The competent sentinel node: an association with an axillary presentation and an occult or a small primary invasive breast carcinoma

The concept of the sentinel node describes a primary or sentinel lymph node (SLN), which exists and through which tumour cells from a primary tumour in a particular location must first travel to spread to a particular regional lymph node group. In this series we present three patients presenting with a pathological axillary node associated with either an occult or very small primary breast cancer. In each case the primary tumour was found to have metastasised to the palpable node, however despite the significant enlargement of this node, no other axillary nodes were found to be affected on axillary node clearance. This has led us to postulate that the SLN in some cases contains unique characteristics that enable it to prevent further spread of the tumour up the lymphatic chain. Hence the term the competent sentinel node

Co‐production of health and social science research with vulnerable children and young people: A rapid review

Background The term ‘care-experienced’ refers to anyone who is currently in care or has been in care at any stage in their life. A complex interplay of factors leads to care-experienced children and young people (CECYP) experiencing poorer oral health and access to dental care than their peers. A rapid review of the co-production of health and social care research with vulnerable children and young people (CYP) was carried out to inform the development of a co-produced research project exploring the oral health behaviours and access to dental services of CECYP. Here, ‘co-production’ refers to the involvement of CYP in the planning or conduct of research with explicit roles in which they generate ideas, evidence and research outputs. Aim To learn how to meaningfully involve vulnerable CYP in the co-production of health and social science research. Objectives To identify: Different approaches to facilitating the engagement of vulnerable CYP in co-production of health and social science research; different activities carried out in such approaches, challenges to engaging vulnerable CYP in co-production of health and social science research and ways to overcome them and areas of best practice in relation to research co-production with vulnerable CYP. Search Strategy A rapid review of peer-reviewed articles was conducted in six databases (MEDLINE, Embase, SocINDEX, CINAHL, PsycINFO and Web of Science) and grey literature to identify studies that engaged vulnerable CYP in co-approaches to health and social research. Main Results Of 1394 documents identified in the search, 40 were included and analysed. A number of different approaches to co-production were used in the studies. The CYP was involved in a range of activities, chiefly the development of data collection tools, data collection and dissemination. Individual challenges for CYP and researchers, practical and institutional factors and ethical considerations impacted the success of co-production. Discussion and Conclusion Co-production of health and social science with vulnerable CYP presents challenges to researchers and CYP calling for all to demonstrate reflexivity and awareness of biases, strengths and limitations. Used appropriately and well, co-production offers benefits to researchers and CYP and can contribute to research that reflects the needs of vulnerable CYP. Adherence to the key principles of inclusion, safeguarding, respect and well-being facilitates this approach. Patient and Public Contribution Members of our patient and public involvement and stakeholder groups contributed to the interpretation of the review findings. This manuscript was written together with a young care leaver, Skye Boswell, who is one of the authors. She contributed to the preparation of the manuscript, reviewing the findings and their interpretation

Emerging dietary patterns: impact on child health

What we eat today and how we decide to produce sufficient food to meet both demand and nutritional requirements will determine the availability, diversity and quality of diets for future generations. Acceptability and normalisation of new dietary patterns must be prioritised to the same extent as education on environmental sustainability and health, because these are important social levers. They can help to reduce the psychosocial barriers and anxieties often connected to the behaviour changes that are needed to transition away from the traditional Western eating habits that are now increasingly subject to critical scrutiny. Without understanding the motivations and facilitators to change eating habits (and then designing and amplifying solutions which make those changes attractive and compelling in the modern world) positive changes to young people’s health and their environment through better food will not come quickly enough to halt potentially catastrophic consequences for people and planet. Changing consumption is seen by experts as the most powerful lever compared to food waste reduction or more efficient food production methods and technological solutions. There is simply not enough on Earth to sustain the increase of intensification required to continue feeding a global population on its current trajectory with a diet so rich in animal produce. However, radical behaviour modification is challenging and therefore cross-sector, bold and perhaps unorthodox leadership is necessary to inspire alteration in the food system, which will have a knock-on effect in terms of changing food environments and therefore food perceptions, narratives and behaviours. There are no ‘quick fix’ solutions, but what is undeniable is that populations can only make effective shifts in dietary patterns if government and the food industry help them to make those changes. This requires budgetary investment in public health information and the implementation of policies that promote ways to eat healthily that are also affordable and environmentally sustainable. The aim is to offer food that tastes as good as it can be made to look so that uptake is maximised and the benefits are cumulative. The inevitable upheaval incurred by making any alteration to entrenched patterns of consumption that have been centuries in the making should not be underestimated, but carrying on as before is no longer credible nor desirable. The aim is to offer ‘nutritious’ food. ‘If we don’t take action, the collapse of our civilisations and the extinction of much of the natural world is on the horizon’ Sir David Attenborough. This Report is our initial contribution to a conversation that has only just begun.It is unlikely to be the last

Access to Dental Care for Children and Young People in Care and Care Leavers: A Global Scoping Review

Aims: This scoping review aimed to explore three research questions: 1. What is the dental care access for children and young people (CYP) in care and care leavers? 2. What factors influence CYP in care and care leavers’ access to dental care? 3. What pathways have been developed to improve access to oral health care for CYP in care and care leavers? Methods: Five databases (Ovid MEDLINE, Ovid Embase, CINAHL, SocINDEX and Dentistry and Oral Sciences Source) and grey literature sources were systematically searched. Articles relating to CYP in care or care leavers aged 0–25 years old, published up to January 2023 were included. Abstracts, posters and publications not in the English language were excluded. The data relating to dental care access were analysed using thematic analysis. Results: The search identified 942 articles, of which 247 were excluded as duplicates. A review of the titles and abstracts yielded 149 studies. Thirty-eight were eligible for inclusion in the review: thirty-three peer-reviewed articles, one PhD thesis and four grey literature sources. All papers were published from very high or medium Human Development Index countries. The studies indicate that despite having higher treatment needs, CYP in care and care leavers experience greater difficulty in accessing dental services than those not care-experienced. Organisational, psycho-social and logistical factors influence their access to dental care. Their experience of dental care may be impacted by adverse childhood events. Pathways to dental care have been developed, but little is known of their impact on access. There are very few studies that include care leavers. The voices of care-experienced CYP are missing from dental access research. Conclusions: care-experienced CYP are disadvantaged in their access to dental care, and there are significant barriers to their treatment needs being met

Factors Influencing Oral Health Behaviours, Access and Provision of Dental Care for Autistic Children and Adolescents in Countries with a Very High Human Development Index: Protocol for a Mixed Methods Systematic Review

Autistic children and adolescents are at high risk of dental disease and experience oral health inequalities. They consistently show high levels of unmet needs in relation to their oral health and access to dental care. There are no systematic reviews that bring together the evidence on the factors that influence oral hygiene behaviours, and access to and provision of dental care for autistic children and adolescents. A systematic search will be carried out in eight international databases and in grey literature of qualitative, quantitative and mixed method research studies from countries with a High Development Index which relate to oral health behaviours, and access to and provision of dental care. Only studies where participants are autistic children and adolescents aged 19 years or under, parents/guardians/caregivers, support staff, or oral health care providers will be included. Quantitative and qualitative data will be synthesized together through data transformation using a convergent integrated approach. Thematic synthesis will be used to carry out an inductive analysis of the data. The findings from the systematic review which this protocol generates will be used in the development of an appropriate local clinic care pathway for autistic children/adolescents and to inform national policies and practices. Prospero registration: CRD 42021248764

'In the wake of a pandemic': dietary patterns and impact on child health after COVID-19

INTRODUCTION Our companion Report: ‘Emerging Dietary Patterns: Impact on Child Health’ discussed ways in which traditional dietary patterns in both the UK and internationally were changing. In concluding we argued that: ‘The interconnected nature of food, climate and health is the biggest challenge we face, but therein also lies its strength and boundless potential should we act with the necessary urgency, creativity and commitment. It is at the local level – supported by national policy – that the largest returns from such pro-activity will accrue.’ We continued: ‘The food that we eat here and now can change the world.’ adding: ‘If we are serious about protecting and restoring natural environments, safeguarding the health and wellbeing of our children today and restoring and protecting that of future generations, then there is only one solution. We must change it.’ Then came Covid-19 and change was imposed – with the arrival and experience of a pandemic. The full outcome of Covid-19; its effects and repercussions not just for the present generations but for the many that will succeed it cannot be estimated now. In the 102 years since Spanish ‘flu devastated an older world order, we are still learning its lessons today. But what has become immediately apparent is that what we eat and how we eat has undergone a revolution in four short months. 6 ‘Coronavirus pandemic will change the food industry and eating habits forever, says CEO of Food and Drink Federation, Ian Wright.’ ([email protected] 7 April 2020) ‘To prevent the next pandemic we must take on factory farming.’ (Jonathan Safran Foer and Aaron Gross, The Guardian, 21 April 2020.) ‘Covid-19 will definitely be an accelerator on the conscious consumer patterns that we see unfolding. As the consumer gets more conscious, we also see more interest in sustainable, locally produced food systems solutions.’ (David Brandes, Food Navigator, 17 April 2020.) ‘The virus is a warning that Britain’s food system must change,’ (‘The Guardian,’ 18th April 2020). It would also be unjust to address the Covid-19 pandemic in isolation without highlighting its interactions with another global force to become manifest in the same era in response to an incident in the US; namely, the police killing of George Floyd and the Black Lives Matter Movement. Pandemics, poor health, systemic inequalities and a lack of environmental protections harm black, ethnic minority and disadvantaged communities in all countries more than any other groups, and the two events have shed a harsh light on those realities and their frightening interconnections – such as the higher death rate in BAME communities including healthcare workers on the frontline (Public Health England, June 2020, ‘Beyond the data: Understanding the impact of COVID-19 on BAME groups’): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/892376/COVID_stakeholder_engagement_synthesis_beyond_the_data.pdf Therefore, to address fall-out from the pandemic without considering these marginalised groups would be inappropriate; to address the environmental crisis without considering its impact on such groups would be pointless and the separation of civil rights from health and environmental policy is delusional. The silos in which policy-making still exists in these fields are stubborn obstacles to change. Both within and without the UK’s boundaries, the diverse spectrum of peoples requires a similar diversity and inclusion in the systems that sustain life – and the production of the food that is eaten in order to live. Sometimes change is immediate and imposed rather than incremental and the pandemic has seen an abrupt conclusion to familiar and traditional ways of living. As we offer our thoughts about the many ways in which Covid-19 has changed our dietary patterns, we must remember that the ‘brave new world’ of our future ambition ‘has such people in it’, (‘The Tempest’, William Shakespeare). Those who would construct better dietary patterns in the wake of this pandemic must ensure that people rather than systems prevail…

Effects of intranasal TNFα on granulocyte recruitment and activity in healthy subjects and patients with allergic rhinitis

<p>Abstract</p> <p>Background</p> <p>TNFα may contribute to the pathophysiology of airway inflammation. For example, we have recently shown that nasal administration of TNFα produces late phase co-appearance of granulocyte and plasma exudation markers on the mucosal surface. The objective of the present study was to examine indices of granulocyte presence and activity in response to intranasal TNFα challenge.</p> <p>Methods</p> <p>Healthy subjects and patients with allergic rhinitis (examined out of season) were subjected to nasal challenge with TNFα (10 μg) in a sham-controlled and crossover design. Nasal lavages were carried out prior to and 24 hours post challenge. Nasal biopsies were obtained post challenge. Nasal lavage fluid levels of myeloperoxidase (MPO) and eosinophil cationic protein (ECP) were analyzed as indices of neutrophil and eosinophil activity. Moreover, IL-8 and α₂-macroglobulin were analyzed as markers of pro-inflammatory cytokine production and plasma exudation. Nasal biopsy numbers of neutrophils and eosinophils were monitored.</p> <p>Results</p> <p>Nasal lavage fluid levels of MPO recorded 24 hours post TNFα challenge were increased in healthy subjects (p = 0.0081) and in patients with allergic rhinitis (p = 0.0081) (<it>c.f</it>. sham challenge). Similarly, α₂-macroglobulin was increased in healthy subjects (p = 0.014) and in patients with allergic rhinitis (p = 0.0034). Lavage fluid levels of ECP and IL-8 were not affected by TNFα challenge. TNFα increased the numbers of subepithelial neutrophils (p = 0.0021), but not the numbers of eosinophils.</p> <p>Conclusion</p> <p>TNFα produces a nasal inflammatory response in humans that is characterised by late phase (i.e., 24 hours post challenge) neutrophil activity and plasma exudation.</p

A REPORT BY THE ALL - PARTY PARLIAMENTARY GROUP ON A FIT AND HEALTHY CHILDHOOD THE IMPACT OF SOCIAL AND ECONOMIC INEQUALITIES ON CHILDREN’S HEALTH

A child born into circumstances of social and economic inequality in the 21st century United Kingdom will start life with one hand tied behind their back. Nowhere is the disparity of experience more marked than in that of health and this, in turn, impacts the entire life course. In the same way that priority is given to securing the national infrastructure, prioritising the health of children from all areas and in all circumstances from the outset would therefore seem to be prudent rather than profligate. Yet as this Report demonstrates,successive Governments have skimped rather thansaved; failedto build upon existing policy and played a costly policy game of ‘catching up later’ instead of deploying the early ntervention me asures that are cheaper andmore effective in the long term

A Scoping Review of the Oral Health Status, Oral Health Behaviours and Interventions to Improve the Oral Health of Children and Young People in Care and Care Leavers

Background: Children and young people (CYP) in care experience poorer physical health and overall wellbeing in comparison to their peers. Despite this, relatively little is known about what their oral health needs and behaviours are. The aim of this scoping review was to provide a global perspective on the oral health status and behaviours of CYP in care and care leavers. It also aimed to synthesise interventions that have been trialled in this population to improve oral health. Methods: Five databases were searched, Ovid Embase, Ovid MEDLINE, CINAHL (EBSCOhost), SocINDEX (EBSCOhost) and Dentistry and Oral Sciences Source (EBSCOhost), alongside grey literature sources up to January 2023. Eligibility criteria were studies that (i) reported on children and adolescents aged 25 years or younger who are currently in formal/informal foster or residential care and care leavers, (ii) pertained to oral health profile, behaviours or oral health promotion interventions (iii) and were published in the English language. Thematic analysis was used to develop the domains for oral health behaviours and interventions. Results: Seventy-one papers were included. Most papers were published from very high or medium Human Development Index countries. CYP in care were found to experience high levels of decay, dental trauma, periodontal disease and poorer oral health-related quality of life. Oral health behaviours included limited oral health self-care behaviours and a lack of oral health-based knowledge. The trialled interventions involved oral health education, supervised brushing and treatment or preventative dental care. Conclusions: This scoping review reveals that CYP in care experience poorer oral health in comparison to their peers. They are also less likely to carry out oral health self-care behaviours. This review highlights a scarcity of interventions to improve the oral health of this population and a paucity of evidence surrounding the oral health needs of care leavers