Why are people afraid of the dentist?:Observations and explanations

Objective: The aim of this review was to explore the peer reviewed literature to answer the question: ‘Why are people afraid of the dentist?’ Method: Relevant literature was identified by searching the following on-line databases: PubMed, PsycInfo, the Cochrane Library and Google Scholar. Publications were extracted if they explored the causes and consequences of dental fear, dental anxiety or dental phobia. Results: The research evidence suggests that the causes of dental fear, dental anxiety or dental phobia are related to exogenous factors such as direct learning from traumatic experiences, vicarious learning through significant others and the media, and endogenous factors such as inheritance and personality traits. Each individual aetiological factor is supported by the evidence provided. Conclusions: The evidence suggests that the aetiology of dental fear, anxiety or phobia is complex and multifactorial. The findings show that there are clear practical implications indicated by the existing research in this area: a better understanding of dental fear, anxiety and phobia may prevent treatment avoidance.Publisher PDFPeer reviewe

Vandetanib-eluting radiopaque beads and stereotactic body radiotherapy in the treatment of liver cancers

Background: Current treatment options for unresectable hepatocellular carcinoma (HCC) and colorectal liver metastases (mCRC) include transarterial chemoembolisation (TACE) and stereotactic body radiotherapy (SBRT). The objectives of this project were: 1. To assess a novel drug-eluting bead for TACE / 2. To report on the safety and efficacy of SBRT in HCC / 3. To assess the feasibility of using radiopaque beads as fiducial markers for SBRT / Methods: In Part 1, a first-in-human trial was performed in patients with HCC and mCRC using a novel vandetanib-eluting radiopaque bead, BTG-002814. Primary trial endpoints were safety/tolerability and the concentrations of vandetanib and its major metabolite in plasma and resected tissue. Biomarker studies included blood cytokines and perfusion imaging parameters. In Part 2, the efficacy of SBRT was explored in a retrospective study of 31 patients with HCC tumours ≤5 cm and in a phase II study of 13 patients with larger tumours. In Part 3 the feasibility of using radiopaque beads as fiducial markers for SBRT was investigated. / Results: BTG-002814 was shown to have a satisfactory safety profile in 8 patients. Vandetanib was present in the plasma of all patients 12 days post-TACE, and present in resected liver tissue up to 32 days post-treatment. There were no significant changes in perfusion parameters. Blood biomarker studies showed increases in leptin, osteopontin and sTie2. SBRT offered 1-year local control rates of 94% in small HCCs and 92% in larger tumours. Radiopaque beads were visible on 4D-CT and CBCT images in all 8 cases and matching successfully performed. / Conclusions: The safety profile and pharmacokinetic characteristics for this novel technology are adequate to proceed to a Phase I/II trial. SBRT is an effective local treatment for HCC. The role of radiopaque beads as fiducial markers is feasible and warrants further exploration as a clinical trial of TACE with SBRT

Strengthening Social Interactions and Constructing New Oral Health and Health Knowledge:The Co-design, Implementation and Evaluation of A Pedagogical Workshop Program with and for Homeless Young People

Young homeless people make up nearly one-third of those experiencing homelessness. The need to provide an educative approach, to strengthen social interacting, and construct new knowledge to increase social inclusivity, is required. The aim of this qualitative exploration was to use critical consciousness as an educative tool, to co-design, implement, and evaluate a series of oral health and health pedagogical workshops to strengthen social engagement and to construct new health knowledge, with, and for, homeless young people and their service providers. An action research design permitted the simultaneous development, implementation, and evaluation of the pedagogical workshop program. A Non-Governmental Organization (NGO), providing supported accommodation for young homeless people, acted as the partner organization. Thirteen young people and five staff members from this NGO participated and co-designed eight workshops. Qualitative data collection included unstructured post-intervention interviews together with verbatim quotes from the group discussions during the workshops and from the post-workshop questionnaires. The qualitative analysis was informed by content analysis to permit the emergence of key themes from the data. The two themes were: 1. ‘trust building and collective engaging’ and 2. ‘constructing knowledge and developing skills’. Theme 1 highlighted engagement with the service provider, illustrating the transformation of the young people’s relationships, strengthening of their social interacting, and enabling their critical reflexive thinking on sensitive issues present in the homelessness trajectory. Theme 2 illustrated the young people’s ability to share, lend, and encode their new health information and convert it into an understandable and useable form. This new comprehension permitted their behavior change and social interaction. These findings provide an approach to increase young people’s knowledge, health literacy, and strengthen their social interacting to support community action

A latitudinal gradient in herbivore resistance in common sunflower, Helianthus annuus (Asteraceae)

Background and aims – The intensity of herbivory is expected to decline with increasing latitude. As herbivory varies spatially and over time, a reliable method of assessing the intensity of herbivory is to examine the degree of herbivore resistance in the plant community. Latitudinal gradients in resistance to herbivory were examined in wild populations of common sunflower, Helianthus annuus. Materials and methods – Seeds from 23 different latitudes, ranging from 20 to 44°N, were obtained from the USDA’s Germplasm Resources Information Network. Plants were grown in a greenhouse for nine weeks. At that time, the size (height, leaf length, number of leaves) and resistance of each plant to herbivory (determined through a bioassay using a generalist herbivore, Helicoverpa zea was assessed. Key results – Resistance to herbivory decreased significantly with latitude, while plant size, as indicated by height, was positively correlated with latitude and negatively correlated with both temperature and resistance to herbivory.Conclusion – Populations from lower latitudes exhibited elevated resistance to herbivory and slower growth, suggesting first, that herbivory is more intense at lower latitudes and second, that there is a tradeoff between growth and defense

Implementing the Smile4life intervention for people experiencing homelessness : a path analytical evaluation

This evaluation was part of the Smile4life programme funded by the Scottish Government (grant number: 121.80.4497).Background: People experiencing homelessness have high levels of dental decay, oral cancer and poor oral health-related quality of life. The Scottish Government sought to address these issues by developing a national oral health improvement programme for people experiencing homelessness, named Smile4life. The aim was to investigate implementation behaviours and the role of work-related beliefs upon the delivery of the Smile4life programme across NHS Board areas in Scotland. Methods: Non-probability convenience sampling, supplemented by snowball sampling, was used to recruit practitioners working across the homelessness sector. The overall evaluation of the implementation of the Smile4life programme was theoretically informed by the Behaviour Change Wheel. The questionnaire was informed by the Theoretical Domains Framework and was divided into three sections, demography and Smile4life Awareness; Smile4life Activities; and Smile4life work-related beliefs. A psychometric assessment was used to develop Smile4life Awareness, Smile4life Activities, Ability to Deliver and Positive Beliefs and Outcomes subscales. The data were subjected to K-R20, exploratory factor analysis, Cronbach’s alpha, t-tests, ANOVA, Pearson’s correlation analysis and a multivariate path analysis. Results: One hundred participants completed the questionnaire. The majority were female (79%) and worked in NHS Boards across Scotland (55%). Implementation behaviour, constructed from the Delivering Smile4life scale and the summated Smile4life activities variable, was predicted using a linear model a latent variable. The independent variables were two raw variables Positive Beliefs and Outcomes, and Ability to deliver Smile4life. Results showed relatively good model fit (chi-square (1.96; p > 0.15), SRMR (< 0.08) and R2 (0.62) values). Positive and highly significant loadings were found describing the Implementation Behaviour latent variable (0.87 and 0.56). The two independent variables were associated (p < 0.05) with Implementation Behaviour. Conclusions: Work-related factors, such as positive beliefs and outcomes and ability to deliver are required for implementation behaviours associated with the delivery of the Smile4life programme. Future work should include training centred on the specific needs of those involved in the homelessness sector and the development of accessible training resources, thereby promoting implementation behaviours to assist the progression and sustainability of the Smile4life programme.Publisher PDFPeer reviewe

Promoting inclusion oral-health:social interventions to reduce oral health inequities

The aim of this collection of papers is to provide the reader with a cogent understanding of the role of evidence in the development of social or community-based interventions to promote inclusion oral-health and reduce oral health, health, and psychosocial inequities. In addition, this material will include various methods used for their implementation and evaluation. At the outset, the reader will be offered a working definition of inclusion oral-health, which will be modelled on the work of Luchenski et al. [1]. The interventions described are theoretically underpinned by a pluralistic definition of evidence-based practice [2] and the radical discourse of health promotion as postulated by Laverack and Labonte [3] and others [4,5]. This Special Issue will consist of eight papers, including an introduction. The first three papers will examine the various sources of evidence used to transform top-down into bottom-up community-based interventions for people experiencing homelessness; people in custody and for families residing in areas of high social deprivation. The final four papers will report on the implementation and evaluation of social or community-based interventions. This collection of research papers will highlight the importance of focusing on prevention and the adoption of a common risk factor agenda to tackle oral health, health and psychosocial inequities felt by those most excluded in our societies

Exploring the engagement behaviours of Smile4life practitioners:lessons from an evaluation of the national oral health improvement programme for people experiencing homelessness in Scotland

Introduction: Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness, aimed at reducing oral health inequalities experienced by this population. This study forms part of an evaluation of how the Smile4life intervention was being implemented within Scottish NHS Boards. The aim was to investigate the influence of the Smile4life intervention upon the engagement behaviours of Smile4life practitioners.Methods: Focus groups were conducted with Smile4life practitioners, to provide an insight into how the Smile4life intervention affected their skills, attitudes and experiences while interacting with people experiencing homelessness and their services providers. A purposive sample of oral health practitioners, including dental health support workers, oral health promoters/educators, and oral health improvement coordinators working in three NHS Boards were invited to take part. One focus group was conducted in each of the three NHS Boards. The focus groups were audio-recorded and transcribed. The COM-B model of behaviour was used as a framework for analysis.Results: Eleven Smile4life practitioners took part in the focus groups. All had first-hand experience of working with the Smile4life intervention. The average focus group length was 67 min. Working on the Smile4life intervention provided the Smile4life practitioners with: (i) the capability (physical and psychological), (ii) the opportunity (to establish methods of communication and relationships with service providers and service users) and (iii) the motivation to engage with Third Sector homelessness services and service users, by reflecting upon their positive and negative experiences delivering the intervention. Enablers and barriers to this engagement were identified according to each of the COM-B categories. Enablers included: practitioners' sense of responsibility, reflecting on positive past experiences and success stories with service users. Barriers included: lack of resources, negative past experiences and poor relationships between Smile4life practitioners and Third Sector staff.Conclusion: The Smile4life programme promoted capability, provided opportunities and increased motivation in those practitioners who cross disciplinary boundaries to implement the Smile4life intervention, which can be conceptualised as “boundary spanning”. Practitioners who were found to be boundary spanners often had a positive mindset and proactive attitude towards the creation of strategies to overcome the challenges of implementation by bridging the gaps between the NHS and the Third Sector, and between oral health and homelessness, operating across differing fields to achieve their aims