RESUMEN
OBJECTIVE: To conduct a capacity and needs assessment identifying important factors for the successful implementation of an oral health coach (OHC) at well-baby clinics. This Toddler Oral Health Intervention (TOHI) provides oral health promotion to parents to prevent early childhood caries. METHODS: A two-round Delphi study was conducted with an expert panel consisting of OHCs and paediatric staff. The survey was based on the Consolidated Framework for Implementation Research (CFIR), consisting of 39 constructs divided over 5 domains: intervention characteristics (8), inner setting (14), outer setting (4), characteristics of individuals (5) and the process of implementation (8). RESULTS: Constructs relating to the inner setting, outer setting and implementation process were identified as essential. Availability of resources, information on how to execute or facilitate the intervention, and the integration of the intervention into existing work tasks were also essential. Alignment and partnership between OHCs and paediatric staff, along with the prioritization of parents' and children's needs were emphasized. A formally appointed internal implementation leader within each organization, capable of transferring their enthusiasm to the team, and regular meetings for progress and experience sharing were considered essential. CONCLUSION: Specific strategies are needed in the implementation phase to increase the adoption, implementation and maintenance of the TOHI, ultimately leading to improved oral health in children. This study provides valuable insights into important factors for implementation of an oral health intervention in a public health setting.
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Caries Dental , Salud Bucal , Lactante , Humanos , Preescolar , Niño , Evaluación de Necesidades , Promoción de la Salud , Salud PúblicaRESUMEN
BACKGROUND & AIM: Malnutrition adversely influences a broad range of physical and psychological symptoms. Although polypharmacy is often mentioned to be associated with malnutrition, especially in older people it is unclear to what extent. The aim of this systematic review was to investigate the extent of the association between polypharmacy and malnutrition in older people. METHODS: The methodology followed the guidelines of the Cochrane Collaboration. Literature search was performed in PubMed, CINAHL and Embase. The population of interest for this systematic review were people of 65 years and older with polypharmacy. Because there is ambiguity with regard to the actual definition of malnutrition and polypharmacy, in this systematic review all articles describing malnutrition prevalence rates were included, regardless of the criteria used. Both observational and intervention studies were screened for eligibility. Selection and quality assessment of the included full text studies was assessed by two reviewers independently. A level of evidence and methodological quality score was adjudged to each article based on this assessment. RESULTS: A total of 3126 studies were retrieved by the literature search, of which seven studies were included in this systematic review. There was considerable variation in the definition of polypharmacy between studies. Two studies defined polypharmacy as the use of five or more drugs, two studies as the use of six or more drugs, two studies provided a mean and standard deviation that corresponded to the minimum of five drugs, and one study distinguished between polypharmacy (five or more drugs) and excessive polypharmacy (ten or more drugs). However, all studies showed a statistically significant association between (the risk) of becoming malnourished and polypharmacy regardless the instrument or criterion used to define risk of malnutrition. Studies presented the associations respectively as OR ≥ 1.177, p-value ≤ 0.028, ß ≥ -0.62 and r ≥ -0.31. CONCLUSION: This review demonstrated a statistically significant association between polypharmacy and malnutrition. Further research is required to determine the magnitude of the effect by increased number of drugs in combination with the type of drugs, on the risk of malnutrition.
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Desnutrición , Polifarmacia , Anciano , Humanos , Desnutrición/epidemiología , PrevalenciaRESUMEN
In 2019, a questionnaire study was started in which the experiences, barriers and needs of users of the Gewoon Gaaf caries prevention method were investigated. The survey was distributed via social media, an email list and the Dutch Ivory Cross newsletter. In total,188 people completed the survey. The results showed that the dental practices using this method are satisfied with it and that prevention assistants apply this method most often in practice, often in collaboration with a dental hygienist and/or a dentist. The participants reported positive experiences: the method provides clear tools for daily practice. However, there is a need to share knowledge and experiences with other oral healthcare providers, for example via digital modules or written information. One of the tips given by many users was to spend a lot of time motivating and educating parents. Users' tips derived from this research can be included in the further development of the method.
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Caries Dental , Personal de Salud , Atención a la Salud , Caries Dental/prevención & control , Humanos , Padres , Encuestas y CuestionariosRESUMEN
BACKGROUND: In frail older people with natural teeth factors like polypharmacy, reduced salivary flow, a decrease of oral self-care, general healthcare issues, and a decrease in dental care utilization contribute to an increased risk for oral complications. On the other hand, oral morbidity may have a negative impact on frailty. OBJECTIVE: This study explored associations between oral health and two frailty measures in community-dwelling older people. DESIGN: A cross-sectional study. SETTING: The study was carried out in a Primary Healthcare Center (PHC) in The Netherlands. PARTICIPANTS: Of the 5,816 persons registered in the PHC, 1,814 persons were eligible for participation at the start of the study. MEASUREMENTS: Two frailty measures were used: 1. Being at risk for frailty, using Electronical Medical Record (EMR) data, and: 2. Survey-based frailty using 'The Groningen Frailty Indicator' (GFI). For oral health measures, dental-record data (dental care utilization, dental status, and oral health information) and self-reported oral problems were recorded. Univariate regression analyses were applied to determine the association between oral health and frailty, followed by age- and sex-adjusted multivariate logistic regressions. RESULTS: In total 1,202 community-dwelling older people were included in the study, 45% were male and the mean age was 73 years (SD=8). Of all participants, 53% was at risk for frailty (638/1,202), and 19% was frail based on the GFI (222/1,202). A dental emergency visit (Odds Ratio (OR)= 2.0, 95% Confidence Interval (CI)=1.33;3.02 and OR=1.58, 95% CI=1.00;2.49), experiencing oral problems (OR=2.07, 95% CI=1.52;2.81 and OR=2.87, 95% CI= 2.07;3.99), and making dietary adaptations (OR=2.66, 95% CI=1.31;5.41 and OR=5.49, 95% CI= 3.01;10.01) were associated with being at risk for frailty and survey-based frailty respectively. CONCLUSIONS: A dental emergency visit and self-reported oral health problems are associated with frailty irrespective of the approach to its measurement. Healthcare professionals should be aware of the associations of oral health and frailty in daily practice.
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Anciano Frágil , Fragilidad/epidemiología , Salud Bucal/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Fragilidad/diagnóstico , Evaluación Geriátrica , Humanos , Vida Independiente , Masculino , Países Bajos/epidemiologíaRESUMEN
Oral care for older people is an underexposed topic in dentistry as well as in general healthcare, while oral care professionals are increasingly confronted with frail and multimorbid older people with complex care needs. The research agenda 'Oral care for the elderly' was developed to encourage the collaboration of researchers in the Netherlands and Flanders (Belgium) to do more research in this area and in this way, to achieve an expansion and implementation of knowledge. This will make possible the provision of a socially responsible and robust basis for sustainable oral care for frail older people. The focus of the agenda is on 3 themes, namely oral health and oral function for older people; multi/interdisciplinary collaboration within primary care and the costs, benefits and long-term effect(s) of oral care throughout the entire course of life. This article provides an overview of this research agenda and the way in which it has been established.
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Atención a la Salud , Atención Primaria de Salud , Anciano , Anciano de 80 o más Años , Bélgica , Anciano Frágil , Humanos , Países Bajos , Salud BucalRESUMEN
With a growing number of female dentists, changes in the collaboration between dentists and dental hygienists are possible. To assess the possible consequences of these changes in dentistry for cooperation with dental hygienists, two important aspects are discussed: differences in vision with respect to treatment and the profession and differences in communication styles. Female dentists seem to be more prevention-orientated and people-orientated and are therefore more like the group of female dental hygienists. The communication style of female dentists is also consistent with the style of their female colleague hygienists; wishes and expectations are more aligned with each other, which makes optimal cooperation more likely. This focus on prevention and the consistency in communication styles offer opportunities for inter-professional collaboration between dentists and dental hygienists. Does this actually mean better collaboration, however, and what about the cooperation between male dentists and female dental hygienists?
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Higienistas Dentales/psicología , Odontólogos/psicología , Relaciones Interprofesionales , Comunicación , Femenino , Humanos , Masculino , Odontología Preventiva , Distribución por SexoRESUMEN
OBJECTIVE: To use a qualitative approach to examine the perceptions of policy makers, general dental practitioners, dental hygienists, dental students and dental hygiene students in the Netherlands following the introduction of a direct access policy in 2006. METHODS: Semi-structured interviews and focus groups were undertaken with a variety of policy makers and clinicians in the Netherlands. These were recorded and transcribed verbatim into MS Word documents. The transcripts were line numbered and subjected to thematic analysis to develop a coding frame using NVivo. RESULTS: Four main themes are reported, which represent a subset of a policy analysis of direct access in the Netherlands. These were entitled: 'The narrative of implementation', 'Working models of direct access', 'Relationship between old- and new-style hygienists' and 'Public attitudes'. CONCLUSIONS: Working relationships within integrated practices in the Netherlands are positive, but attitudes towards independent practice are mixed. Good examples of collaborative working across practices were observed, but relationships between the professional bodies remain difficult seven years on since the introduction of the policy.
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Atención Odontológica , Higienistas Dentales , Accesibilidad a los Servicios de Salud , Actitud del Personal de Salud , Actitud Frente a la Salud , Atención a la Salud/métodos , Atención a la Salud/organización & administración , Atención Odontológica/métodos , Atención Odontológica/organización & administración , Higienistas Dentales/organización & administración , Odontólogos , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Países Bajos , Reino UnidoRESUMEN
OBJECTIVES: This study compares the scope of practice of Dutch dental hygienists (DHs) educated through a 2- or 3-year curriculum ('old-style DHs') with that of hygienists educated through a new extended 4-year curriculum leading to a bachelor's degree ('new-style DHs'), with the aim to investigate whether an extended scope of practice positively affects perceived skill variety, autonomy and job satisfaction. METHODS: The questionnaires were obtained from old- and new-style DHs (n = 413, response 38%; n = 219, response 59%, respectively), in which respondents had recorded their dental tasks, perceived skill variety, autonomy and job satisfaction. T -tests were used to analyse differences between old- and new-style DHs, and regression analyses were performed to assess the relation between scope of practice and skill variety, autonomy and job satisfaction. RESULTS: New-style DHs have a more extended scope of practice compared with old-style DHs. Despite their more complex jobs, which are theoretically related to higher job satisfaction, new-style DHs perceive lower autonomy and job satisfaction (P < 0.05). Skill variety is the strongest predictor for DHs' job satisfaction (ß = 0.462), followed by autonomy (ß = 0.202) and caries decisive tasks, the last affecting job satisfaction negatively (ß = -0.149). Self-employment is the strongest significant predictor for autonomy (ß = 0.272). CONCLUSIONS: The core business of DHs remains the prevention and periodontology services. New-style DHs combine these tasks with extended tasks in the caries field, which can lead to comparatively less job satisfaction, because of a lower experienced autonomy in performing these extended tasks.
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Higienistas Dentales/psicología , Educación en Odontología/métodos , Satisfacción en el Trabajo , Autonomía Profesional , Trabajo/psicología , Competencia Clínica , Higienistas Dentales/educación , Humanos , Países Bajos , Práctica Profesional , Estrés PsicológicoRESUMEN
Last decennia much attention has been paid to improve the oral health of schoolchildren. The purpose of this study was to examine the present caries prevalence and the state of oral health of schoolchildren. Therefore 1.147 children from group 2 and group 8 of the primary school (6 and 12 years of age) in the province Drenthe were examined. Of the children 33% had caries and 13% had gingivitis. The highest percentages of caries were found in the low SES-group and among children that have education at schools for children with special needs. The study showed that these children brushed their teeth less often, they visited the dentist for the first time at an older age and they were eating many snacks. Children who had received an instruction in how to brush one's teeth, did not score better in the caries prevalence compared to children without previous instruction. Also the children whose parents had information about oral health, did not score better than the other children.
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Caries Dental/epidemiología , Gingivitis/epidemiología , Salud Bucal , Niño , Femenino , Humanos , Masculino , Países Bajos/epidemiología , Higiene Bucal , Prevalencia , Instituciones Académicas , Factores SocioeconómicosRESUMEN
INTRODUCTION: Generalisability coefficients are widely used as a measure of reliability in educational sciences. However, coefficients do not inform about how much individual and/or educational variance is needed for borderline competence. Probing depth measurements were used as an example to demonstrate the use of generalisability and decision studies in educational decision-making. METHOD: All six probing depths of seven elements of the first quadrant were assessed in a random crossed four-way 'elements' (7), 'probing depth' (6) 'observers' (7-8) and 'repetitions' design for both students (8) and faculty staff (7). Borderline competence was assessed in four decision study designs. RESULTS: In decision studies the generalisability coefficient varied from 0.31 to 0.88 for the first single and fourth repeated study design, respectively. The standard error of the measurement varied from 1.73 to 0.64 mm with a corresponding 95% confidence interval varying from 3 to 1 mm. CONCLUSION: Repeated measurement is not the most efficient way to improve educational decision-making. What is new to this approach is that we used the 95% confidence interval of the standard error of measurement as a measure for 'borderline competence' expressed in the unity of the measurement instrument. Correctly performing the procedure of probing depth assessment is of clinical and educational importance in deciding whether further treatment is necessary and whether students fail or pass their exams.