stability and bone to implant contact. Thus osteotomy by bone expanders may be suggested as a promising method especially in compromised bone.

A comparison of clinical outcomes between vaccinated and vaccine-naive patients of COVID-19, in four tertiary care hospitals of Kerala, South India.

THE PROBLEM CONSIDERED: This multi-centric study analyzed data of COVID-19 patients and compared differences in symptomatology, management, and outcomes between vaccinated and vaccine-naive patients. METHODS: All COVID-19 positive individuals treated as an in-or out-patient from the 1stMarch to 15th May 2021 in four selected study sites were considered for the study. Treatment details, symptoms, and clinical course were obtained from hospital records. Chi-square was used to test the association of socio-demographic and treatment variables with the vaccination status and binary logistic regression were used to obtain the odds ratio with a 95% confidence interval. RESULTS: The analysis was of 1446 patients after exclusion of 156 with missing data of which males were 57.3% and females 42.7%. 346 were vaccinated; 189 received one dose and 157 both doses. Hospitalization was more in vaccinated (38.2% vs 27.4%); ICU admissions were less in vaccinated (3.5% vs 7.1%). More vaccinated were symptomatic (OR = 1.5); half less likely to be on non-invasive ventilation (OR = 0.5) while vaccine naive patients had 4.21 times the risk of death. CONCLUSION: Severe infection, duration of hospital stays, need for ventilation and death were significantly less among vaccinated when compared with vaccine naive patients.

Prevalence of malocclusion among 8-15 years old children, India - A systematic review and meta-analysis.

OBJECTIVE: We designed this review to assess the prevalence of malocclusion among 8-15 years old Indian children. METHODOLOGY: The review protocol was registered in PROSPERO data with register number CRD42020214211. We employed the standard methodological procedures according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic search was done in PubMed database and other sources in 2020 to identify studies. Only studies published in English after January 1, 2000 that assessed prevalence of malocclusion using Dental aesthetic Index (DAI) or Angle's classification of malocclusion were considered for screening. Selection of articles, data extraction and validity assessment were done independently by the two reviewers. RESULTS: Pooled prevalence of malocclusion is 35.40% (CI:35.37-35.43, 54 studies, 97959 participants). Males had higher proportion of malocclusion (36.20%, CI: 36.12-36.28,33 studies, 40456 participants). 13 years had higher prevalence of malocclusion (33.50%, CI:33.34-33.66, 11 studies, 3366 participants).Prevalence of malocclusion was higher among urban population (32.78%, CI:32.71 32.85,11 studies, 18313 participants). South India showed higher prevalence of malocclusion (39.58%, CI:39.54-39.62, 41 studies, 58645 participants). Prevalence of malocclusion as assessed by mean DAI score was 21.23 (CI:21.14-21.33,11 studies, 12345 participants). CONCLUSIONS: The pooled prevalence of malocclusion among 8-15 years children in India is 35.40% (CI:35.37-35.43,54 studies, 97959 participants).Included studies were heterogeneous in their methods of assessment of malocclusion.