Linking families with pre-school children from healthcare services to community resources: a systematic review protocol

Background: Poor health and health inequalities persist despite increasing investment in health improvement programmes across high-income countries. Evidence suggests that to reduce health inequalities, a range of activities targeted at different levels within society and throughout the life course should be employed. There is a particular focus on addressing inequalities in early years as this may influence the experience of health in adulthood. To address the wider determinants of health at a community level, a key intervention which can be considered is supporting patients to access wider community resources. This can include processes such as signposting, referral and facilitation. There is a lack of evidence synthesis in relation to the most effective methods for linking individuals from health services to other services within communities, especially when considering interventions aimed at families with young children. Method/design: The aim of this study is to understand the way health services can best help parents, carers and families with pre-school children to engage with local services, groups and agencies to address their wider health and social needs. The review may inform future guidance to support families to address wider determinants of health. The study is a systematic review, and papers will be identified from the following electronic databases: Web of Science, Embase, MEDLINE and CINAHL. A grey literature search will be conducted using an internet search engine and specific grey literature databases (TRiP, EThOS and Open Grey). Reference lists/bibliographies of selected papers will be searched. Quality will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies and the CASP tool for qualitative studies. Data will be synthesised in a narrative form and weighted by study quality. Discussion: It is important to understand how health services can facilitate access to wider services for their patients to address the wider determinants of health. This may impact on the experience of health inequalities. This review focuses on how this can be achieved for families with pre-school children, and the evidence obtained will be useful for informing future guidance on this topic

Trends of oral cavity, oropharyngeal and laryngeal cancer incidence in Scotland (1975 - 2012) - a socioeconomic perspective

Aim: To examine current incidence trends (1975–2012) of oral cavity (OCC), oropharyngeal (OPC) and laryngeal cancer in Scotland by socioeconomic status (SES). Methods: We included all diagnosed cases of OCC (C00.3-C00.9, C02-C06 excluding C2.4), OPC (C01, C2.4, C09-C10, C14) and laryngeal cancer (C32) on the Scottish Cancer Registry (1975–2012) and annual midterm population estimates by age, sex, geographic region and SES indices (Carstairs 1991 and Scottish Index of Multiple Deprivation 2009). Age-standardized incidence rates were computed and adjusted Poisson regression rate-ratios (RR) compared subsites by age, sex, region, SES and year of diagnosis. Results: We found 28,217 individuals (19,755 males and 8462 females) diagnosed with head and neck cancer (HNC) over the study period. Between 1975 and 2012, relative to the least deprived areas, those living in the most deprived areas exhibited the highest RR (>double) of OCC, OPC and laryngeal cancer, and an almost dose-like response was observed between SES and HNC incidence. Between 2001 and 2012, this socioeconomic inequality tended to increase over time for OPC and laryngeal cancer but remained relatively unchanged for OCC. Incidence rates increased markedly for OPC, decreased for laryngeal cancer and remained stable for OCC, particularly in the last decade. Males exhibited significantly higher RRs compared to females, and the peak age of incidence of OPC was slightly lower than the other subsites. Conclusion: Contrary to reports that OPC exhibits an inverse socioeconomic profile, Scotland country-level data show that those from the most deprived areas consistently have the highest rates of head and neck cancers

Extending dental nurses' duties: a national survey investigating skill-mix in Scotland's child oral health improvement programme (Childsmile)

Background: Childsmile is Scotland’s national child oral health improvement programme. To support the delivery of prevention in general dental practice in keeping with clinical guidelines, Childsmile sought accreditation for extended duty training for dental nurses to deliver clinical preventive care. This approach has allowed extended duty dental nurses (EDDNs) to take on roles traditionally undertaken by general dental practitioners (GDPs). While skill-mix approaches have been found to work well in general medicine, they have not been formally evaluated in dentistry. Understanding the factors which influence nurses’ ability to fully deliver their extended roles is necessary to ensure nurses’ potential is reached and that children receive preventive care in line with clinical guidance in a cost-effective way. This paper investigates the supplementation of GDPs’ roles by EDDNs, in general dental practice across Scotland. Methods: A cross-sectional postal survey aiming to reach all EDDNs practising in general dental practice in Scotland was undertaken. The survey measured nurses’: role satisfaction, perceived utility of training, frequency, and potential behavioural mediators of, preventive delivery. Frequencies, correlations and multi-variable linear regression were used to analyse the data. Results: Seventy-three percent of practices responded with 174 eligible nurses returning questionnaires. Respondents reported a very high level of role satisfaction and the majority found their training helpful in preparing them for their extended role. While a high level of preventive delivery was reported, fluoride vanish (FV) was delivered less frequently than dietary advice (DA), or oral hygiene advice (OHA). Delivering FV more frequently was associated with higher role satisfaction (p < 0.001). Those nurses who had been practising longer reported delivering FV less frequently than those more recently qualified (p < 0.001). Perceived difficulty of delivering preventive care (skills) and motivation to do so were most strongly associated with frequency of delivery (p < 0.001 for delivery of FV, DA and OHA). Conclusions: This study has provided insight into EDDNs’ experiences and demonstrates that with appropriate training and support, EDDNs can supplement GDPs’ roles in general dental practice in Scotland. However, some barriers to delivery were identified with delivery of FV showing scope for improvement

A protocol for a systematic review of clinical guidelines and published systematic reviews on the early detection of oral cancer

Background: The predicted increase in incidence of oral cavity cancer (OCC) coupled with high mortality and poor prognosis – particularly when diagnosed at a late/advanced stage – highlights the need for prevention and early detection/screening to reverse these trends. Dental healthcare professionals in primary care settings have a pivotal role in this effort. Aim: The aim of this protocol is to detail the process for assessing the evidence for the best practice and methods of early detection/screening for OCC in primary care dental settings by undertaking a systematic review of global clinical guidelines and published systematic reviews. Method: Searches for clinical guidelines and systematic reviews will be conducted in the following databases: Cochrane library, Medical Literature Analysis and Retrieval System Online (Ovid), Excerpta Medical dataBASE, PubMed, Turning Research into Practice, SCOPUS and Web of Science Core Collection. Our search will extend to include Google Scholar and international professional organizations/associations websites. In addition, we will handsearch the bibliographies and undertake citation searches of the selected papers. Quality appraisal will be undertaken using the Appraisal of Guidelines for Research and Evaluation version II instrument for the clinical guidelines and both A MeaSurement Tool to Assess Systematic Reviews and Risk of Bias in Systematic Reviews tools for the systematic reviews. A narrative synthesis approach will be used to assess the evidence of extracted data, primarily taking account of quality appraisal and recency of publication. Discussion: The synthesis of evidence will determine best practice for OCC early detection/screening by primary care dental healthcare professionals and will evaluate the relationship between clinical guidelines and the evidence base available from systematic reviews in this area

Inequalities in the dental health needs and access to dental services among looked after children in Scotland: a population data linkage study

Background: There is limited evidence on the health needs and service access among children and young people who are looked after by the state. The aim of this study was to compare dental treatment needs and access to dental services (as an exemplar of wider health and well-being concerns) among children and young people who are looked after with the general child population. Methods: Population data linkage study utilising national datasets of social work referrals for ‘looked after’ placements, the Scottish census of children in local authority schools, and national health service’s dental health and service datasets. Results: 633 204 children in publicly funded schools in Scotland during the academic year 2011/2012, of whom 10 927 (1.7%) were known to be looked after during that or a previous year (from 2007–2008). The children in the looked after children (LAC) group were more likely to have urgent dental treatment need at 5 years of age: 23%vs10% (n=209/16533), adjusted (for age, sex and area socioeconomic deprivation) OR 2.65 (95% CI 2.30 to 3.05); were less likely to attend a dentist regularly: 51%vs63% (n=5519/388934), 0.55 (0.53 to 0.58) and more likely to have teeth extracted under general anaesthesia: 9%vs5% (n=967/30253), 1.91 (1.78 to 2.04). Conclusions: LAC are more likely to have dental treatment needs and less likely to access dental services even when accounting for sociodemographic factors. Greater efforts are required to integrate child social and healthcare for LAC and to develop preventive care pathways on entering and throughout their time in the care system

A class of Lorentzian Kac-Moody algebras

We consider a natural generalisation of the class of hyperbolic Kac-Moody algebras. We describe in detail the conditions under which these algebras are Lorentzian. We also construct their fundamental weights, and analyse whether they possess a real principal so(1,2) subalgebra. Our class of algebras include the Lorentzian Kac-Moody algebras that have recently been proposed as symmetries of M-theory and the closed bosonic string.Comment: 40 pages TeX, 5 eps-figure

Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors:definitions, trends and risk factors

Introduction Head and neck cancer appears to be increasing in incidence, with potential changes in aetiology proposed. This paper aims to provide a narrative overview of the epidemiological literature to describe the disease burden and trends in terms of incidence and mortality both in the UK and globally and to review the evidence on current risk factors. Methods A search was performed on multiple databases (PubMed and Epistemonikos), applying filters to identify systematic reviews and meta-analyses which investigated head and neck cancer incidence, mortality and risk factors. International and UK cancer registries and sources were searched for incidence and mortality data. Results Multiple definitions of head and neck cancer are employed in epidemiology. Globally, incidence rates have increased in recent decades, largely driven by oropharyngeal cancer. Mortality rates over the last decade have also started to rise, reflecting the disease incidence and static survival rates. Major risk factors include tobacco smoking alone and in combination with alcohol consumption, betel chewing (particularly in Southeast Asian populations) and the human papillomavirus in oropharyngeal cancer. Conclusions These epidemiological data can inform clinical and preventive service planning for head and neck cancer

The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland:a natural experiment

Background: Financial incentives are often used to influence professional practice, yet the factors which influence their effectiveness and their behavioural mechanisms are not fully understood. In keeping with clinical guidelines, Childsmile (Scotland’s oral health improvement programme) advocates twice yearly fluoride varnish application (FVA) for children in dental practice. To support implementation Childsmile offered dental practitioners a fee-per-item payment for varnishing 2–5-year-olds’ teeth through a pilot. In October 2011 payment was extended to all dental practitioners. This paper compares FVA pre- and post-roll-out and explores the financial incentive’s behavioural mechanisms. Methods: A natural experimental approach using a longitudinal cohort of dental practitioners (n = 1090) compared FVA pre- (time 1) and post- (time 2) financial incentive. Responses from practitioners who did not work in a Childsmile pilot practice when considering their 2–5-year-old patients (novel incentive group) were compared with all other responses (continuous incentive group). The Theoretical Domains Framework (TDF) was used to measure change in behavioural mechanisms associated with the incentive. Analysis of covariance was used to investigate FVA rates and associated behavioural mechanisms in the two groups. Results: At time 2, 709 74%, of eligible responders, were followed up. In general, FVA rates increased over time for both groups; however, the novel incentive group experienced a greater increase (β [95% CI] = 0.82 [0.72 to 0.92]) than the continuous incentive group. Despite this, only 33% of practitioners reported ‘always’ varnishing increased risk 2–5-year-olds’ teeth following introduction of the financial incentive, 19% for standard risk children. Domain scores at time 2 (adjusting for time 1) increased more for the novel incentive group (compared to the continuous incentive group) for five domains: knowledge, social/professional role and identity, beliefs about consequences, social influences and emotion. Conclusions: In this large, prospective, population-wide study, a financial incentive moderately increased FVA in dental practice. Novel longitudinal use of a validated theoretical framework to understand behavioural mechanisms suggested that financial incentives operate through complex inter-linked belief systems. While financial incentives are useful in narrowing the gap between clinical guidelines and FVA, multiple intervention approaches are required