How do you identify the patient with ‘high expectations’ of orthodontic treatment - An empirical approach

Objectives: To identify an empirical method for identifying patients with ‘high expectations’ of orthodontic treatment with fixed appliances using a questionnaire-based approach. Design: Secondary analysis of data from four studies which collected data on patients’ expectations of orthodontic treatment using the same questionnaire. Setting: Secondary care orthodontic services. Participants: All four datasets comprised new patients aged 12–15 years, with no history of orthodontic treatment, who fulfilled the criteria for NHS treatment using the Index of Orthodontic Treatment Need (IOTN). Unpublished dataset 1 comprised 100 participants, while dataset 2 had 70 participants, dataset 3 had 67 participants and dataset 4 comprised 40 participants. Methods: The questionnaire utilised in all studies had a question which asked respondents to rate seven different expectations of outcome relating to straight teeth, better smile, ease of eating, speaking, cleaning teeth, improved career prospects and social confidence. Dataset 1 was analysed to determine the proportion of patients who had rated all seven outcome expectation items at a maximum score. Similar analyses were performed for the other three datasets to explore the trend in the proportion of patients with high expectations over time. Results: For dataset 1, 2.0% of participants had high expectations, as defined by their scores on the questionnaire. The proportions for the datasets 2, 3 and 4 were 4.0%, 4.5% and 2.5%, respectively. Conclusion: The method outlined provides an empirical basis for identifying patients with statistically infrequent high expectations. This can potentially help clinicians in the management of such patients

Assessing the effectiveness and acceptability of a personalised mobile phone App in improving adherence to oral hygiene advice in orthodontic patients: protocol for a feasibility study and a Randomised Controlled Trial

Background: Orthodontic treatment is a common health care intervention; treatment duration can be lengthy (2-3 years on average), and adherence to treatment advice is therefore essential for successful outcomes. It has been reported that up to 43% of patients fail to complete treatment, and there are currently no useful predictors of noncompletion. Given that the National Health Service England annual expenditure on primary-care orthodontic treatment is in excess of £200 million (US $267 million), noncompletion of treatment represents a significant inefficient use of public resources. Improving adherence to treatment is therefore essential. This necessitates behavior change, and interventions that improve adherence and are designed to elicit behavioral change must address an individual’s capability, opportunity, and motivation. Mobile phones are potentially an invaluable tool in this regard, as they are readily available and can be used in a number of ways to address an individual’s capability, opportunity, and motivation. Objective: This study will assess the effectiveness and acceptability of a personalized mobile phone app in improving adherence to orthodontic treatment advice by way of a randomized controlled trial. Methods: This study will be conducted in 2 phases at the Eastman Dental Hospital, University College London Hospitals Foundation Trust. Phase 1 is feasibility testing of the My Braces app. Participants will be asked to complete the user version of the Mobile Application Rating Scale. The app will be amended following analysis of the responses, if appropriate. Phase 2 is a randomized controlled trial to test the effectiveness and acceptability of the My Braces app. Results: This study was approved by the London – Bloomsbury Research Ethics Committee on November 5, 2019 (reference 19/LO/1555). No patients have been recruited to date. The anticipated start date for recruitment to phase 1 is October 2020. Conclusions: Given the availability, affordability, and versatility of mobile phones, it is proposed that they will aid in improving adherence to treatment advice and hence improve treatment completion rates. If effective, the applicability of this methodology to developing behavior change/modification interventions and improving adherence to treatment across health care provides an exciting opportunity

Patient expectations: Is there a typical patient?

Objectives: To qualitatively explore, and analyse, patients’ expectations before the start of fixed appliance orthodontic treatment and determine whether typologies exist. Design: A prospective cross-sectional qualitative study, which involved 13 patients (aged 12–15 years). Setting: NHS Hospital Orthodontic Department (UK). Materials and methods: In-depth interviews were conducted with patients who consented to participate before the start of fixed appliance orthodontic treatment. The in-depth interview data were transcribed and then managed using a framework approach, followed by associative analysis. Results: The in-depth interviews revealed two major themes and associated subthemes which were: first, patients’ expectations about the treatment process and outcome; and second, patients’ expectations of themselves during and after treatment. Three typologies related to patients’ expectations of the orthodontic treatment process were also identified. The first group of participants had minimal expectations of the treatment process, did not anticipate discomfort or pain and did not anticipate that treatment would cause disruption to their daily life. The second group of participants had expectations that treatment would involve arch wire changes, dental extractions and result in some discomfort/pain, which would cause some limited disruption to their daily life (moderate expectations). The third type of participant had expectations of the treatment process involving arch wire changes and dental extractions, and anticipated that the discomfort and pain experienced would significantly affect their daily life (marked expectations). Conclusions: These results provide the clinician with information about patient typologies and provide the clinician with some direction when communicating with their patients and managing their expectations before the start of treatment

Hmong Adults Self-Rated Oral Health: A Pilot Study

Since 1975, the Hmong refugee population in the U.S. has increased over 200%. However, little is known about their dental needs or self-rated oral health (SROH). The study aims were to: (1) describe the SROH, self-rated general health (SRGH), and use of dental/physician services; and (2) identify the factors associated with SROH among Hmong adults. A cross-sectional study design with locating sampling methodology was used. Oral health questionnaire was administered to assess SROH and SRGH, past dental and physician visits, and language preference. One hundred twenty adults aged 18–50+ were recruited and 118 had useable information. Of these, 49% rated their oral health as poor/fair and 30% rated their general health as poor/fair. Thirty-nine percent reported that they did not have a regular source of dental care, 46% rated their access to dental care as poor/fair, 43% visited a dentist and 66% visited a physician within the past 12 months. Bivariate analyses demonstrated that access to dental care, past dental visits, age and SRGH were significantly associated with SROH (P \u3c 0.05). Multivariate analyses demonstrated a strong association between access to dental care and good/excellent SROH. About half of Hmong adults rated their oral health and access to dental care as poor. Dental insurance, access to dental care, past preventive dental/physician visits and SRGH were associated with SROH

Comparison of the Near-Threshold Production of eta- and K-Mesons in Proton-Proton Collisions

The pp -> pp eta and pp -> pLambda K^+ reactions near threshold are dominated by the first and second S_11 resonance respectively. It is shown that a one-pion-exchange model exciting these isobars reproduces well the ratio of the production cross sections. The consequences for this and other channels are discussed.Comment: 10 pages, LaTeX2e, 1 eps-figur

The numerical control of the motion of a passive particle in a point vortex flow

This work reports numerical explorations in the advection of one passive tracer by point vortices living in the unbounded plane. The main objective is to find the energy-optimal displacement of one passive particle (point vortex with zero circulation) surrounded by N point vortices. The direct formulation of the corresponding control problems is presented for the case of N = 1, N = 2, N = 3 and N = 4 vortices. The restrictions are due to (i) the ordinary differential equations that govern the displacement of the passive particle around the point vortices, (ii) the available time T to go from the initial position z0 to the final destination zf; and (iii) the maximum absolute value umax that is imposed on the control variables. The resulting optimization problems are solved numerically. The numerical results show the existence of nearly/quasi-optimal control.info:eu-repo/semantics/publishedVersio

Depression, drugs and dental anxiety in prisons:A mediation model explaining dental decay experience

Funding: Scottish Government (award number: 121.804485) and support from the Scottish Prison Service and participating NHS Boards.Objective To test a theoretical mediation model and investigate whether drug use and/or dental anxiety act as mediating factors between depression and dental decay experience among prisoners. Method A cross‐sectional survey was conducted on a convenience sample of 300 prisoners across three prison establishments in Scotland. Depression and dental anxiety were measured using the Centre for Epidemiological Studies Depression Scale and the Modified Dental Anxiety Scale, respectively. Drug use was assessed using three yes (scoring 1)/ no (scoring 0) questions: ‘ever taken (illegal) drugs’, ‘injecting drugs’ and ‘ever participated in a rehabilitation programme’. Participants had an oral examination to determine dental caries experience (missing [MT] and untreated decay [D3cvT]) in all four quadrants. Latent variable path analysis was conducted to test the mediation model. Results A total of 342 prisoners participated, of which 298 yielded a complete data set. Depression was associated with missing teeth and untreated decay (D3T) through an indirect pathway (Total standardized indirect effects = 0.11, P < .01) via drug use and dental anxiety (X2 [71] = 89.8, P = .07; Root Mean Square Error of Approximation: 0.03; Comparative Fit Index: 0.994 and Tucker‐Lewis index: 0.992). Twenty‐two percent of the variance in untreated decay and missing teeth was explained by both drug use and dental anxiety; however, the strongest predictor was drug use (total standardized direct effects = 0.45, P < .001). Conclusion A relatively simple model to assist understanding dental decay experience of people in prison has been proposed. The data collected were consistent with our specified model. Drug use acted as the primary mediator and dental anxiety as a secondary mediator between depression and dental decay experience. Given the co‐morbidity between mental health and drug use and dental decay experience, an integrated or shared approach is proposed. We recommend that future research should concentrate on building a firmer picture by replicating and extending the framework presented.PostprintPeer reviewe

Relationship Between Non-Hodgkin's Lymphoma and Blood Levels of Epstein-Barr Virus in Children in North-Western Tanzania: A Case Control Study.

Non-Hodgkin's Lymphomas (NHL) are common in African children, with endemic Burkitt's lymphoma (BL) being the most common subtype. While the role of Epstein-Barr Virus (EBV) in endemic BL is known, no data are available about clinical presentations of NHL subtypes and their relationship to Human Immunodeficiency Virus (HIV) infection and Epstein Barr Virus (EBV) load in peripheral blood of children in north-western, Tanzania. A matched case control study of NHL subtypes was performed in children under 15 years of age and their respective controls admitted to Bugando Medical Centre, Sengerema and Shirati district designated hospitals in north-western, Tanzania, between September 2010 and April 2011. Peripheral blood samples were collected on Whatman 903 filter papers and EBV DNA levels were estimated by multiplex real-time PCR. Clinical and laboratory data were collected using a structured data collection tool and analysed using chi-square, Fisher and Wilcoxon rank sum tests where appropriate. The association between NHL and detection of EBV in peripheral blood was assessed using conditional logistic regression model and presented as odds ratios (OR) and 95% confidence intervals (CI). A total of 35 NHL cases and 70 controls matched for age and sex were enrolled. Of NHLs, 32 had BL with equal distribution between jaw and abdominal tumour, 2 had large B cell lymphoma (DLBCL) and 1 had NHL-not otherwise specified (NHL-NOS). Central nervous system (CNS) presentation occurred only in 1 BL patient; 19 NHLs had stage I and II of disease. Only 1 NHL was found to be HIV-seropositive. Twenty-one of 35 (60%) NHL and 21 of 70 (30%) controls had detectable EBV in peripheral blood (OR = 4.77, 95% CI 1.71 - 13.33, p = 0.003). In addition, levels of EBV in blood were significantly higher in NHL cases than in controls (p = 0.024). BL is the most common childhood NHL subtype in north-western Tanzania. NHLs are not associated with HIV infection, but are strongly associated with EBV load in peripheral blood. The findings suggest that high levels of EBV in blood might have diagnostic and prognostic relevance in African children