Community service doctors in Limpopo province.
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Adult↗
Biomedical subjects
M J Rudolph
Publications and source records attributed to M J Rudolph.
Informed consent in oral health care.
BACKGROUND: Informed consent and autonomy are the major ethical principles that define the relationship between health workers and the patient. A patient should be given adequate information on the risks and benefits of treatment to be undertaken and also alternative treatment options. OBJECTIVES: To investigate what and how much information dental patients perceived to had been given by oral health workers about treatment, benefits, risks and management alternatives in order to take decisions and give informed consent about their treatment. DESIGN: Cross sectional descriptive survey. SETTING: The study was conducted at Ann Latsky Nursing College, Johannesburg. SUBJECTS: The sample size consisted of 173 student nurses in their first, second and third years of training. Only students who had treatment in the previous three years were included in the study. RESULTS: The majority of the students were treated in the private sector (85.0%) by male oral health workers (61.6%) and dentists (89.5%) as opposed to dental therapists or oral hygienists. The study indicated that the majority of the respondents (75.6%) were given information about the treatment to be undertaken. The information appeared to have pertained to costs, pain, chances of success and duration of treatment. One hundred (74.07%) gave verbal consent and (16.30%) gave both verbal and written consent. Only 37.79% of the respondents were told of alternative options available, 47.17% of the benefits, and 38.6% of the risks of treatment. CONCLUSION: These findings have ethical implications for oral health workers. There is an urgent need to sensitise oral health workers on the specifics of informed consent.
Adolescent↗
Dental caries in six, 12 and 15 year old Venda children in South Africa.
BACKGROUND: Oral diseases is still a major problem in most developing countries. Within the Republic of South Africa, there remains areas where few or no studies have been done on the oral health status. The emerging district health system with decentralisation of health services to address past inequity in health care in South Africa also provides compelling case for data collection at regional levels. OBJECTIVES: To assess the prevalence and severity of dental caries of school children; determine the caries patterns of the study population and to provide useful data for the planning of oral health services in this region. DESIGN: Descriptive analytical study. SETTING: School children in the Donald Fraser Health District, Venda in the Northern province, Republic of South Africa. SUBJECTS/METHODS: A total of 519 school children in the age groups 6, 12 and 15 years were examined by a calibrated examiner for dental caries using WHO diagnostic criteria. Both the schools, which were divided into rural and peri-urban locations and the children that participated were randomly selected. RESULTS: A mean dmft(sd) of 2.68(3.29) in six year olds and a mean DMFT (sd) scores of 0.61(1.50) and 1.26 (2.18) were recorded in the 12 and 15 year olds respectively. In the six year olds the upper anterior teeth showed highest susceptibility to caries, clearly indicating that black children suffer from early infant caries. At ages of 12 and 15 the mandibular molars were the teeth most affected. The decayed component constituted the main part of the dmft and DMFT scores. Ninety-nine percent of these lesions were untreated and the restorative care was almost nil. CONCLUSION: An important finding was the doubling of the mean DMFT from the 12-year-olds to 15-year olds and the caries levels for all age groups was higher than the provincial average. The treatment required were mostly extractions and simple fillings, the majority of which could be managed by dental auxiliaries using the Atraumatic Restorative Treatment Technique. This study indicates that preventive oral health measures should be implemented on the younger age groups in order to control dental caries.
Adolescent↗
Oral health knowledge and original practices of African traditional healers in Zonkizizwe and Dube, South Africa.
Self reported oral health knowledge and practices of 83 traditional healers in Zonkizizwe (56) and Dube (27) Gauteng Province, South Africa were carried out using a questionnaire and clinical photographs of common oral conditions. The mean age for the total group was 49.5 with 35 males and 48 females. Although only 17 of the healers were members of a professional association, many indicated their willingness to join one. 40 (71%) of healers in Zonkizizwe kept written client records but far fewer 3 (11%) did so in Dube. More than 90% of traditional healers from both areas correctly identified photographs of gingival inflammation, dental caries and oral candidiasis. Over 50% of healers from both areas had patients who presented with mouth problems. Ninety percent of healers in Zonkizizwe referred patients to the formal health care sector but less than 50% in Dube did so. A vast majority of healers gave oral health advice to their patients, many of whom gave specific tooth brush instruction. The study provides an initial understanding of the practices of healers regarding oral health.
Adolescent↗
Minimal intervention dentistry (MI) for South Africa.
The intention of Minimal Intervention Dentistry (MI) is to preserve as much tooth tissue as possible and to offer less threatening care to fearful patients. MI is based on a new understanding of cariology and the therapeutic value of biomimetic materials such as Glass lonomers. It has particular relevance to a new caries classification and employs treatment concepts such as selective caries removal and sealed restorations. The MI approach is appropriate for the vast majority of the population in South Africa; it addresses the public fear of dental treatment. It can be an effective private practice builder and is thus applicable to private and public services.
Biomimetic Materials↗
Undergraduate training in the atraumatic restorative treatment (ART) approach--an activity report.
The Division of Public Oral Health at the University of the Witwatersrand conducted a 2-week ART training course for 5th year dental students in the School of Oral Health Sciences. Students were taught both theoretical knowledge and clinical skills in ART. Course evaluation showed that the course achieved its aims and objectives and was considered a worthwhile experience by students. However, there were some limitations to the format of the programme. We recommend that ART should be integrated as part of clinical student training in the BDS curriculum.
Adolescent↗
Policies and protocols for preventing transmission of HIV infection in oral health care in South Africa.
Human immunodeficiency virus (HIV) infection constitutes an unparalleled public health challenge. The unique nature of most oral health procedures, instrumentation and patient-care settings requires specific strategies and protocols aimed at preventing the transmission of HIV/AIDS between oral health care providers and patients, as well as between patients themselves. The present study investigated the level of information and training about protocols and policies for preventing the transmission of HIV/AIDS in oral health care settings in South Africa. The data collection techniques utilised available information, in-depth interviews and an open-ended questionnaire. The respondents were 20 purposively selected key informants who were senior officers for HIV/AIDS programmes and/or oral health organisations. Sixteen (80%) of the respondents reported that there were no existing oral health policies on HIV/AIDS in their health care institutions or organisations. None of the interviewees knew of any specific protocols on HIV/AIDS in the oral health care setting that emanated from South Africa. In addition, none of the dental professional associations had established an infection control committee or a support system for members who might become infected with HIV and develop AIDS. Territorial boundaries existed between sectors within the medical disciplines, as well as between the medical and oral health disciplines. Numerous general impediments were identified, such as prejudice, denial and fear, inadequate training and/or information about the infection, lack of representation and resources for policy planning, a lack of interest from the business sector, and approaching HIV/AIDS in the workplace as a 'one-time issue' Other obstacles identified included unemployment, poverty, illiteracy, disempowerment of women and inadequate communication of policies to service providers. Additional issues raised included the migrant labour systeM, complexities of language and culture, the large unstructured sex industry, high prevalence of sexually transmitted infections and lack of funding. All of these have an impact on oral health. Future policy directions identified included 'increasing access to HIV information and postexposure prophylaxis' 'shift towards care and support for those living with HIV/AIDS with emphasis on community and home-based care' and 'improving intersectoral co-ordination and collaboration'. The study demonstrated gaps in availability and access to policies and protocols on HIV/AIDS by managers and health workers. Specific strategic recommendations are made for oral health.
Clinical Competence↗
Structure-based design, synthesis and SAR of a novel series of thiopheneamidine urokinase plasminogen activator inhibitors.
The serine protease urokinase plasminogen activator (uPA) is thought to play a central role in tumor metastasis and angiogenesis. Molecular modeling studies suggest that 5-thiomethylthiopheneamidine inhibits uPA by binding at the S1 pocket of the active site. Further structure based elaboration of this residue resulted in a novel class of potent and selective inhibitors of uPA.
Antimetabolites↗
Synthesis of thiophene-2-carboxamidines containing 2-aminothiazoles and their biological evaluation as urokinase inhibitors.
The serine protease urokinase (uPa) has been implicated in the progression of both breast and prostate cancer. Utilizing structure based design, the synthesis of a series of substituted 4-[2-amino-1,3-thiazolyl]-thiophene-2-carboxamidines is described. Further optimization of this series by substitution of the terminal amine yielded urokinase inhibitors with excellent activities.
Amidines↗
Crystal structure of molybdopterin synthase and its evolutionary relationship to ubiquitin activation.
Molybdenum cofactor (Moco) biosynthesis is an evolutionarily conserved pathway present in eubacteria, archaea and eukaryotes, including humans. Genetic deficiencies of enzymes involved in Moco biosynthesis in humans lead to a severe and usually fatal disease. Moco contains a tricyclic pyranopterin, termed molybdopterin (MPT), that bears the cis-dithiolene group responsible for molybdenum ligation. The dithiolene group of MPT is generated by MPT synthase, which consists of a large and small subunits. The 1.45 A resolution crystal structure of MPT synthase reveals a heterotetrameric protein in which the C-terminus of each small subunit is inserted into a large subunit to form the active site. In the activated form of the enzyme this C-terminus is present as a thiocarboxylate. In the structure of a covalent complex of MPT synthase, an isopeptide bond is present between the C-terminus of the small subunit and a Lys side chain in the large subunit. The strong structural similarity between the small subunit of MPT synthase and ubiquitin provides evidence for the evolutionary antecedence of the Moco biosynthetic pathway to the ubiquitin dependent protein degradation pathway.
Amino Acid Sequence↗
DNA-binding by Ig-fold proteins.
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Amino Acid Motifs↗
Implementation of the ART approach in South Africa: an activity report.
The Atraumatic Restorative Treatment (ART) approach has been adopted in public dental services in South Africa as an appropriate and economical means to provide basic restorative care in communities where it was not possible before. The approach also offers a less-traumatic treatment concept for fearful patients and children in the private dental practice. In 2000, the Division of Community Dentistry, University of the Witwatersrand, implemented a training, research and service programme in the ART approach. The aim of these activities was the promotion of ART at various levels within the oral health care system in the Republic of South Africa. The objectives of the programme were to initiate and provide training of oral health workers in ART, to evaluate the outcome of training and service programmes and to disseminate results. This paper describes the Division's ART activities in 2000, regarding public, private and refugee health services.
Adult↗
Clinical evaluation of the ART approach and materials in peri-urban farm schools of the Johannesburg area.
In this study, 1,325 school children from 7 farm schools were examined. Their mean age (+/- SD) was 10.5 +/- 3.0 (range 6-11) years. At baseline, the mean DMFT score was 1.1 +/- 1.7 and 36.4% of the children had caries. The prevalence of fluorosis among the children was 12.6%. Curative treatment was offered to all the children. A total of 113 children (8.5%) with one-surface cavities on permanent teeth and without fluorosis were treated using the atraumatic restorative treatment (ART) approach. A total number of 163 cavities were included in the study, of which 82 were treated with Fuji IX glass-ionomer cement and 81 with Ketac-MOLAR (hand mix). One year after treatment, restoration and sealant parts of ART fillings were examined. Caries status was also determined. The placing of the ART fillings and their evaluation were performed by different practitioners. A total number of 108 restorations (58 with Fuji IX, 50 with Ketac-MOLAR) were evaluated. Results of ART fillings showed a survival rate of 93.1% with Fuji and 94.0% with Ketac-MOLAR. Retention of the sealant parts of ART fillings was observed in 81% of restorations with Fuji IX and 76% with Ketac-MOLAR, not connected to the filled cavity. Caries was absent on all teeth restored with Fuji IX and noted in only one tooth restored with Ketac-MOLAR, not connected to the filled cavity. The retention rate after a 12-month period was acceptable and ART approach proved to be an appropriate technique for restoring teeth in this population group. There were no statistically significant differences between the survival rates of the two glass-ionomer restorative materials (P > 0.05).
Child↗
Oral health status in an institutionalised elderly Jewish population.
The oral health status and treatment needs of 95 institutionalised elderly Jewish persons were determined. The mean DMFT was 23.4, with the M component increasing with age. Untreated carious lesions were identified in men and women of all ages. A relatively small percentage (10.5%) of subjects were affected by root caries. In 75% of cases of identified periodontal disease, the condition presented as bleeding or calculus. All subjects were in need of oral hygiene instruction and 64 (67.3%) required scaling and root planing. Complex treatment formed only a small percentage of the overall treatment needs. A low prevalence of temporomandibular joint problems, denture stomatitis and angular cheilitis was noted. A relatively high prevalence of untreated oral disease of low severity was observed, indicating the need for a comprehensive form of preventive and basic oral care.
Age Factors↗
Managed health care and dentists in the Gauteng province.
Managed health care (MHC) has emerged in South Africa as an alternative system to control the cost of health care. Fears, negative perceptions and much uncertainty have surrounded this issue since its introduction in South Africa. The purpose of this study was to assess the understanding, perceptions and opinions of dentists residing in the Gauteng province about the emergence, benefits, impact, and future of MHC in South Africa. Eighty-six dentists (21.5%) out of the sample population of 400 responded to the questionnaire. The majority (66.7%) of the respondents perceived MHC to be a threat to their practices, with most feeling that MHC will interfere with the doctor-patient relationship. Forty-two per cent of the respondents were of the opinion that MHC will not succeed in South Africa. The results suggest that this sample of dentists do not consider MHC to be an alternative to the existing fee-for-service system. The introduction of MHC in South Africa is mostly based on models used in the USA, which might not be appropriate in the unique South African environment.
Adult↗
The impact of the ART approach on the treatment profile in a mobile dental system (MDS) in South Africa.
The changing profile of oral care rendered through the Mobile Dental System (MDS), after the introduction of the Atraumatic Restorative Treatment (ART) approach is described. During the first year of introduction of ART, the percentages of amalgam restorations and tooth extractions decreased significantly (P < 0.0001). This is partly ascribed to a change in choice of treatment by dental operators in favour of ART and also due to an increase in acceptance by patients because of the reduced fear, and the patient-friendly nature of the ART approach. The reduction in amalgam restorations was 16.0 per cent for permanent and 1.4 per cent for primary posterior teeth. Extraction of posterior teeth was reduced by 17.4 per cent in the permanent and 35.7 per cent in the primary dentitions. The restorative component of oral care increased by 33.4 per cent in the permanent and 37.1 per cent in primary posterior teeth. The one-year survival of one-surface ART restorations using Fuji IX and KetacMolar was 93.6 per cent. Full and partial (more than 90 per cent) retention of the sealant part of the ART restoration was obtained in 75 per cent of the cases after one-year. During the one-year period, infection control was made more simple and this facilitated easier maintenance of mobile dental equipment. The introduction of the ART approach reduced extraction, restored more teeth and made oral care in the MDS more preventive, less threatening and thus more patient-friendly.
Child↗
An oral health promotion module for the primary health care nursing course in Acornhoek, South Africa.
The severe personnel shortage in the health professions in most developing communities is well documented. This dearth of health workers and the widespread adoption of the primary health care approach (PHCA), requires that health professionals be trained to understand and effectively utilize the skills offered by other disciplines in the health care field. Nurses are expected to play active roles in the promotion of health including oral health, particularly in the rural under-served communities. There is a paucity of oral health education in nursing curricula. This article describes a 4-day module on oral health promotion developed and delivered to 36 nurses as part of a 12-month primary health care nursing (PHCN) training course. The module utilized a variety of educational methods and materials to facilitate and encourage both individual and group learning. The module was evaluated using both student academic attainment and perceptions as outcome measures. The evaluation and the experience of facilitating this module show that an oral health promotion module of short duration can sensitize nurses to the importance of oral health and increase oral health knowledge and skills.
Curriculum↗
Oral health among Liberian refugees in Ghana.
OBJECTIVE: To promote community involvement in the provision of oral health services. DESIGN: The project consisted of a four-week training course in oral health for selected refugees, an oral health survey based on WHO guidelines and conducted by the refugees themselves and the provision of oral health care services to the community by the trained refugees. SETTING: Liberian refugee camp, Gomoa Buduburam in Ghana. SUBJECTS: Liberian refugees of all ages. INTERVENTIONS: Twelve refugees were given short term training in oral health. In the oral health survey, 196 refugees were clinically examined for dental caries, periodontal disease and malocclusion. MAIN OUTCOME MEASURES: DMFT (for dental caries), CPITN (for periodontal disease), and malocclusion scores for selected subjects. Also clinical services rendered. RESULTS: Oral health survey revealed a mean age (+/- SD) of 25.7 (+/- 9.5) years. Only thirty nine (19.9%) of the subjects were caries-free, and total DMFT was 2.5 +/- 2.2. Based on the CPITN, 107 (54.6%) required oral hygiene instructions (OHI), and 41 (20.9%) required prophylactic scaling with OHI. Forty four (22.5%) of the subjects had normal occlusion and 152 (77.5%) mild to severe malocclusion. Periodontal (75.5%), prosthetic (52.5%) interventions and extractions (34.2%) constituted the bulk of the treatment needs required. Clinical treatment was rendered by the trained refugees to 846 patients over a twelve month period. CONCLUSION: Relief programmes for refugees should emphasise a primary health care approach, focusing on prevention, based on appropriate technology, and promoting involvement by the refugee community in the provision of services.
Adolescent↗