Conscious sedation: is this provision equitable? Analysis of sedation services provided within primary dental care in England, 2012-2014.

Aim: Patients receiving primary dental care may occasionally require conscious sedation as an adjunct to care. It is one of a range of options to support anxious patients or those undergoing difficult procedures. The aim of this study was to examine patterns of conscious sedation within primary dental care in relation to patient demography, deprivation status, geography (local authority, region) and type of care (Band) within England to examine equity in distribution of service provision. Materials and Methods: Descriptive analysis of cross-sectional primary dental care data, obtained from national claims held by the National Health Service (NHS) Business Services Authority, on patients who had received one or more courses of care involving sedation. Results: Just under 137,000 episodes of care involving sedation are provided for over 120,000 patients per year, the majority of which are for adults. Four out of ten (41%) patients were children, with 6-12-year-olds forming the largest group; 6% were aged under six years. Eleven per cent of patients had more than one course of care involving sedation, with adults aged 25-34 years having the highest rate: 1.17 (s.d.: 0.887) in 2012/2013 and 1.16 (s.d.: 0.724) in 2013/2014. There was a clear social gradient, whereby the most deprived quintile had the highest volume of patients that had received sedation at least once in primary dental care in both years (31.5%). Whilst there was a clear social gradient amongst children and young adults who received sedation, the gradient flattened among middle-aged and was flat amongst older adults. The majority of courses of care involving sedation were associated with Band 2 claims for care (88.6% in 2012/2013; 88.8 in 2013/2014). Whilst one or more patients in all higher tier local authorities received care involving sedation, there were marked geographic inequalities. Discussion: Patients receive sedation in support of NHS primary dental care across the life course and social spectrum. Whilst the pattern of uptake of care parallels the social gradient in younger age groups overall, there are clear geographical inequalities in provision. As sedation is only one of a series of adjuncts to care which may be provided across different sectors of the health system, a wider systems analysis should be undertaken as the findings raise important issues about equitable access to appropriate care. Furthermore, there should be a greater emphasis on prevention to reduce the need for care. The implications for child oral health, access and quality are discussed

Effects of ecstasy/polydrug use on memory for associative information

Rationale. Associative learning underpins behaviours that are fundamental to the everyday functioning of the individual. Evidence pointing to learning deficits in recreational drug users merits further examination. Objectives. A word pair learning task was administered to examine associative learning processes in ecstasy/polydrug users. Methods. After assignment to either single or divided attention conditions, 44 ecstasy/polydrug users, and 48 nonusers were presented with 80 word pairs at encoding. Following this, four types of stimuli were presented at the recognition phase; the words as originally paired (old pairs), previously presented words in different pairings (conjunction pairs), old words paired with new words, and pairs of new words (not presented previously). The task was to identify which of the stimuli were intact old pairs. Results. Ecstasy/ploydrug users produced significantly more false positive responses overall compared to nonusers. Increased long-term frequency of ecstasy use was positively associated with the propensity to produce false positive responses. It was also associated with a more liberal signal detection theory (SDT) decision criterion value. Measures of long term and recent cannabis use were also associated with these same word pair learning outcome measures. Conjunction word pairs, irrespective of drug use, generated the highest level of false positive responses and significantly more false positive responses were made in the DA condition compared to the SA condition. Conclusions. Overall, the results suggest that long-term ecstasy exposure may induce a deficit in associative learning and this may be in part a consequence of users adopting a more liberal decision criterion value. Key Words: Ecstasy, Drug Use, Cognition, Memory, Associative Learning, Word Pair

Coupling marine ecosystem state with environmental management and conservation: A risk-based approach

\ua9 2024 The Author(s)The sustainability of marine ecosystems demands a focus on ecological improvement, necessitating managers and conservationists to consider a range of actions from those that limit stressors to those that actively restore. Deciding the most appropriate action should be informed by environmental context, which includes assessing information on both degradation and recovery potential. Here, we provide an analysis of how the degree of ecological degradation coupled with the stressor regime can inform environmental management and conservation actions (e.g., stressor reductions, adaptive management, assisted recovery/restoration). With this analysis we design a risk framework combining principles that define ecosystem resilience and recovery times with those that characterize stressor regimes (i.e., the number, type, and impact). The combination of these principles defines where an ecosystem is placed along sliding scales of degradation and recovery and likely response to protective and restorative interventions. It is designed to facilitate place-based conversations regarding the risks of different management actions informed by the temporal dynamics of ecosystem degradation and recovery

Awareness in severe Alzheimer’s disease: a systematic review

OBJECTIVE: There is limited understanding about how people in the severe stages of Alzheimer’s disease (AD) experience and demonstrate awareness. We synthesised all available evidence with the aim of understanding how awareness is preserved or impaired in severe AD and what evidence there is for different levels of awareness according to the levels of awareness framework. METHOD: A systematic search of the following databases: Embase, PsycINFO, MEDLINE and Web of Science was carried out. A narrative synthesis and analysis was conducted of all included studies. All studies were assessed for quality using the AXIS and CASP tools. RESULTS: Our findings suggest that lower level sensory awareness is relatively maintained in severe AD. Findings for higher level awareness are variable and this may be related to the diversity of methods that have been used to explore awareness in these circumstances. CONCLUSION: Awareness is complex, heterogeneous and varies significantly between individuals. Environmental and contextual factors have a significant impact on whether awareness is observed in people with severe AD. Adaptation of the environment has the potential to facilitate the expression of awareness while education of caregivers may increase understanding of people with severe AD and potentially improve the quality of care that is received

Promoting access to dental care in South London: adult patients' perspectives.

Objective: To evaluate patients' views on health service initiatives established to improve uptake of NHS primary dental care amongst adult patients in a socially deprived area, comparing practices with extended and regular contract capacity. Study design: Service evaluation and cross-sectional survey. Method: Questionnaire survey of patients attending a random sample of dental practices in three inner-metropolitan boroughs of south London following initiatives to improve access to dental care (across dental practices delivering regular and extended contracts for services) exploring attendance patterns and the influence and awareness of local initiatives to promote access. Results: Four hundred fifty adults across 12 dental practices completed questionnaires: 79% reported attending for routine and 21% for urgent care. Patients were most aware of banners outside practices, followed by dental advertisements in newspapers. Vouchers for free treatments were considered of the highest possible influence, followed by vouchers for reduced treatment costs and an emergency out-of-hours helpline. Awareness and influence were not aligned, and there was no evidence of difference by practice contract type whilst there were differences by age and type of attendance. Conclusion: The findings suggest that financial incentives and emergency services are considered the most influential initiatives for adult patients whose attendance patterns appear to be related to personal circumstances rather than merely being influenced by the provision of information