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

The equity implications of an expanded health and wellbeing role for housing associations

Objectives: in light of the acknowledged relationship between housing circumstances and health outcomes, the research explored the implications of the diversifying role of housing associations, considering the extent and form of engagement with the health sector and the potential repercussions for inequalities. Study design: the research was based on a single case study of the Manchester city-region, chosen to provide a way of considering the role of recently agreed devolved governance and funding arrangements in respect of housing and health. Methods: primary qualitative data were assembled via a programme of semi-structured interviews with housing and health policy actors and direct observation of six quarterly meetings of a housing-health steering group established as part of new devolved governance arrangements. Results: the findings reveal a perception among housing managers that the reorientation of housing association services to offset the rationalisation of mainstream provision risks exacerbating inequalities. Interview and observational data suggest that the diversification of housing association activity may have begun to erode the sector's ability and willingness to provide affordable housing on a universal basis to those in need. Conclusions: The growing non-landlord functions of some housing associations can act as a deterrent to the allocation of housing to applicants with complex (and expensive) needs. This reinforces the increased selectivity in housing association stock allocations, linked to marketization and the increasingly commercial outlook of some providers. Further inequalities may be engendered because while tenants can benefit from the extended housing associations services, others continue to depend on a weakened statutory sector

The role of temporary use in urban regeneration : ordinary and extraordinary approaches in Bristol and Liverpool

This paper attempts to extend research on the temporary reuse of brownfield land through an examination of its role in regeneration strategies. The analysis draws upon empirical experience in two case study areas: one, Bristol’s Temple Quarter where regeneration policy has tried purposely to promote temporary use, and the other, Liverpool’s Creative Quarter, where policy has attempted retrospectively to capitalise upon ‘meanwhile’ development. Drawing on interviews with key regeneration and development actors, the paper demonstrates that regeneration strategies in different local economic contexts are poorly attuned to the needs of temporary users, who assume disproportionate levels of risk

Stakeholder mobilisation and sports stadium regeneration: antecedent factors underpinning the formation of the Our Tottenham community network

Research question: Within sport management, there is a lack of empirical research on the reasons why stakeholders mobilise. This article identifies four antecedent factors underpinning the formation of the Our Tottenham community network: a network formed by community groups in Tottenham to challenge, inter-alia, the stadium-led regeneration scheme. Research methods: The research draws on a longitudinal, qualitative case study, involving interviews, participant observation of community meetings, and analysis of documents. Results and Findings: Four factors underpinned the development of the Our Tottenham community network. The erosion of local democracy and the violation of reciprocity are categorised as reactive forces, in which mobilisation occurred as a response to the behaviour of the Council and the football club. Protecting community interests and increasing salience were driven more by the needs of the community and are categorised as proactive forces underpinning mobilisation. Implications: In the context of this case study, we argue that mobilising efforts occurred due to the presence of both reactive and proactive forces. This helped the Our Tottenham network to build a salient stakeholder coalition. The findings also suggest that focal organisations need to recognise how their behaviour can create the antecedent conditions for stakeholder mobilisation and put in place structures that enable community stakeholders to have a voice during stadium-led regeneration

Epidemiology of basal and cutaneous squamous cell carcinoma in the U.K. 2013–15:a cohort study

BACKGROUND: Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), together known as keratinocyte cancers (KCs), are the commonest cancer in white ethnic populations. Recent improvements to registry data collection in England has allowed more accurate analysis of the epidemiology of BCC and cSCC and for the first time we are able to provide an accurate (representative) tumour burden for KC in the U.K. OBJECTIVES: To estimate the incidence of BCC and cSCC in the U.K. METHODS: A cohort of patients with KCs between 2013 and 2015 were identified using linkage to diagnostic codes derived from pathology reports collected into the national cancer registry. Data from England's cancer registry were combined with data from Scotland, Northern Ireland and Wales. European age-standardized incidence rates (EASRs) of the first BCC and cSCC per patient per annum (PPPA) were calculated. RESULTS: In the U.K, the EASR of the first BCC and cSCC PPPA in 2013-15 were 285 and 77 per 100 000 person years, respectively (211 120 KCs total in 2015). The mean annual percentage increase was 5% between 2013 and 2015 for both BCC and cSCC. By counting the first KC PPPA, we include an additional 51% KCs compared with the previous reporting technique which counts only the first BCC and cSCC in a patient's lifetime, yet it represents a probable underestimation of 5-11% of the true tumour count. CONCLUSIONS: Based on an improved methodology, a more representative incidence of KC is presented, which is essential to healthcare planning and will lead to improved understanding of the epidemiology of KC. What's already known about this topic? Keratinocyte cancers (KCs) are the most common cancers affecting white ethnic populations. The incidence of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) is increasing worldwide including the U.K., most commonly in elderly male Caucasian patients. These cancers are traditionally substantially underreported and frequently excluded from national cancer statistics. What does this study add? Using improved data collection methods in England and validated tumour-reporting techniques, we report the most accurate BCC and cSCC incidence data for the U.K. ever published. Identifying the first BCC and cSCC per patient per annum, the incidence of BCC and cSCC in the U.K. (excluding Wales) was 285 and 77 per 100 000 person years, respectively, between 2013 and 2015, with more than 210 000 KCs in the U.K. in 2015

Audiovisual time perception is spatially specific

Our sensory systems face a daily barrage of auditory and visual signals whose arrival times form a wide range of audiovisual asynchronies. These temporal relationships constitute an important metric for the nervous system when surmising which signals originate from common external events. Internal consistency is known to be aided by sensory adaptation: repeated exposure to consistent asynchrony brings perceived arrival times closer to simultaneity. However, given the diverse nature of our audiovisual environment, functionally useful adaptation would need to be constrained to signals that were generated together. In the current study, we investigate the role of two potential constraining factors: spatial and contextual correspondence. By employing an experimental design that allows independent control of both factors, we show that observers are able to simultaneously adapt to two opposing temporal relationships, provided they are segregated in space. No such recalibration was observed when spatial segregation was replaced by contextual stimulus features (in this case, pitch and spatial frequency). These effects provide support for dedicated asynchrony mechanisms that interact with spatially selective mechanisms early in visual and auditory sensory pathways