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

Oral health of people experiencing homelessness in London: a mixed methods study

Abstract Background Those experiencing homelessness have significant health and oral health needs and are at the extreme of health inequalities. The aim of the study was to conduct an oral health needs assessment for those experiencing homeless in London and impacts on their oral health-related quality of life. Methods The oral health needs assessment consisted of quantitative and qualitative methods. This included a survey questionnaire to assess perceived oral health needs, and oral health related quality of life. In addition, a focus group was conducted with 13 peer advocates. Results Findings from the focus group revealed numerous challenges for homeless populations to maintain good oral health and access to dental care including mental ill-health, stigma, costs, and chaotic lifestyles. A response rate of 79% (n = 315) was achieved for the questionnaire survey. Results showed high levels of unmet dental needs and risky health behaviours including 60% reporting being smokers, 39% consuming high amounts of sugar and 52.4% brushing their teeth less than twice a day. More than a third (32.1%) had experienced toothache. The majority of respondents 80% (n = 224) were very or fairly concerned about their dental health. There were significant associations between perceived oral health status and oral health-related quality of life. Conclusion Those experiencing homelessness in London were found to have high levels of unmet oral health needs, which significantly impacted on their oral health-related quality of life. Focusing on changing behaviours alone is insufficient and therefore addressing the structural determinants of homelessness is vital in improving oral and health outcomes of this vulnerable population

Secondary analysis of child hospital admission data for dental caries in London, UK: what the data tells us about oral health inequalities

Objectives Dental caries is the most common reason for hospital admissions for children aged 6–10 years in England. The prevalence in the experience of hospital admission is not uniform across all populations. This paper reports on the analysis of secondary data on dental hospital episodes for children residing in London, and its association with oral health inequalities.Design, setting and participants Retrospective, non-identifiable patient data sourced from the Hospital Episode Statistics dataset was analysed. Finished consultant episodes (FCEs) were extracted for children aged 1–19 years, residing in London and admitted with a primary diagnosis of caries between 2015/2016 and 2020/2021.Outcome measures The number and rates of FCEs with a primary diagnosis of dental caries for children aged 1–19 years old was analysed for six consecutive financial years (2015/2016 to 2020/2021). To assess oral health inequalities in children experiencing hospital admission due to dental caries, several demographic variables were analysed: deprivation, age, and sex.Results Between the financial years of 2015–2016 and 2020–2021, there were a total of 57 055 hospital admissions for dental caries for children aged 1–19 years (average rate of admission was 465.1 per 100 000 of children). A year-on-year decline was noted between 2015–2016 and 2020–2021. Regression analysis demonstrated clear social gradients with significant oral health inequalities; those from the most deprived areas experienced over two times the number of hospital admissions (58%). Children aged 4–9 years accounted for 68.9% (39 325) for the total dental hospital episodes from 2015–2016 to 2020–2021.Conclusion London’s year-on-year reduction in hospital admission for dental caries is due to various factors including effective prevention interventions and an effective paediatric clinical care pathway. Sociodemographic factors remain to act as key predictors for hospital admission for child with dental caries. While health service level changes may reduce the number of hospital admissions, persistent child oral health inequalities continue to exist

What Does This Mutation Mean? The Tools and Pitfalls of Variant Interpretation in Lymphoid Malignancies

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Glycerol Improves Skin Lesion Development in the Imiquimod Mouse Model of Psoriasis: Experimental Confirmation of Anecdotal Reports from Patients with Psoriasis

Glycerol is used in many skin care products because it improves skin function. Anecdotal reports by patients on the National Psoriasis Foundation website also suggest that glycerol may be helpful for the treatment of psoriasis, although to date no experimental data confirm this idea. Glycerol entry into epidermal keratinocytes is facilitated by aquaglyceroporins like aquaporin-3 (AQP3), and its conversion to phosphatidylglycerol, a lipid messenger that promotes keratinocyte differentiation, requires the lipid-metabolizing enzyme phospholipase-D2 (PLD2). To evaluate whether glycerol inhibits inflammation and psoriasiform lesion development in the imiquimod (IMQ)-induced mouse model of psoriasis, glycerol’s effect on psoriasiform skin lesions was determined in IMQ-treated wild-type and PLD2 knockout mice, with glycerol provided either in drinking water or applied topically. Psoriasis area and severity index, ear thickness and ear biopsy weight, epidermal thickness, and inflammatory markers were quantified. Topical and oral glycerol ameliorated psoriasiform lesion development in wild-type mice. Topical glycerol appeared to act as an emollient to induce beneficial effects, since even in PLD2 knockout mice topical glycerol application improved skin lesions. In contrast, the beneficial effects of oral glycerol required PLD2, with no improvement in psoriasiform lesions observed in PLD2 knockout mice. Our findings suggest that the ability of oral glycerol to improve psoriasiform lesions requires its PLD2-mediated conversion to phosphatidylglycerol, consistent with our previous report that phosphatidylglycerol itself improves psoriasiform lesions in this model. Our data also support anecdotal evidence that glycerol can ameliorate psoriasis symptoms and therefore might be a useful therapy alone or in conjunction with other treatments

Performances of Targeted RNA Sequencing for the Analysis of Fusion Transcripts, Gene Mutation, and Expression in Hematological Malignancies

International audienceRNA sequencing holds great promise to improve the diagnostic of hematological malignancies, because this technique enables to detect fusion transcripts, to look for somatic mutations in oncogenes, and to capture transcriptomic signatures of nosological entities. However, the analytical performances of targeted RNA sequencing have not been extensively described in diagnostic samples. Using a targeted panel of 1385 cancer-related genes in a series of 100 diagnosis samples and 8 controls, we detected all the already known fusion transcripts and also discovered unknown and/or unsuspected fusion transcripts in 12 samples. Regarding the analysis of transcriptomic profiles, we show that targeted RNA sequencing is performant to discriminate acute lymphoblastic leukemia entities driven by different oncogenic translocations. Additionally, we show that 86% of the mutations identified at the DNA level are also detectable at the messenger RNA (mRNA) level, except for nonsense mutations that are subjected to mRNA decay. We conclude that targeted RNA sequencing might improve the diagnosis of hematological malignancies. Standardization of the preanalytical steps and further refinements of the panel design and of the bioinformatical pipelines will be an important step towards its use in standard diagnostic procedures

Exome sequencing identifies recurrent BCOR alterations and the absence of KLF2, TNFAIP3 and MYD88 mutations in splenic diffuse red pulp small B-cell lymphoma.

International audienceSplenic diffuse red pulp lymphoma is an indolent small B-cell lymphoma recognised as a provisional entity in the WHO 2008 classification. Its precise relationship with other related splenic B-cell lymphomas with frequent leukaemic involvement or other lymphoproliferative disorders remains undetermined. We performed whole-exome sequencing to explore the genetic landscape of 10 splenic diffuse red pulp lymphoma cases from paired tumour and normal samples. A selection of 109 somatic mutations was then evaluated in a cohort including 42 splenic diffuse red pulp lymphoma samples and compared to those identified in 46 splenic marginal zone lymphoma and 8 hairy-cell leukaemia samples. Recurrent mutations or losses in BCOR (gene encoding the BCL6 corepressor)-frameshift (n=3), nonsense (n=2), splicing site (n=1), and copy number loss (n=4)- were identified in 10/42 splenic diffuse red pulp lymphoma (24%), whereas only one frameshift mutation was identified in 46 splenic marginal zone lymphoma cases (2%). Inversely, KLF2, TNFAIP3 and MYD88 mutations were rare (one KLF2 mutant out of 42 samples; 2%) or absent (TNFAIP3 and MYD88) in splenic diffuse red pulp lymphoma compared to splenic marginal zone lymphoma. These findings define an original genetic profile of splenic diffuse red pulp lymphoma, suggesting distinct mechanisms of pathogenesis from splenic marginal zone lymphoma and hairy-cell leukaemia