A Dental Student Perspective on the Impacts of an Inter-professional Engagement Module

Community engagement, defined as the process of getting communities involved in decisions that affect them (NICE, 2008), is paramount to the development and governance of services and activities that promote health and target inequalities (Buck, Baylis, Dougall, & Robertson, 2018; NICE, 2008). The inter-professional engagement module is an integral part of the curriculum of Peninsula Dental School, University of Plymouth, United Kingdom. It enables second-year undergraduate dental and dental therapy and hygiene students to develop and deliver an oral health intervention targeted at disadvantaged groups in the community. These groups commonly experience higher levels of dental disease (Public Health England, 2018; Office of the Director of Public Health, Plymouth City Council, 2018). As part of this module, we, a second-year group of undergraduate dental students, worked alongside the Family Intensive Intervention Project (FIIP) and its beneficiaries to improve vulnerable families’ awareness of oral and general health, and to break down barriers toward accessing dental care. FIIP provides holistic support to families with complex needs who may have difficulties with issues such as substance misuse, mental health and evidence of neglectful parenting (W. Kirby, personal communication, 2018)

Dental Pain in Care Homes: Is It a Phenomenon? A Systematic Review of the Literature.

Background: Evidence suggests that 80% of residents living in nursing homes have moderate to severe pain, could dental causes be an under reported contributory factor. The evidence suggests that this is an under-researched area. Our project aims were to explore and consolidate the current literature and conduct some stakeholder groups with care home managers and dentists. Our stakeholder group will be reported elsewhere. Methods: We used the SPIDER framework to set out key search terms. Which included “dementia” OR “cognitively-impaired” OR “carehome residents” AND “dental pain” OR “oralfacial pain” OR “mouth pain” AND “pain assessment” OR “pain identification”. A literature search was carried out on 8 and 9 March 2022 in the electronic databases: Cochrane, PubMed, Medline, Dental & Oral Sciences Source, CINAHL, Global Health, SocINDEX, Ovid (Medline) and Scopus. Restrictions were placed on dates and language (2012–2022 and English only). Results: The search yielded 775 papers up to the year 2020. After screening and exclusion, we were left with five papers: four quantitative and one qualitative. Conclusions: This review demonstrates that there has been very little research into oral health and/or dental pain in adults with dementia. Furthermore, the recommendations have yet to be taken forward. Identifying pain in older adults with dementia remains challenging. There is a need to develop an algorithm in conjunction with care home staff and dental practitioners in order to identify and address the pain associated with dental disease in adults with dementia

A Case-Finding Protocol for High Cardiovascular Risk in a Primary Care Dental School—Model with Integrated Care

Background: National Health Service (NHS) strategies in the United Kingdom (UK) have highlighted the need to maximise case-finding opportunities by improving coverage in non-traditional settings with the aim of reducing delayed diagnosis of non-communicable diseases. Primary care dental settings may also help to identify patients. Methods: Case-finding appointments took place in a primary care dental school. Measurements of blood pressure, body mass index (BMI), cholesterol, glucose and QRisk were taken along with a social/medical history. Participants with high cardiometabolic risk were referred to their primary care medical general practitioner (GP) and/or to local community health self-referral services, and followed up afterwards to record diagnosis outcome. Results: A total of 182 patients agreed to participate in the study over a 14-month period. Of these, 123 (67.5%) attended their appointment and two participants were excluded for age. High blood pressure (hypertension) was detected in 33 participants, 22 of whom had not been previous diagnosed, and 11 of whom had uncontrolled hypertension. Of the hypertensive individuals with no previous history, four were confirmed by their GP. Regarding cholesterol, 16 participants were referred to their GP for hypercholesterolaemia: 15 for untreated hypercholesterolaemia and one for uncontrolled hypercholesterolaemia. Conclusions: Case-finding for hypertension and identifying cardiovascular risk factors has high acceptability in a primary dental care setting and supported by confirmational diagnoses by the GP.</jats:p

Comparison of beamformer implementations for MEG source localization

Beamformers are applied for estimating spatiotemporal characteristics of neuronal sources underlying measured MEG/EEG signals. Several MEG analysis toolboxes include an implementation of a linearly constrained minimum-variance (LCMV) beamformer. However, differences in implementations and in their results complicate the selection and application of beamformers and may hinder their wider adoption in research and clinical use. Additionally, combinations of different MEG sensor types (such as magnetometers and planar gradiometers) and application of preprocessing methods for interference suppression, such as signal space separation (SSS), can affect the results in different ways for different implementations. So far, a systematic evaluation of the different implementations has not been performed. Here, we compared the localization performance of the LCMV beamformer pipelines in four widely used open-source toolboxes (MNE-Python, FieldTrip, DAiSS (SPM12), and Brainstorm) using datasets both with and without SSS interference suppression. We analyzed MEG data that were i) simulated, ii) recorded from a static and moving phantom, and iii) recorded from a healthy volunteer receiving auditory, visual, and somatosensory stimulation. We also investigated the effects of SSS and the combination of the magnetometer and gradiometer signals. We quantified how localization error and point-spread volume vary with the signal-to-noise ratio (SNR) in all four toolboxes. When applied carefully to MEG data with a typical SNR (3-15 dB), all four toolboxes localized the sources reliably; however, they differed in their sensitivity to preprocessing parameters. As expected, localizations were highly unreliable at very low SNR, but we found high localization error also at very high SNRs for the first three toolboxes while Brainstorm showed greater robustness but with lower spatial resolution. We also found that the SNR improvement offered by SSS led to more accurate localization.Peer reviewe

Obesity and caries in four-to-six year old English children: a cross-sectional study.

BACKGROUND: Obesity and caries are common conditions in childhood and can have significant implications on children's wellbeing. Evidence into their association remains conflicting. Furthermore, studies examining the ssociation between obesity and caries commonly focus on individual-level determinants. The present study aimed to examine the association between obesity and caries in young English children and to determine the impact of deprivation and area-level characteristics on the distribution of the two conditions. METHODS: This was a cross-sectional study among children in Plymouth city aged four-to-six years. Anthropometric measurements included weight and height (converted to Body Mass Index centiles and z-scores), and waist circumference. Caries was assessed by using the sum of the number of teeth that were decayed, missing or filled. A questionnaire was used to obtain information on children's demographic characteristics, oral hygiene, and dietary habits. The impact of deprivation on anthropometric variables and caries was determined using Linear and Poisson regression models, respectively. Multiple logistic regression was used to assess the association between different anthropometric measures and caries. Logistic regression models were also used to examine the impact of several demographic characteristics and health behaviours on the presence of obesity and caries. RESULTS: The total sample included 347 children aged 5.10 ± 0.31 (mean ± SD). Deprivation had a significant impact on caries and BMI z-scores (p < 0.05). Neither BMI- nor waist circumference z-scores were shown to be significantly associated with dental caries. Among the neighbourhood characteristics examined, the percentage of people dependent on benefits was found to have a significant impact on caries rates (p < 0.05). Household's total annual income was inversely related to caries risk and parental educational level affected children's tooth brushing frequency. CONCLUSIONS: No associations between any measure of obesity and caries were found. However, deprivation affected both obesity and caries, thus highlighting the need to prioritise disadvantaged children in future prevention programmes

Fulvestrant-induced expression of ErbB3 and ErbB4 receptors sensitizes oestrogen receptor-positive breast cancer cells to heregulin β1

Introduction We have previously reported that induction of epidermal growth factor receptor and ErbB2 in response to antihormonal agents may provide an early mechanism to allow breast cancer cells to evade the growth-inhibitory action of such therapies and ultimately drive resistant cell growth. More recently, the other two members of the ErbB receptor family, ErbB3 and ErbB4, have been implicated in antihormone resistance in breast cancer. In the present study, we have investigated whether induction of ErbB3 and/or ErbB4 may provide an alternative resistance mechanism to antihormonal action in a panel of four oestrogen receptor (ER)-positive breast cancer cell lines. Methods MCF-7, T47D, BT474 and MDAMB361 cell lines were exposed to fulvestrant (100 nM) for seven days, and effects on ErbB3/4 expression and signalling, as well as on cell growth, were assessed. Effects of heregulin β1 (HRGβ1) were also examined in the absence and presence of fulvestrant to determine the impact of ER blockade on the capacity of this ErbB3/4 ligand to promote signalling and cell proliferation. Results Fulvestrant potently reduced ER expression and transcriptional activity and significantly inhibited growth in MCF-7, T47D, BT474 and MDAMB361 cells. However, alongside this inhibitory activity, fulvestrant also consistently induced protein expression and activity of ErbB3 in MCF-7 and T47D cells and ErbB4 in BT474 and MDAMB361 cell lines. Consequently, fulvestrant treatment sensitised all cell lines to the actions of the ErbB3/4 ligand HRGβ1 with enhanced ErbB3/4-driven signalling activity, reexpression of cyclin D1 and significant increases in cell proliferation being observed when compared to untreated cells. Indeed, in T47D and MDAMB361 HRGβ1 was converted from a ligand having negligible or suppressive growth activity into one that potently promoted cell proliferation. Consequently, fulvestrant-mediated growth inhibition was completely overridden by HRGβ1 in all four cell lines. Conclusions These findings suggest that although antihormones such as fulvestrant may have potent acute growth-inhibitory activity in ER-positive breast cancer cells, their ability to induce and sensitise cells to growth factors may serve to reduce and ultimately limit their inhibitory activity

A mixed method study to investigate the facilitators and barriers that influence the delivery of prevention guidance in NHS dental practice, and to identify the attitudes and motivation of NHS dentists towards prevention

Abstract Introduction: Recent research has shown that the delivery of prevention in NHS dental practice is variable and not always supported by evidence. In response the Department of Health published a clinical guideline in 2007 titled 'Delivering better oral health – an evidence based toolkit for prevention' to support the delivery of evidence-based care in practice for the benefit of patients. The aim of this mixed-method study was to investigate the barriers and facilitators dentist perceive to influence the implementation of the clinical guideline in NHS dental practice; and to understand the attitudes and motivation of NHS dentists towards the guideline and prevention in general by identifying dentists shared viewpoints on prevention. Subjects and methods: The study was divided into two parts. The first part involved an investigation into the implementation of the clinical guideline 'Delivering better oral health’ in NHS dental practice. This was carried out by distribution of a pre-validated 'barriers and facilitators‟ questionnaire to 508 NHS dentists practising in Devon. The objective for this part of the study was to determine important issues concerning implementation of the guideline that warranted further investigation in part two of the study. The second part of the research involved twenty-six NHS dentists conducting Q-methodology; a hybrid quantitative/qualitative technique predominantly used in the social sciences to investigate human subjectivity. The objective for this part of the study was to gain a greater behavioural insight into the motivating factors of dentists towards prevention by considering factors as part of their overall decision-making profile. Results: The first part of the study generated thirty-six statements. Twenty-six health service dentists then completed the Q-process by sorting and ranking these statements on a forced distribution grid ranging from 'most agree‟ to 'most disagree'. Factor analysis with rotation identified the principle patterns in the ranking of statements. The resulting factors indicated that the majority of the dentists were characterised by three distinct motivation profiles. The results suggested that dentists in each subgroup had distinctly different viewpoints on delivering prevention guidance contained in 'Delivering better oral health' in practice. Conclusions: Motivation to deliver prevention guidance in this group of dentists from health service practice varied. Further research should investigate this finding with a particular focus on the implications that different motivation profiles have on the type of care patients receive. Q-methodology is an innovative and valid tool for investigating and characterising groups of dentists based on the similarity of their attitudes and motivation towards a phenomeno

Who cares for the young carers?

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