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

The oral microbiome of denture wearers is influenced by natural dentition

Objectives: The composition of dental plaque has been well defined, whereas currently there is limited understanding of the composition of denture plaque and how it directly influences denture related stomatitis (DS). The aims of this study were to compare the microbiomes of denture wearers, and to understand the implications of these towards inter-kingdom and host-pathogen interactions within the oral cavity. Methods: Swab samples were obtained from 123 participants wearing either a complete or partial denture; the bacterial composition of each sample was determined using bar-coded illumina MiSeq sequencing of the bacterial hypervariable V4 region of 16S rDNA. Sequencing data processing was undertaken using QIIME, clustered in Operational Taxonomic Units (OTUs) and assigned to taxonomy. The dentures were sonicated to remove the microbial flora residing on the prosthesis, sonicate was then cultured using diagnostic colorex Candida media. Samples of unstimulated saliva were obtained and antimicrobial peptides (AMP) levels were measured by ELISA. Results: We have shown that dental and denture plaques are significantly distinct both in composition and diversity and that the oral microbiome composition of a denture wearer is variable and is influenced by the location within the mouth. Dentures and mucosa were predominantly made up of Bacilli and Actinobacteria. Moreover, the presence of natural teeth has a significant impact on the overall microbial composition, when compared to the fully edentulous. Furthermore, increasing levels of Candida spp. positively correlate with Lactobacillus spp. AMPs were quantified, though showed no specific correlations. Conclusions: This is the first study to provide a detailed understanding of the oral microbiome of denture wearers and has provided evidence that DS development is more complex than simply a candidal infection. Both fungal and bacterial kingdoms clearly play a role in defining the progression of DS, though we were unable to show a defined role for AMPs

Public Relations, Law, and Environmental Pollution

In public relations, however, the relationship is a complementary one, in which the law acts as the formulator of the rules of society and public relations serves as the interpreter of them to the people. Beyond that, public relations often can support the law by creating an atmosphere in which the law can more effectively perform its function of protecting the people and preserving the health of society. Perhaps nowhere is this more evident than in the area of air and water pollution control

Better Housing Better Health: A qualitative study of energy advice and support in Oxfordshire

The Better Housing Better Health (BHBH) service is provided by the National Energy Foundation (NEF) across Oxfordshire and other locations in the south of England. Delivering advice and support to residents to help them stay warm and healthy in their homes, the service has been running since 2013. In 2022, home visits were introduced into the service with the aim of better supporting residents and tailoring advice more closely to their needs. For this research we have conducted a set of qualitative interviews with 13 householders who have received support from BHBH and with 13 stakeholders who have been involved in the delivery of the service or worked in the wider network of support organisations in Oxfordshire. We have also referred to transcripts from BHBH delivery meetings. These provided a window on the prior development of BHBH, shed light on the challenges faced by the staff team, and helped to inform the design of the interview question guides

“It’s changed my life not to have the continual worry of being warm” – health and wellbeing impacts of a local fuel poverty programme:a mixed-methods evaluation

BACKGROUND: Living in a cold home and being fuel poor can contribute to adverse physical and mental health. Energy efficiency interventions are considered the simplest ways of tackling fuel poverty and preventing associated negative health, wellbeing, and socio-economic consequences. The overall aim of the current study was to provide a greater understanding of the impact of a locally administered programme, which funded the installation of major heating/insulation measures in areas of high fuel poverty, on the health and wellbeing of beneficiaries of the programme. METHODS: A mixed-methods approach to explore the health and wellbeing impacts of a fuel poverty programme in East Sussex that took place between October 2016 and March 2018. Beneficiaries completed the Warwick-Edinburgh Mental Wellbeing Scale before and after any heating/insulation work had been completed in their home. Beneficiaries were also asked to retrospectively rate their health pre- and post-installation. Interviews with 23 beneficiaries of the programme were conducted to explore in-depth the impact of the programme on people’s health and wellbeing and the wider social determinants of health. RESULTS: A major heating/insulation measure was installed in 149 homes. The majority of measures installed were boilers (57.7%) and new central heating systems (32.2%). Self-rated health and wellbeing were significantly higher post-installation. Interviewees described clear examples of the positive impacts on physical health and wellbeing such as fewer chest infections, reduced pain, feeling less anxious and depressed, and generally feeling happier and more relaxed. Interviews also highlighted broader areas of impact such as reduced social isolation and increased use of domestic space. Many of the beneficiaries also reported a reduction in their energy bills since their new heating systems had been installed. CONCLUSIONS: The findings from the evaluation suggest that the installation of major heating or insulation measures such as new boilers have substantial benefits for the health and wellbeing of beneficiaries. The findings also suggest that the programme had a positive impact on wider determinants of health including reduction in stress and isolation that are likely to be part of the pathways between fuel poverty interventions and mental and physical health outcomes

Marine Isotope Stage 11c in Europe:Recent advances in marine–terrestrial correlations and their implications for interglacial stratigraphy – a review

The interglacial known as MIS 11c (c. 426 000–396 000 years ago) receives intensive international interest because of its perceived role as an analogue for the current interglacial and its importance for understanding future climate change. Here we review the current understanding of the stratigraphy of this interglacial in Europe. This study considers (i) the evidence for the environmental history of this interglacial as reconstructed from the varved lake records from northern Europe, (ii) the climate history of MIS 11c as preserved in the long pollen records of southern Europe and (iii) a comparison of both of these with marine records from the North Atlantic. The result of this review is a discussion of the evidence for millennial and centennial scale climate change found in European records of MIS 11c,the patterns of warming that are seen across this interglacial and the discrepancy in aspects of the duration of this interglacial that seems to exist between the marine and terrestrial records of this warm period. A review of the recent advances in the study of MIS 11c in Europe confirms its importance for understanding both the past evolution of the Holocene and the future patterns of long-term climate change

Vermont State Colleges Reading & Technology Survey 2013

The Vermont State Colleges libraries designed this survey to provide quantitative and qualitative data about the current extent of digital reading, the strength of users’ preferences for different formats, and the relationship between reading formats and academic study. The VSC libraries intend to use these data to make their collections more responsive to users’ needs, specifically by reconsidering the balance of investment in printed books and investment in digital texts

Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial

BACKGROUND: The ESPAC-3 trial showed that adjuvant gemcitabine is the standard of care based on similar survival to and less toxicity than adjuvant 5-fluorouracil/folinic acid in patients with resected pancreatic cancer. Other clinical trials have shown better survival and tumour response with gemcitabine and capecitabine than with gemcitabine alone in advanced or metastatic pancreatic cancer. We aimed to determine the efficacy and safety of gemcitabine and capecitabine compared with gemcitabine monotherapy for resected pancreatic cancer. METHODS: We did a phase 3, two-group, open-label, multicentre, randomised clinical trial at 92 hospitals in England, Scotland, Wales, Germany, France, and Sweden. Eligible patients were aged 18 years or older and had undergone complete macroscopic resection for ductal adenocarcinoma of the pancreas (R0 or R1 resection). We randomly assigned patients (1:1) within 12 weeks of surgery to receive six cycles of either 1000 mg/m(2) gemcitabine alone administered once a week for three of every 4 weeks (one cycle) or with 1660 mg/m(2) oral capecitabine administered for 21 days followed by 7 days' rest (one cycle). Randomisation was based on a minimisation routine, and country was used as a stratification factor. The primary endpoint was overall survival, measured as the time from randomisation until death from any cause, and assessed in the intention-to-treat population. Toxicity was analysed in all patients who received trial treatment. This trial was registered with the EudraCT, number 2007-004299-38, and ISRCTN, number ISRCTN96397434. FINDINGS: Of 732 patients enrolled, 730 were included in the final analysis. Of these, 366 were randomly assigned to receive gemcitabine and 364 to gemcitabine plus capecitabine. The Independent Data and Safety Monitoring Committee requested reporting of the results after there were 458 (95%) of a target of 480 deaths. The median overall survival for patients in the gemcitabine plus capecitabine group was 28·0 months (95% CI 23·5-31·5) compared with 25·5 months (22·7-27·9) in the gemcitabine group (hazard ratio 0·82 [95% CI 0·68-0·98], p=0·032). 608 grade 3-4 adverse events were reported by 226 of 359 patients in the gemcitabine plus capecitabine group compared with 481 grade 3-4 adverse events in 196 of 366 patients in the gemcitabine group. INTERPRETATION: The adjuvant combination of gemcitabine and capecitabine should be the new standard of care following resection for pancreatic ductal adenocarcinoma

Urban agriculture:evaluating informal and formal practices

Urban agriculture (UA) is a fast-increasing element in many settlements in the Global North. This paper reviews the diversity of UA activity, ranging from legal to illegal, formal to informal. Focusing particularly on current research on UA projects in England, including small-scale guerrilla gardening and large community projects supported by community and government funding, we look at the realities of UA. We suggest that it is under-theorised as previous research has focused on practicalities and activism. In particular, we highlight the problematic contribution of UA to food production, the wider value in terms of community development, health and wellbeing, and warn of the danger of the ‘local trap’

Perceptions of contextual factors during chronic low back pain care: a modified Delphi study

This dataset contains anonymised data from a modified two-round Delphi study exploring UK musculoskeletal (MSK) practitioners’ perceptions of contextual factors (CFs) that may influence outcomes in the clinical management of chronic low back pain (cLBP). The study was conducted as part of a doctoral research project. Round 1 (n = 39) included 64 CF-related statements and open-ended questions, while Round 2 (n = 23) featured 74 refined statements rated using a 5-point Likert scale. Participants were qualified MSK practitioners (physiotherapists, chiropractors, osteopaths, or sports therapists) with a minimum of three years’ clinical experience treating cLBP. Data were collected via the JISC online surveys platform and analysed using descriptive statistics to assess group-level consensus. The dataset includes: (a) two Excel files containing anonymised participant responses for each Delphi round; (b) two corresponding coding keys explaining all variables and response categories; and (c) one README document outlining key study information. The data may support future research on chronic low back pain, contextual factors, practitioner perceptions, and Delphi consensus methods. If using or citing the dataset, please reference the associated publication: Sherriff, B., Clark, C., Killingback, C., & Newell, D. (2023). Musculoskeletal practitioners’ perceptions of contextual factors that may influence chronic low back pain outcomes: a modified Delphi study. Chiropractic & Manual Therapies, 31(1), 12. https://doi.org/10.1186/s12998-023-00482-