Ratika Sharma

Mobile-phone text messaging (SMS) for providing oral health education to mothers of preschool children in Belgaum City:

We compared the effectiveness of two media (text messages and pamphlets) in imparting health education to mothers of preschool children. Mothers and their children were randomized into two groups. There were 72 mothers and their children in the pamphlet group and 71 in the text message group. The mothers were given health education by one of the two modes for four weeks. Knowledge, attitude and practices of the mothers were assessed by a questionnaire pre- and post-intervention. Visible plaque scores of their children were also recorded pre- and post-intervention. There were significant improvements in knowledge (P < 0.001), attitude (P < 0.001) and practices (P < 0.001) in both groups. There was also a significant reduction in visible plaque scores (P < 0.001) in both groups. Text messaging was more effective than pamphlets in improving knowledge, attitude and practices of mothers, but the comparative reduction in plaque score between groups was not significant. Text messaging appears to be an effective means of imparting oral health education.

The challenge of reducing smoking in people with serious mental illness

The high prevalence of smoking in people with serious mental illness contributes substantially to the disproportionately high morbidity and premature mortality in this population. There is an urgent need to help people with serious mental illness to quit smoking. We discuss competing explanations for the high prevalence of smoking in people with serious mental illness and the effectiveness of available smoking cessation interventions. We propose trials of harm reduction options, such as nicotine replacement therapy and electronic cigarettes (e-cigarettes), as long-term substitutes for cigarettes in smokers with serious mental illness who are unable to quit smoking. We also propose that smoke-free psychiatric units provide smoking cessation support on patient admission to the hospital and after discharge.

Traumatic dental injuries in primary school children of South India--a report from district-wide oral health survey.

AIM The aim of this study was to investigate the prevalence of dental trauma among primary school children aged 6-11 years in Belgaum, India. MATERIALS AND METHODS A sample of 13,200 children from primary schools of Belgaum district was examined for dental trauma. WHO classification of dental trauma was used. RESULTS Total number of children suffering from dental trauma was found to be 1946 (14.74%). A significant gender influence on the occurrence of dental trauma was observed, with more boys (17.26%) experiencing dental trauma than girls (12.29%). More than 3 mm overjet and incompetent lips were also significantly associated with dental trauma in children. CONCLUSION The findings of this study show that dental trauma has a moderately high prevalence among Indian primary school children. Community, especially parents and school teachers, should be educated about prevention and early management of dental trauma in children.

Australian mental health care practitioners’ practices and attitudes for encouraging smoking cessation and tobacco harm reduction in smokers with severe mental illness

Reducing the burden of physical illness among people living with severe mental illnesses (SMI) is a key priority. Smoking is strongly associated with SMIs resulting in excessive smoking related morbidity and mortality in smokers with SMI. Smoking cessation advice and assistance from mental health practitioners would assist with reducing smoking and smoking-related harms in this group. This study examined the attitudes and practices of Australian mental health practitioners towards smoking cessation and tobacco harm reduction for smokers with SMI, including adherence to the 5As (ask, assess, advise, assist and arrange follow up) of smoking cessation. We surveyed 267 Australian mental health practitioners using a cross-sectional, online survey. Most practitioners (77.5%) asked their clients about smoking and provided health education (66.7%) but fewer provided direct assistance (31.1-39.7%). Most believed that tobacco harm reduction strategies are effective for reducing smoking related risks (88.4%) and that abstinence from all nicotine should not be the only goal discussed with smokers with SMI (77.9%). Many respondents were unsure about the safety (56.9%) and efficacy (39.3%) of e-cigarettes. Practitioners trained in smoking cessation were more likely (OR: 2.9, CI: 1.5-5.9) to help their clients to stop smoking. Community mental health practitioners (OR: 0.3, CI: 0.1-0.9) and practitioners who were current smokers (OR: 0.3, CI: 0.1-0.9) were less likely to adhere to the 5As of smoking cessation intervention. The results of this study emphasize the importance and need for providing smoking cessation training to mental health practitioners especially community mental health practitioners.

Motivations and limitations associated with vaping among people with mental illness: a qualitative analysis of Reddit discussions

This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes.

YouTube as a source of quit smoking information for people living with mental illness

Background YouTube is the most popular video sharing website, and is increasingly used to broadcast health information including smoking cessation advice. This study examines the quality and quantity of YouTube quit smoking videos targeted at people living with mental illness (MI). Methods We systematically searched YouTube using selected relevant search terms. The first 50 videos obtained for each search term were screened for relevance and further videos screened through snowball sampling. Forty unique, English language videos focussing on people with MI were included in the assessment and evaluated for general video characteristics, themes, format, targeted smoking cessation and harm reduction information. Results Most videos either discussed the problem of high smoking rates among people with MI (n=12) or smoking cessation programmes and policies at an institutional level (n=13). Only nine videos were aimed at providing quit smoking advice to this population. One video recommended higher doses of nicotine replacement therapy (NRT) for people with MI while six videos referred to possible changes in medication dosage on quitting smoking. Four videos suggested cutting down smoking for harm reduction. Conclusions Very few YouTube videos specifically focus on the problem of high smoking rates among people with MI and even fewer provide targeted smoking cessation and harm reduction advice for this priority population. There is a need to develop comprehensive, evidence based, quit smoking video resources for smokers with a MI.

Effect of Two Herbal Mouthwashes on Gingival Health of School Children

This study aimed at determining the effect of indigenously prepared neem and mango chewing stick mouthwashes on plaque and gingival indices. A sample of 105 children aged 12-15 years was randomized into three groups, namely neem, mango, and chlorhexidine mouthwash groups. All the children were examined at baseline and gingival and plaque indices were recorded. Baseline scores for plaque and gingivitis were fair and moderate, respectively, in all the three groups and there existed no statistically significant difference among them. Ten millilitres each of herbal and chlorhexidine mouthwashes (0.2%) were administered according to the group allocation twice daily for 21 days. Indices were reassessed at 21 days (immediately after intervention) and at 1 month, 2 months, and 3 months after discontinuing the mouthwashes. Statistically significant reduction (P < 0.001) in plaque index was found in all the three mouthwash groups at 21 days and at 1 month from discontinuing the mouthwash. Chlorhexidine additionally showed statistically significant reduction in plaque index at 2 months from discontinuing the mouthwash. Statistically significant reduction (P < 0.001) in gingival index was found in all the three mouthwash groups at 21 days (immediately after discontinuing the mouthwash) and at 1 and 2 months from discontinuing the mouthwash. To conclude, all the three mouthwashes were effective antiplaque and antigingivitis agents. Chlorhexidine and neem possess equivalent efficacy in reducing plaque, while chlorhexidine has superior antigingivitis properties.

An appraisal of practice guidelines for smoking cessation in people with severe mental illness

Objective: To review the quality of current smoking cessation guidelines that include recommendations for people with severe mental illness. Methods: A systematic search of scientific databases, central government health authority websites, psychiatry peak bodies, guideline clearing houses and Google was undertaken for relevant smoking cessation guidelines. Three reviewers independently assessed guideline quality using the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) instrument. Two reviewers extracted recommendations specific to smokers with severe mental illness. Results: Thirteen guidelines met the inclusion criteria. Seven guidelines scored ⩾60% in at least four domains. Median scores for ‘Editorial independence’, ‘Rigour of development’, ‘Stakeholder Involvement’ and ‘Applicability’ were less than 60%. The highest median scores were for ‘Scope and purpose’ (87%, 69–96%) and ‘Clarity of presentation’ (87%, 56–98%). ‘Editorial independence’ (33.3%, 0–86%) and ‘Rigour of development’ (54%, 11–92%) had the lowest median domain scores. The guidelines varied greatly in their recommendations but the majority recommended nicotine replacement therapy, bupropion or varenicline as first-line pharmacotherapy, along with behavioural support. Conclusion: Many guidelines did not adequately report their methods or the competing interests of the authors. Future guidelines development may benefit from more specifically addressing AGREE II criteria and the needs of smokers with severe mental illness.

Should we encourage smokers with severe mental illness to switch to electronic cigarettes

Australian & New Zealand Journal of Psychiatry, 51(7) Although smoking rates in Australia have declined significantly in recent years, the very high smoking prevalence in patients with severe mental illness (SMI) has remained unchanged (Cooper et al., 2012). In all, 70% of patients with schizophrenia and 61% of patients with bipolar disorder smoke, compared to 16% of those without mental illness (Cooper et al., 2012). People with SMI have substantially poorer physical health and a reduced life expectancy by 15– 20 years compared to the general population. Smoking is the leading cause of this health gap. Smokers with SMI are just as motivated to quit as other smokers and most make repeated attempts to do so (Cooper et al., 2012). However, quit rates are low in this population due to a range of factors, including heavier smoking, more severe nicotine dependence, the beneficial effects of nicotine, comorbid substance use and environmental and social factors that reinforce smoking (Sharma et al., 2016). Additional approaches are urgently needed to reduce the devastating consequences to physical and mental health in those who are unable or unwilling to quit with conventional treatments. One novel option is switching to long term use of electronic cigarettes (e-cigarettes) (Sharma et al., 2016). Smokers with SMI who are unable to quit smoking could benefit from long-term substitution of combustible tobacco with ‘clean’ nicotine product such as e-cigarettes (tobacco harm reduction). E-cigarettes deliver the nicotine to which smokers are addicted without the products of combustion that cause almost all the adverse health effects of smoking (Royal College of Physicians [RCP], 2016). E-cigarette vapour contains low levels of toxins, but the Royal College of Physicians estimates the long-term risk from e-cigarette use (vaping) as likely to be no more than 5% of smoking tobacco (RCP, 2016). Similar harm reduction strategies are widely used for other harmful behaviours, such as the opiate substitution therapy and clean needle exchange to reduce risks from intravenous opiate use. E-cigarettes also have the added appeal of simulating the behavioural, sensory and social aspects of the smoking ritual. Many studies have shown that nicotine-containing e-cigarettes alleviate cravings and nicotine withdrawal symptoms and large population studies from Europe and the United Kingdom suggest that e-cigarettes are helping many smokers to quit combustible tobacco. The limited studies so far suggest that e-cigarettes can also help people with SMIs to stop or substantially reduce their smoking without serious adverse effects, even in those not ready to quit (Sharma et al., 2016). Further trials are underway to test the effectiveness of e-cigarettes in smokers with SMI. Switching completely to e-cigarettes is likely to lead to significant physical and mental health benefits, but there is also evidence that even partial substitution (dual use) may produce some health improvements. Those who reduce smoking while using e-cigarettes are more likely to quit smoking altogether in the longterm, as is the case with long-term use of nicotine replacement therapy. E-cigarettes appear to be an appealing option for smokers with SMI. Research suggests that smokers with SMI are more likely to have tried e-cigarettes and are more likely to be current users than other smokers (Cummins et al., 2014). Adherence to treatment is more likely if the products used are acceptable to patients. According to the Smoking Toolkit study (United Kingdom), e-cigarettes are now the most popular aid to quitting in the United Kingdom. The continued use of nicotine in e-cigarettes may also benefit specific illness-related deficits in SMI by augmenting the release of dopamine and several other neurotransmitters. Nicotine modestly improves Should we encourage smokers with severe mental illness to switch to electronic cigarettes?