Delivering smoking cessation interventions in NHS primary dental care - lessons from the ENHANCE-D trial.

Introduction Smoking is a major contributor to health inequalities in the UK. The ENHANCE-D trial is evaluating three smoking cessation interventions (nicotine replacement therapy [NRT], electronic cigarettes [ECs] or 'very brief advice') delivered in NHS primary dental care. This qualitative study aimed to provide insight into the factors that could influence the adoption of the interventions in these settings.Methods Interviews were conducted at two timepoints. Purposive maximum variation sampling was used to recruit and interview a total of 24 dental patients, 12 dental professionals and three NHS dental commissioners. Thematic analysis was carried out using normalisation process theory as an analytical framework.Results Dental settings were perceived as an appropriate location to deliver smoking cessation interventions. Patients had several motivating and demotivating factors regarding use of NRTs or ECs; they often had negative preconceptions. Financial considerations were major influencers for both patients and dental teams. The time pressures for dental practices were identified as a major barrier. Some practical issues, such as procurement and stock supply, would need to be considered if the ENHANCE-D interventions were to be implemented in routine practice.Conclusion Primary dental care teams are well-placed to deliver smoking cessation interventions. However, a number of facilitators and deterrents have been identified and strategic changes are needed for successful implementation.

Nicotine pouches: a review for the dental team.

Nicotine pouches are tobacco-free products that are becoming increasingly popular in the UK. They are held between the user's lip and gum to provide a source of nicotine. This article describes the composition of nicotine pouches, the legality surrounding their production and sale, patterns of use and explores possible oral and general health effects of their usage.

Perceptions and attitudes around perinatal mental health in Bangladesh, India and Pakistan: a systematic review of qualitative data.

BACKGROUND: Perinatal mental health (PMH) is a worldwide public health issue crossing cultural boundaries. However, the prevalence of PMH conditions vary considerably. These disparities stem in part from poor understanding and stigma surrounding PMH which hinder pregnant women from seeking mental health care and may exacerbate their conditions. Bangladesh, India and Pakistan are South Asian countries with a higher burden of PMH conditions than in the Global North-West and very different social and cultural norms around gender and mental health. The aim of this systematic review (PROSPERO Ref: CRD42020167903) was to identify, synthesise and appraise the available literature on perceptions and attitudes of perinatal (pregnant and postpartum) women, their families and healthcare providers surrounding PMH in Bangladesh, India and Pakistan. METHODS: Five electronic databases, MEDLINE, Embase, PsycINFO, Scopus and Web of science, and grey literature were searched using predefined search terms. Qualitative or quantitative articles with a qualitative component reporting perceptions and attitudes surrounding PMH in Bangladesh, India and Pakistan were eligible for inclusion, if published in English between January 2000 and January 2021. The Critical Appraisal Skills Programme Qualitative Research Checklist and Newcastle-Ottawa Scale for cross-sectional studies were used to assess study quality. Findings were synthesised using thematic synthesis, as described by Thomas and Harden 2008. RESULTS: Eight studies were included. Five overarching themes comprising 17 sub-categories were identified. These descriptive themes were: perceived causes of PMH, perceived symptoms of PMH, perceptions of motherhood, accessing PMH care and emotional sharing and coping strategies. Sociocultural expectations underpin many of the themes identified in this review including the importance of familial and societal causes of PMH, emphasis on physical symptoms, sacredness of motherhood, lack of awareness, stigma, shame, limited resources allocated for mental health and lack of emotional sharing. CONCLUSIONS: There is a complex range of perceptions and attitudes around PMH which influence women's experiences and access to PMH care. These findings will inform policy and practice through targeted interventions to tackle stigmatising attitudes and increasing education and training for healthcare providers.

Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis.

BACKGROUND: Pregnancy is a time of major psychological changes making pregnant women more susceptible to depression and anxiety. Prevalence is higher among women living in Bangladesh, India and Pakistan, compared to high-income countries, due to poor understanding and lack of mental health integration within antenatal care. Antenatal depression/anxiety is associated with adverse outcomes including postnatal depression, low birth weight and impaired fetal development. Existing systematic reviews provided only limited information on the social determinants of antenatal depression/anxiety in these South Asian countries. OBJECTIVE: This review aimed to identify, synthesise and appraise the evidence on the social determinants associated with antenatal depression and anxiety in women living in Bangladesh, India and Pakistan. METHODS: We searched five databases (MEDLINE, Embase, PsycINFO, Scopus, Web of Science) and PROSPERO. Observational studies published between 1st January 2000 and 4th January 2021 were included if they were in the English language, used validated tools for measuring depression/anxiety in pregnant women and reported statistical associations or raw numbers. Summary estimates were obtained using random-effects model. Heterogeneity and publication bias was measured using the I2 statistic and Egger's test, respectively. This review was registered on PROSPERO (reference: CRD42020167903). RESULTS: We included 34 studies (with 27,379 women). Meta-analysis of Adjusted Odds Ratios (AOR) found that Intimate partner violence (AOR 2.48, 95% CI 1.41-4.33), unplanned pregnancy (AOR 1.53, 95% CI 1.28-1.83), male gender preference (AOR 3.06, 95% CI 1.40-6.72) and poor relationship with in-laws (AOR 2.69, 95% CI 1.25-5.80) were significantly associated with antenatal depression/anxiety. CONCLUSION: The review identified a complex range of social determinants of antenatal depression and anxiety in Bangladesh, India and Pakistan. Screening tools to identify pregnant women at high risk should be integrated within antenatal care to prevent adverse outcomes. Knowledge of these social determinants will inform the development of such screening tools and interventions.