Bakgrund: En god munhälsa betyder mycket för välbefinnandet och området är sparsamt studerat inom palliativ vård. För att kunna bedöma munstatus på ett strukturerat sätt rekommenderas Revised Oral Assessment Guide (ROAG) att användas i Sverige. Året som studien utfördes gavs en prestationsersättning till alla svenska kommuner som använde ROAG och dokumenterade munhälsa i det nationella kvalitetsregistret senior alert. Syfte: Syftet med studien var att undersöka om munhälsobedömningar gjorts enligt ROAG, och om åtgärderna som vidtagits stämmer överens med ROAGs rekommendationer. Det har även studerats om läkare eller tandläkare konsulterats, då allvarliga problem med munhälsan upptäcktes. Metod: En retrospektiv kvantitativ studie ägde rum på en palliativ slutenvårdsavdelning Pappersjournaler av 68 patienter granskades. Patienter som inte var i en palliativ fas eller som hade gått bort inom en vecka efter ankomst exkluderades från studien. En granskningsmall och anteckningsblock användes för att kunna sammanställa all dokumentation från journalerna. Resultat: Resultatet visade brist på dokumentation inom området munvård, och ROAG formuläret hade använts i en av 68 journaler. Det fanns få beskrivna åtgärder. Av 103 identifierade problemområden fanns 8 problemområden där åtgärderna fullständigt stämde överens med ROAG. 29 patienter hade läkemedel mot munsvamp ordinerat av läkare. Av dessa 29 fanns 12 journaler där det inte stod någonting om munvård, utom just i läkemedelslistan. Slutsats: Denna studie tyder på att det finns brister i dokumentationen av munhälsa och munvård. Bristerna skulle kunna leda till ett onödigt vårdlidande för patienten. Orsaken till detta behöver undersökas, och rutiner för munvårdsbedömningar bör säkerställas. / Background: Good oral health is important for general wellbeing and there is a lack of studies within this area.  In Sweden it is recommended that Revised Oral Assessment Guide (ROAG) is used in order to assess oral health in a structured way. The year the study was performed a monetary performance reward was given to all Swedish counties if they used ROAG and documented oral health in a Swedish national register called senior alert. Aim: The aim of this study was to examine if oral health care assessments had been made using ROAG (revised oral assessment guide), and weather the measures that were made coincided with ROAGS recommendations. The aim also included studying if a doctor or dentist were consulted, if serious problems with oral health were discovered. Method: A retrospective study took place at a hospice. The printed journals of 68 patients were studied. Patients who were not in a palliative phase, or had passed away within a week of arrival were excluded from the study. A review template and a notebook were used to compile the documentation from the journals. Result: The result showed a lack of documentation of oral health and that the ROAG form was only used in one of 68 journals. There were few documented actions mentioned to rectify identified problems. Amongst 103 problem areas there were 8 that had actions mentioned that coincided with ROAGs recommendations. 29 patients had an oral antifungal drug prescribed by a doctor. Amongst these 29 patients there were 12 journals that did not mention oral health care in any way, except from on the medical ordination list. Conclusion: This study showed that there was a lack of documentation within the nursing field of oral health care. This could lead to unnecessary suffering for the patient. The reason behind this should be examined, and routines for the use of oral assessment guides should be secured.

Treatment of head and neck cancer with radiation therapy is associated with adverse side effects to the oral cavity and surrounding areas. These complications include mucositis, mucosal fibrosis and atrophy, salivary gland dysfunction, increased risk of dental caries, increased susceptibility to infections, tissue necrosis, taste dysfunction, and muscular and/or cutaneous fibrosis. The often permanent nature of the radiation-induced damage necessitates the maintenance of a strict oral care program, involving frequent flossing and brushing in addition to daily fluoride applications, for the rest of the patient's life. An additional concern among patients with head and neck cancer is the use of tobacco and alcohol. Both are known risk factors in the development of head and neck cancers and failure to abstain from either after diagnosis increases the risk for relapse and development of secondary cancers. The present study was a longitudinal investigation of several factors that may influence patients' consistency in following their prescribed oral care program and abstaining from alcohol and tobacco use, including, but not limited to, patient satisfaction with the doctor-patient communication, patient coping, and patient illness perceptions. The study examined an integrative model seeking to explain patient adherence to the oral care regimen as well as tobacco and alcohol use. While results were inconclusive with respect to the model, there were several interesting findings, which were consistent with previous literature examining doctor-patient communication and illness perceptions among other cancer populations. Results from this study suggested that both satisfaction with doctor-patient communication and coping play an important role in forming patients’ illness perceptions. Furthermore beliefs about the severity of oral complications emerged as a predictor of oral care at follow-up. / text

<p>Patient satisfaction is critical for the growth of oral health service and practice. The present study was a descriptive study on patient satisfaction with oral health care provided by a district dental clinic. The aim of the study was to determine whether patients attending the dental clinic of the Lagos State University hospital were satisfied with the care they received.</p>

Magister Scientiae Dentium - MSc(Dent) / Tuberculosis is the world’s leading cause of death from a single infective agent. The World Health Organisation has declared the disease a “global emergency”. Extrapulmonary presentations form a major proportion of new cases, especially since the advent of the acquired immunodeficiency syndrome epidemic. Therefore, it is important that oral health care workers are aware of tuberculosis in the head and neck region and its varied manifestations. This study reports on one hundred and four patients diagnosed with tuberculosis and with head and neck tuberculosis lesions.The aim of the study was to determine the extent to which tuberculosis presents in the head and neck region. It was a descriptive, retrospective, record-based study on a cohort of tuberculosis patients that presented with head and neck tuberculosis at private practices in the Durban area over a fourteen month period. A structured data capture sheet was the method chosen for recording the data.The majority of the sample (89.4%) had tuberculosis of the head and neck lymph nodes, five (4.8%) had tuberculosis of the tonsil, two (1.9%) had tuberculosis of the larynx, two (1.9%) had tuberculosis of the ear, one (1%) had parotid gland tuberculosis and one (1%) had tuberculosis of the nose. The records indicate that excision biopsy and histopathological examinations were used to make a diagnosis. A third (33.7%) of the patients were confirmed with human immunodeficiency virus infection.A high index of suspicion of tuberculosis is important in the differential diagnosis of neck swellings, hoarseness and otorrhoea and in human immunodeficiency virus positive patients with an enlarging neck mass. A biopsy is usually necessary for diagnosis. Successful outcome depends upon appropriate chemotherapy and timely surgical intervention when necessary. Oral health care workers need to be fully cognizant of all the various presentations of head and neck tuberculosis to allow early diagnosis and quick commencement of appropriate treatment.

Magister Scientiae Dentium - MSc(Dent) / Candida glabrata (C. glabrata/ Cg) is a pathogenic organism that is increasingly developing frank innate and acquired resistance to the most commonly used antifungal agents, namely, azole group of antifungals. Furthermore, C. glabrata-associated oropharyngeal infections affecting immunocompromised patients, are more difficult to treat and the development of resistance worsen the prognosis. Molecular studies related the emergence of resistance in C. glabrata to the upregulation of ATP-binding cassette (ABC) transporter genes, which work by reducing drug concentration within the cell via drug efflux mechanism, and among these genes, CgCDR1 is considered to play a major role in resistance development. Thus, in order to overcome this problem, several combinations of antifungal agents are being studied. Aim: To evaluate the effect of a combination therapy of fluconazole and amphotericin B on the growth and CDR1 gene expression of C. glabrata. Research design and methodology: This in-vitro study evaluated the effect of a combination therapy of fluconazole and amphotericin B on the growth of C. glabrata and related it to the expression of CgCDR1 resistance gene. C. glabrata was revived in brain heart infusion (BHI) broth and later inoculated onto agar plates. Following overnight incubation, 5 colonies were transferred using a sterile loop into 2 ml of phosphate buffered saline (PBS) solution to establish McFarland (Mcf) standard. Later, the solution was diluted by transferring 200 μL to 400 ml of yeast peptone dextrose (YPD) agar (flask 1). From (flask 1), 90 ml, 99 ml and 89 ml of inoculum were allocated into 3 separate flasks, into which 10 ml fluconazole, 1 ml amphotericin B and 11 ml combination (10 ml fluconazole + 1 ml amphotericin B) were added, respectively. The inoculums were left to settle for 20 minutes, then incubated at 37oC with serial dilutions carried after 30 minutes, 2, 4, 6 and 24 hours. From the 96-microtiter plate, 10 μL for each treatment arm and time interval were transferred from selected wells and onto 30 Casein-peptone Soymeal-peptone (CASO) agar plates, and incubated for 24 hours. After incubation, the number of colonies were counted using an automated colony counter, to establish colony forming unit (CFU)/ml. CgCDR1 gene expression was analyzed using real time polymerase chain reaction. After 6 hours of incubation, a sample was taken from each treatment arm, transferred into CASO agar plates and incubated for 24 hours at 37oC. After establishing Mcf, gene extraction and gene expression were carried out according to manufacturer’s instructions. Results and discussion: No significant difference between the effect of the combination and amphotericin B was evident regarding C. glabrata growth. However, the combination therapy was more effective against C. glabrata than fluconazole, with a marked decrease in candidal growth at 30 minutes and 6 hours. Furthermore, the expression of CgCDR1 gene at 6 hours contact time was more pronounced in the samples of C. glabrata treated with the combination therapy, compared to that of the monotherapy. Conclusion: The combination therapy had better effect on the growth of C. glabrata than fluconazole monotherapy. On the other hand, the expression of CgCDR1 was detected in the samples of C. glabrata treated with the combination therapy, suggesting the ability of the yeast to adapt and develop resistance in such environment.

Bakgrund: God munhälsa har betydelse för hälsa och livskvalitet. För patienter som drabbats av stroke kan nedsatt egenvårdsförmåga orsaka svårigheter att upprätthålla en god munhälsa på egen hand. Munhälsovård ingår i sjuksköterskans omvårdnad som ska främja hälsa, förebygga sjukdom, återställa hälsa och lindra lidande. Syfte: Syftet var att belysa faktorer som påverkar sjuksköterskans utförande av munhälsovård hos patienter som drabbats av stroke.Metod: Studien var en allmän litteraturstudie med induktiv ansats. Åtta artiklar valdes ut till resultatet och data bearbetades med innehållsanalys. Resultat: Munhälsovård tillhandahölls inte effektivt på grund av avsaknad av kompetens och utbildning bland sjuksköterskor samt prioritering av andra medicinska uppgifter. Tidsbrist och bristande resurser utgjorde hinder för en adekvat munhälsovård. Hälsotillstånd och ovilja gentemot omvårdnadsområdet hos de som drabbats av stroke påverkade utförandet av munhälsovård. Konklusion: Kunskap bland sjuksköterskor och patienter var bristfälligt och arbetsmiljöfaktorer som arbetsbelastning och tidsbrist har resulterat i låg prioritering av omvårdnadsområdet. Tydligare riktlinjer, rutiner och utbildning kan förbättra munhälsovården hos patienter som drabbats av stroke. / Background: Good oral health is important for health and quality of life. For patients who suffered a stroke, impaired self-care can cause difficulties in maintaining good oral health on their own. Oral health care is part of the nurse’s care, which is to promote health, prevent disease, restore health and relieve suffering. Aim: The aim was to highlight factors affecting the nurse’s execution of oral health care in patients who had suffered a stroke. Method: The study was a general litterature study with an inductive approach. Eight articles were selected for the result and data were processed with content analysis. Results: Oral health care was not provided effectively due to lack of skills and training among nurses and prioritization of other medical tasks. Lack of time and resources were obstacles for an adequate oral health care. Patients who suffered a stroke’s health status and reluctance towards the nursing field influenced the performance of oral health care. Conclusions: Knowledge among nurses and patients were deficient and work environment factors such as workload and lack of time have resulted in low prioritization of the nursing area. Clearer guidelines, routines and training can improve oral health care in patients who suffered a stroke.

<p>The negative effect of poor oral health on quality of life and financial implication of work days lost as a result of dental pain can be accepted as a rationale for inclusion of oral health in the primary health care (PHC) package for South Africa. The norms of the PHC package for oral health services are to expose at least 50% of primary schools to organized school preventive programmes and to ensure basic coverage of everybody in the catchment areas. Currently these norms are not adequately fulfilled in Randfontein. The purpose of this study was to gather information that can be used to improve oral health services in Randfontein. The aim of the study was to gain an understanding of the factors that influence the choice of oral health care seeking behaviour as perceived&nbsp / by residents in different contexts and to use these perceptions to inform appropriate health planning strategies and implementation of measures that can improve health promotion in Randfontein. This qualitative study explored oral health care seeking behaviour. The study population comprised all residents of Randfontein above seventeen years old who had visited the oral health section in the Randfontein Primary Health Care (PHC) Facility. There were two focus group discussions (FGDs) from each of three separate residential areas namely Mohlakeng with&nbsp / mainly black residents, Toekomsrus with mainly coloured race residents and from town which is a predominantly Caucasian race area. Data collected was analysed during the data collection stage and thereafter until they made sense to the researcher. To strengthen validity, the accuracy of the interpretation of what respondents said was confirmed with them. Analysed themes were&nbsp / coded and categorized to enable the key researcher to interpret them for final reporting. Appropriate ethical procedures were followed. The findings were that although all focus groups preferred&nbsp / allopathic oral health care seeking, various barriers existed. The study concluded that there should be adequate oral health education and promotion, effectivecommunication and an expansion of these services to Toekomsrus, where they do not exist. Perceptions on factors influencing oral health seeking by Randfontein residents&nbsp / </p>

<p>The negative effect of poor oral health on quality of life and financial implication of work days lost as a result of dental pain can be accepted as a rationale for inclusion of oral health in the primary health care (PHC) package for South Africa. The norms of the PHC package for oral health services are to expose at least 50% of primary schools to organized school preventive programmes and to ensure basic coverage of everybody in the catchment areas. Currently these norms are not adequately fulfilled in Randfontein. The purpose of this study was to gather information that can be used to improve oral health services in Randfontein. The aim of the study was to gain an understanding of the factors that influence the choice of oral health care seeking behaviour as perceived&nbsp / by residents in different contexts and to use these perceptions to inform appropriate health planning strategies and implementation of measures that can improve health promotion in Randfontein. This qualitative study explored oral health care seeking behaviour. The study population comprised all residents of Randfontein above seventeen years old who had visited the oral health section in the Randfontein Primary Health Care (PHC) Facility. There were two focus group discussions (FGDs) from each of three separate residential areas namely Mohlakeng with&nbsp / mainly black residents, Toekomsrus with mainly coloured race residents and from town which is a predominantly Caucasian race area. Data collected was analysed during the data collection stage and thereafter until they made sense to the researcher. To strengthen validity, the accuracy of the interpretation of what respondents said was confirmed with them. Analysed themes were&nbsp / coded and categorized to enable the key researcher to interpret them for final reporting. Appropriate ethical procedures were followed. The findings were that although all focus groups preferred&nbsp / allopathic oral health care seeking, various barriers existed. The study concluded that there should be adequate oral health education and promotion, effectivecommunication and an expansion of these services to Toekomsrus, where they do not exist. Perceptions on factors influencing oral health seeking by Randfontein residents&nbsp / </p>

Magister Public Health - MPH / The negative effect of poor oral health on quality of life and financial implication of work days lost as a result of dental pain can be accepted as a rationale for inclusion of oral health in the primary health care (PHC) package for South Africa. The norms of the PHC package for oral health services are to expose at least 50% of primary schools to organized school preventive programmes and to ensure basic coverage of everybody in the catchment areas. Currently these norms are not adequately fulfilled in Randfontein. The purpose of this study was to gather information that can be used to improve oral health services in Randfontein. The aim of the study was to gain an understanding of the factors that influence the choice of oral health care seeking behaviour as perceived by residents in different contexts and to use these perceptions to inform appropriate health planning strategies and implementation of measures that can improve health promotion in Randfontein. This qualitative study explored oral health care seeking behaviour. The study population comprised all residents of Randfontein above seventeen years old who had visited the oral health section in the Randfontein Primary Health Care (PHC) Facility. There were two focus group discussions (FGDs) from each of three separate residential areas namely Mohlakeng with mainly black residents, Toekomsrus with mainly coloured race residents and from town which is a predominantly Caucasian race area. Data collected was analysed during the data collection stage and thereafter until they made sense to the researcher. To strengthen validity, the accuracy of the interpretation of what respondents said was confirmed with them. Analysed themes were coded and categorized to enable the key researcher to interpret them for final reporting. Appropriate ethical procedures were followed. The findings were that although all focus groups preferred allopathic oral health care seeking, various barriers existed. The study concluded that there should be adequate oral health education and promotion, effectivecommunication and an expansion of these services to Toekomsrus, where they do not exist. Perceptions on factors influencing oral health seeking by Randfontein residents. / South Africa

This qualitative study focused on the dental disparities in Blount County, TN and sought to determine if there are enough dental clinics within the dental safety net. Interviews were conducted with 18 individuals who were either service providers or clients of organizations such as the Salvation Army, Alcoa Good Samaritan Clinic, the local health department, Trinity Dental Clinic, Volunteer Ministry Center, Remote Area Medical, and Blount Memorial Hospital. Inclusion criteria for clients included: homeless or living below the poverty level, uninsured, 18 to 65 years of age, has not seen a dentist in the past year and currently suffering a dental problem. The most obvious common theme among the 11 clients interviewed was that they struggle with getting dental care. Patients were asked when the last time they had seen a dentist and they answered years ago, most over ten years ago. Eight of the eleven clients did not know of any facilities they could go to. Cost was the main reason for these clients not seeking dental care. Two dentists were asked about the reasons for disparities in dental care. The major common themes between the dentists were cost, access to care, and education. All five case managers said that they had clients experiencing dental needs ranging from a simple cleaning to an abscess. Currently in Blount County only one dental clinic serves over 17,000 residents who live in poverty.