Signs of addiction
Continued use despite harmful affects
Withdrawal symptoms urges use during abstinence
Failure of attempts to stop
Withdrawal syndrome symptoms
Nicotine craving Inc. appetite Mood change: irritable, restless Difficulty concentrating Disturbed sleep Light headed
Evidence for NRT
Individual 4x more likely to successful quit smoking with medication + behaviour support
NRT helps manage withdrawal
Types of NRT
Patches: 1ry, work well for most
Gum
Nasal/mouth sprays
Inhalators
Others: lozenges, oral strips, micro tabs
Define smokeless tobacco
NICE 2012: Any tobacco product placed in mouth/nose + not burned
NICE 3 categories of smokeless tobacco
W/ or w/o flavourants: misri Indian tobacco
W/ alkaline modifier: khaini, naswar
W/ slaked lime (alkaline modifier) + Areca nut: gutkha, zarda
- slaked lime inc. nicotine uptake
Epidemiology of smokeless tobacco
~50y
Deprived/low SES
F>M
Reasons for smokeless tobacco use
Culture - social tradition - religious significance - traditional Fresh breath Ease digestion Attractive Ease oral pain Cheap + easy to buy Nicotine addiction
Health effects of smokeless tobacco
Oral submucous fibrosis Leukoplakia Oral cancer Gum disease PLWB
PHE Smoke free + smiling recommendations
All smokers receive advice + offered support w/ referral to local stop smoking service
Commissioners of dental teaching ensure cessation training available + meets national standards
Dental teams routinely proactive in engaging tobacco users
Commissioning bodies implement appropriate measures to support above
Global prevalence of oral conditions (Global burden of disease 2010)
- UnTx caries (permanent); 35%
6: severe PD; 10%
10: unTx caries (1ry); 9%
36: severe tooth loss; 2%
Why is oral disease still major problem globally?
Failure to
- implement what is known about prevention
- understand social determinants of oral disease
Reliance on
- activities by GDP
- advice to adopt healthy behaviours, avoid unhealthy ones
Recommendations for integrating OH and NCD strategies (FDI, NCDA)
- Incl. OH in national + global NCD + SDG strategies + monitoring framework
- Integrate OH + NCD care into programmes to achieve universal health coverage
- Address common risk factors + social determinants of health
- Strengthen inter-professional education + collaboration
- Promote research into effective interventions for OH + NCD
- Adopt an OH and Health in all policies approach
Key components of health care system
Structure: how organised Functions: what it wants to achieve Target popn.: who for Personnel: who provides Funding: how funded Reimbursement: how HCP paid
Describe NHS constitution
Provide comprehensive service, available to all
Access based on clinical need not ability to pay
Highest standards of excellence + professionalism
Pt at heart of everything
Work across organisational boundaries
Provide best value for taxpayers’ money
Accountable to public, communities, pt it serves
Overview of NHS structure
Commissioners: NHSE, CCGs, Local Authorities
Providers: private, voluntary, GPs + 1ry care, trusts
Regulators: CQC, NHS Improvement
Function of health care system
Improve health status of individuals/families/communities
Defend popn. against health threats
- immunisations
Protect against financial consequences of ill-health
Provide equitable access to care
Allow people to participate in decisions re health + health system
Factors influence health care systems
PEST Political Economic Social Technological
Discuss political and economic impact on health system
Political
- inc. devolved decision making + more active participation in public services
- inc. choice + competition within health + care markets
Economic
- financial crisis: temporary economy contraction, permanent red. output
— slow recovery potentially impact health + health behaviours
Discuss social and technological impact on health care system
Social
- older popn.: >65y; different health needs, specialised HCP req.
- changing household structures; inc. lone person households
- large inc. ethnic groups + geographic variation
Technological
- dec. price inc. accessibility
- inc. digitalisation of health care
- inc. opportunities for remote/flexible working
- potential to change location of care
- may become inc. personalised
Define collaborative practice
Dynamic process when multiple health workers from different professional backgrounds work together w/ pt/family/community/carer to delivery highest quality of care
Define interprofessional practice and education
Practice: ability to share knowledge + skills among professions
- conducive to better understanding, shared values, respect
Education: students from 2/+ professions learn about, from + w/ each other to enable effective collaboration and improve health outcomes
Why should collaborative practice be adopted?
Common risk factor approach: coordinated tackling of OH can help systemic condition
OH has impact on health related QoL + wider impacts
Poor OH
- dec. academic performance
- adverse behaviour
- adverse social development
Benefits of collaborative practice
Inc. efficiency + quality in relation to delivery
Improve access + quality of service
Red. costs: avoid duplication
Improves mutual trust + accountability of HCP = better coordinated care
