Universal access to screening and management of diabetes in pregnancy in Trinidad using an ICT solution

Objective: Undetected diabetes in pregnancy (DiP) can lead to deleterious consequences. Strengthening health systems and implementing national standardized protocols for screening and management can improve outcomes. This study aimed to achieve consensus on clinical guidelines and facilitate universal screening using standardized testing and an app. Design and Methodology: An integrated care model was developed and antenatal caregivers were trained on screening and management of DiP. A secure Information and Communication Technologies (ICT) solution for real-time communication of results was designed and piloted as the reporting system. The app provided automatic alerts to patients and doctors facilitating timely intervention and offered self-management tools. Pregnant women ≥ 18 years, n = 655 at two antenatal clinics in Trinidad (1 public and 1 private hospital) were screened using a standard 75g 2-hour oral glucose tolerance test (OGTT) after an overnight fast. Seven lab technologists and 24 doctors were trained to use the app. Cost-effectiveness was assessed. Results: National consensus was achieved with 197 antenatal caregivers, for universal screening for DiP. The app facilitated a reporting system of blood glucose results and delivered real-time SMS text and e-mail alerts to participants. 10.1% of participants had abnormal fasting glucose and 14.1% had at least one abnormal reading between 0hr to 2hrs. Universal screening for GDM was cost-effective in the local setting. Results: National consensus was achieved with 197 antenatal caregivers, for universal screening for DiP. The app facilitated a reporting system of blood glucose results and delivered real-time SMS text and e-mail alerts to participants. 10.1% of participants had abnormal fasting glucose and 14.1% had at least one abnormal reading between 0hr to 2hrs. Universal screening for GDM was cost-effective in the local setting. Conclusions: The high prevalence of DiP in T&T justifies the need for universal screening and related health systems change. Training healthcare teams in DiP screening and ICT-enabled management are essential elements of a standardized health system which features real-time reporting.

A Cross-sectional Study of Patients' Satisfaction with Dental Care Facilities: A Survey of Adult Treatment at The University of the West Indies, School of Dentistry.

OBJECTIVES: To determine the level of satisfaction with adult dental care at The University of the West Indies (UWI), School of Dentistry, using the Dental Satisfaction Questionnaire (DSQ) developed by Davies and Ware (1982) and to inferentially explore the factors associated with various patients' demographics. METHODS: A cross-sectional study was performed among adult dental patients attending UWI adult dental clinics. Data were collected using a self- administered, structured questionnaire which consisted of 19 questions on three subscales of pain management, quality and access (total). RESULTS: Sixty-nine per cent were female, 40% were between 45 and 64 years old, and 31.3% had excellent self-rated dental health status. A Dental Satisfaction Index (DSI overall) of 76.42% satisfaction was found, with the highest satisfaction subscale for quality (81.17%), while access (72%) was the lowest occurring subscale. The mean DSI was 3.57 for the UWI emergency dental clinic and 3.87 for the polyclinic. The difference between the DSI overall in the emergency clinic compared to the polyclinic was statistically significant (p < 0.05) CONCLUSIONS: There was a high level of overall satisfaction with dental care at the UWI dental school. Self-rated oral health status may be important in patients' satisfaction. Policies and strategies promoting preventive dental advice are likely to improve patients' satisfaction with dental care and may lead to increased satisfaction with dental services.

Attitudes towards dentists' involvement in smoking cessation activities among patients attending health centres in Trinidad.

OBJECTIVE: To determine whether dental patients in Trinidad would accept smoking cessation advice from their dentist. STUDY DESIGN: Patients attending General practice clinics from twelve randomly selected public health centres in Trinidad were invited to answer a 28- item administered questionnaire. STUDY METHOD: Demographic data, knowledge of effects of smoking on health and dentists' role in smoking cessation were determined. RESULTS:340 patients participated , with 93% response rate. 62.6% were female. 94.7% said they would appreciate it, if their dentist provided smoking cessation advice. 90.3% had good knowledge of the effects of smoking and lung cancer and 79.4% on oral cancer. 76.35% of smokers said they would try to quit if their dentist suggested it. CONCLUSION: positives views were held towards dentists' advice on smoking cessation. Dentists should inform all patients who smoke about the benefits of quitting and provide support with smoking cessation techniques.

A preliminary investigation of periodontal disease and diabetes in Trinidad.

OBJECTIVES: To describe periodontal disease status in diabetic patients in Trinidad. METHOD: A cross-sectional study was conducted. Patients attending a tertiary referral centre for diabetes at an out-patient clinic were invited to undergo oral examinations. The basic periodontal examination (BPE) was used to assess periodontal disease status. RESULTS: Seventy-two patients participated in the study. Mean age was 55.7 years, 54.2% were female, with 66.7% and 22.2% being of Indo-Trinidadian and Afro-Trinidadian ethnicity respectively. There were 61.1% who had not attended for dental treatment within the last year and 56.9% only attended when in pain; 15.3% had a history of cigarette smoking and 31.9% currently wore a denture. Plaque was detectable with the use of a probe in 40.3% of the 67% that underwent a BPE assessment; 38.8% were found to have advanced periodontal disease. CONCLUSION: The prevalence of periodontal disease in this sample of diabetic patients suggests that regular dental examinations, oral health education, and collaborative patient care between medical and dental practitioners should form part of the routine management of diabetic patients in Trinidad.

A Preliminary investigation of periodontal disease and diabetes in Trinidad / Una investigación de la enfermedad periodontal y la diabetes en Trinidad

OBJECTIVES: To describe periodontal disease status in diabetic patients in Trinidad. METHOD: A cross-sectional study was conducted. Patients attending a tertiary referral centre for diabetes at an out-patient clinic were invited to undergo oral examinations. The basic periodontal examination (BPE) was used to assess periodontal disease status. RESULTS: Seventy-two patients participated in the study. Mean age was 55.7 years, 54.2% were female, with 66.7% and 22.2% being of Indo-Trinidadian and Afro-Trinidadian ethnicity respectively. There were 61.1% who had not attended for dental treatment within the last year and 56.9% only attended when in pain; 15.3% had a history of cigarette smoking and 31.9% currently wore a denture. Plaque was detectable with the use of a probe in 40.3% of the 67% that underwent a BPE assessment; 38.8% were found to have advanced periodontal disease. CONCLUSION: The prevalence of periodontal disease in this sample of diabetic patients suggests that regular dental examinations, oral health education, and collaborative patient care between medical and dental practitioners should form part ofthe routine management ofdiabetic patients in Trinidad.

OBJETIVOS: Describir el estado de la enfermedad periodontal en los pacientes diabéticos en Trinidad. MÉTODO: Se llevó a cabo un estudio transversal. Un número de pacientes que asistían a un centro terciario de remisión terciario para la diabetes en una clínica ambulatoria, fue invitado a recibir exámenes orales. Se usó el examen periodontal básico (EPB) para evaluar el estado de la enfermedad periodontal. RESULTADOS: Setenta y dos pacientes participaron en el estudio. La edad promedio fue 55.7 años, 54.2% fueron hembras; 66.7% y 22.2% fueron de etnicidad indotrinitense y afrotrinitense respectivamente. Hubo un 61.1% que no habían asistido para recibir tratamiento dental en el último año, y 56.9% que sólo asistieron cuando tuvieron dolor; el 15.3% tenía una historia de hábito de fumar cigarrillos, y el 31.9% usaba una prótesis dental. La placa era detectable usando una sonda dental en el 40.3% del 67% que recibió la evaluación del EPB, en tanto que se halló que el 38.8% tenía la enfermedad periodontal en estado avanzado. CONCLUSIÓN: La prevalencia de la enfermedad periodontal en esta muestra de pacientes diabéticos indica que los exámenes dentales regulares, la educación para la salud oral, y el cuidado colaborativo entre pacientes y trabajadores de la salud dental, deben formar parte del manejo de los pacientes diabéticos en Trinidad.