Regenerative Endodontic Procedures, Disinfectants and Outcomes: A Systematic Review

Aims: This systematic review aims to identify and synthesise available evidence to determine the clinical and radiographic outcomes of REP involving any disinfection irrigant together with a non-antibiotic intracanal medicament. Methods: Experimental and observational studies evaluating the outcomes of REP in immature non-vital permanent teeth in 6-16 year olds, where the protocol used any type of disinfectant irrigant together with a non-antibiotic intracanal medicament (non-setting calcium hydroxide) were included. Data was narratively synthesised and presented in respect to the primary outcome (elimination of symptoms and infection) and secondary outcomes (increase in root length/width; positive response to vitality testing; patient-reported outcomes; adverse effects). Main findings: 1628 studies were identified, of which five met the eligibility criteria for inclusion in the review. Studies included one randomised control trial and four observational studies. All five studies showed an absence of clinical signs and symptoms for all teeth postoperatively with radiographic resolution or absence of pathology following the disinfection stages of the REP used. Choice of secondary outcomes were inconsistent but included further root development, coronal discolouration and root canal calcifications postoperatively. There was a high risk of bias in all five studies and subsequently the quality of the evidence base was judged to be low. Principle conclusions: REP using a non-antibiotic disinfectant approach appears capable of providing satisfactory outcomes for a non-vital immature permanent tooth. Further high-quality research is required before solid recommendations towards clinical practice guidelines for the disinfection portion of REP can be implemented

Levels of house dust mite allergen in cars [Razine alergena prašinskih grinja u automobilima]

This small study investigated house dust mite (HDM) allergen levels in cars and their owners’ homes in north-east Scotland. Dust samples from twelve households and cars were collected in a standardised manner. The dust samples were extracted and measured for the Dermatophagoides group 2 allergens (Der p 2 and Der f 2) and total soluble protein. Allergen levels at homes tended to be higher than in the cars, but not significantly. However, they significantly correlated with paired car dust samples expressed either per unit weight of dust or soluble protein (rho=0.657; p=0.02 and 0.769; p=0.003, respectively). This points to house-to-car allergen transfer, with the car allergen levels largely reflecting levels in the owner’s home. Car HDM allergen levels were lower than those reported in Brazil and the USA. Twenty-five percent of the houses and none of the cars had allergen levels in dust greater than 2000 ng g-1. This value is often quoted as a threshold for the risk of sensitisation, although a number of studies report increased risk of sensitisation at lower levels. This small study does not allow for characterisation of the distribution of HDM allergen in vehicles in this geographic area, or of the likely levels in other warmer and more humid areas of the UK. Cars and other vehicles are an under-investigated micro-environment for exposure to allergenic material. U ovome smo preliminarnom istraživanju izmjerili razine alergena prašinskih grinja u automobilima i domovima njihovih vlasnika u sjevernoistočnoj Škotskoj. Uzorci prašine uzeti su na standardizirani način iz dvanaest domova i dvanaest odgovarajućih automobila. Nakon ekstrakcije izmjerene su razine 2. skupine alergena grinja roda Dermatophagoides (Der p 2 i Der f 2) te njihove ukupne topljive bjelančevine. Razine alergena u kućama bile su mahom više nego u automobilima, ali ne značajno. Uočena je međutim značajna korelacija njihovih razina s razinama u automobilima, bez obzira na to jesu li iskazane udjelom težine po gramu prašine ili topljivim bjelančevinama (rho=0,657; p=0,02 odnosno 0,769; p=0,003). To upućuje na prijenos alergena iz kuće u auto tj. pokazuje da razine alergena u autima odražavaju razine u domovima njihovih vlasnika. Razine alergena kućnih prašinskih grinja u automobilima u Škotskoj bile su niže od onih izmjerenih u Brazilu i SAD-u. U 25 % domova razina alergena bila je viša od 2000 ng g-1, a ni u jednom uzorku nije izmjerena razina viša od te. Ta se vrijednost često smatra graničnom za rizik od senzitizacije, premda neka istraživanja govore o povišenom riziku od senzitizacije i pri nižim razinama alergena. Rezultati ovog istraživanja ne daju uvida u stvarnu prisutnost alergena kućnih prašinskih grinja u vozilima u sjeveroistočnoj Škotskoj niti upućuju na to kolike bi mogle biti njihove razine u toplijim i vlažnijim krajevima Ujedinjenog Kraljevstva. Automobili i ostala vozila zanemareni su kao izvori izloženosti alergenima

Impact of COVID-19 pandemic on characteristics, extent and trends in child maltreatment in 34 Euro-CAN COST Action countries: a scoping review protocol.

Introduction While the factors commonly associated with an increased risk of child maltreatment (CM) were found to be increased during COVID-19, reports of actual maltreatment showed varying trends. Similarly, evidence regarding the impact of COVID-19 on CM within the European Cooperation on Science and Technology and Network Collaborative (COST) Action countries remains inconsistent. This scoping review aims to explore the extent and nature of evidence pertaining to CM within the countries affiliated with the Child Abuse and Neglect in Europe Action Network (Euro-CAN), funded by the COST. Methods and analysis Key electronic databases were searched to identify eligible papers, reports and other material published between January 2020 and April 2023: PubMed, EMBASE, PsycINFO, Social Policy and Practice, Scopus and Web of Science. To cover the breadth of evidence, a systematic and broad search strategy was applied using a combination of keywords and controlled vocabulary for four concepts: children, maltreatment, COVID-19 and Euro-CAN countries, without restrictions on study design or language. Grey literature was searched in OpenGrey and Google Scholar. Two reviewers will independently screen full-text publications for eligibility and undertake data extraction, using a customised grid. The screening criteria and data charting will be piloted by the research team.The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews will be followed to present the results. Results will be summarised in a tabular form and narratively. Ethics and dissemination This review will identify and summarise publicly available data, without requiring ethical approval. The findings will be disseminated to the Euro-CAN Network and reported to the COST Association. They will also be published in a peer-reviewed journal. This protocol is registered on Open Science Framework

Impact of COVID-19 pandemic on characteristics, extent and trends in child maltreatment in 34 Euro-CAN COST Action countries: a scoping review protocol

Introduction While the factors commonly associated with an increased risk of child maltreatment (CM) were found to be increased during COVID-19, reports of actual maltreatment showed varying trends. Similarly, evidence regarding the impact of COVID-19 on CM within the European Cooperation on Science and Technology and Network Collaborative (COST) Action countries remains inconsistent. This scoping review aims to explore the extent and nature of evidence pertaining to CM within the countries affiliated with the Child Abuse and Neglect in Europe Action Network (Euro-CAN), funded by the COST. Methods and analysis Key electronic databases were searched to identify eligible papers, reports and other material published between January 2020 and April 2023: PubMed, EMBASE, PsycINFO, Social Policy and Practice, Scopus and Web of Science. To cover the breadth of evidence, a systematic and broad search strategy was applied using a combination of keywords and controlled vocabulary for four concepts: children, maltreatment, COVID-19 and Euro-CAN countries, without restrictions on study design or language. Grey literature was searched in OpenGrey and Google Scholar. Two reviewers will independently screen full-text publications for eligibility and undertake data extraction, using a customised grid. The screening criteria and data charting will be piloted by the research team. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews will be followed to present the results. Results will be summarised in a tabular form and narratively. Ethics and dissemination This review will identify and summarise publicly available data, without requiring ethical approval. The findings will be disseminated to the Euro-CAN Network and reported to the COST Association. They will also be published in a peer-reviewed journal. This protocol is registered on Open Science Framework

Clinical care of childhood sexual abuse: a systematic review and critical appraisal of guidelines from European countries

Background: The clinical management of Child sexual abuse (CSA) demands specialised skills from healthcare professionals due to its sensitivity, legal implications, and serious physical health and mental health effects. Standardised, comprehensive clinical practice guidelines (CPGs) may be pivotal. In this systematic review, we examined existing CSA national CPGs (NCPGs) from European countries to assess their quality and reporting. Methods: We systematically searched six international databases and multiple grey literature sources, reporting by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Eligible guidelines were CSA guidance from national health agencies or societies in 34 COST Action 19106 Network Countries (CANC), published between January 2012 and November 2022. Two independent researchers searched, screened, reviewed, and extracted data. NCPGs were compared for completeness with reference WHO 2017 and 2019 guidelines. We used the Appraisal of Guidelines for Research and Evaluation (AGREE II) to appraise quality and reporting. PROSPERO: CRD42022320747. Findings: Of 2919 records identified by database searches, none met inclusion criteria. Of 4714 records identified by other methods, 24 NCPGs from 17 (50%) of CANC countries were included. In 17 (50%) of eligible countries, no NCPGs were found. Content varied significantly within and between countries. NCPGs lacked many components in state-of-the art clinical practice compared to WHO reference standards, particularly in safety and risk assessment, interactions with caregivers, and mental health interventions. Appraisal by AGREE II revealed shortcomings in NCPG development, regarding scientific rigour, stakeholder involvement, implementation and evaluation. Interpretation: A notable number of European countries lack an NCPG; existing NCPGs often fall short. The healthcare response to CSA in Europe requires a coordinated approach to develop and implement high-quality CPGs. We advocate for a multidisciplinary team to develop a pan-European CSA guideline to ensure quality care for survivors

Let us talk about it: An exploratory qualitative study of older adults' priorities for oral health in North West England

Objectives: The aim of this study was to explore oral health experiences and priorities in a diverse group of adults aged over 60 in North West England, an area with high oral health inequality. Methods: Participants were selected using purposive sample from multiple settings across the North West: community, primary dental care and residential care home. Data were collected between October 2018 and March 2019 and involved eight focus groups and three individual interviews with a total of 47 participants. The data were analysed using thematic analysis. Results: Four key themes were identified. The first was issues important to people over 60, which included the appearance of one's teeth, communication, continuity of care and the treatment experience. These were informed by two further themes, past experiences of treatment, which were not always favourable, and perceived barriers, such as accessing NHS dentistry, cost, physical access and oral care in institutional settings. The fourth, connected theme focussed on how oral healthcare messages for different audiences should be disseminated. Conclusions: There are shortfalls in the provision of oral healthcare to older adults in the UK. Communication and continuity of care with a trusted oral healthcare provider are key priorities for this population. However, our participants felt that current public provision of dental services is not meeting their needs

Let’s talk about it: An exploratory qualitative study of older adults' priorities for oral health in North-West England

Objectives The aim of this study was to explore oral health experiences and priorities in a diverse group of adults aged over 60 in North-West England, an area with high oral health inequality. Methods Participants were selected using purposive sample from multiple settings across the North-West: community, primary dental care, and residential care-home. Data were collected between October 2018 and March 2019 and involved eight focus groups and three individual interviews with a total of 47 participants. The data were analysed using thematic analysis. Results Four key themes were identified. The first was issues important to people over 60, which included the appearance of one’s teeth, communication, continuity of care and the treatment experience. These were informed by two further themes, past experiences of treatment, which were not always favourable, and perceived barriers, such as accessing NHS dentistry, cost, physical access and oral care in institutional settings. The fourth, connected theme focussed on how oral healthcare messages for different audiences should be disseminated. Conclusions There are shortfalls in the provision of oral healthcare to older adults in the UK. Communication and continuity of care with a trusted oral healthcare provider are key priorities for this population. However, our participants felt that current public provision of dental services is not meeting their needs

Two main subtypes of wheezing illness? Evidence from the 2004 Aberdeen schools asthma survey

To compare risk factors for wheezy bronchitis (WB) and multi-trigger wheeze (MTW) in pre-pubertal children along the spectrum of disease severity. Cross-sectional survey of children aged 7-12 yr in Aberdeen city primary schools in 2004 using parent-completed questionnaires as used in surveys in 1964, 1989, 1994, and 1999. Children were grouped into five categories: no wheeze in the past three years, non-severe wheeze triggered only by a cold (non-severe WB), non-severe wheeze triggered by other factors (non-severe MTW), severe WB, or severe MTW. Severe wheeze was defined as greater than four wheezing attacks, greater than or equal to one disturbed night per week, or speech limitation in the last 12 months. Questionnaires were returned by 3271 children (57.3%), of whom 7.4% had WB (6.1% non-severe and 1.3% severe) and 17.2% had MTW (9.4% non-severe and 7.8% severe). Severe disease was more frequent in children with MTW (31.8%) than in those with WB (5.1%). Whereas the prevalence of MTW had increased since 1964, the prevalence of WB had remained stable over this period. After adjustment for confounders, age had no influence on either wheeze type, and male sex was only associated with non-severe WB [OR 1.44, 95% confidence intervals (1.03-2.02)]. In the WB group eczema or/and hay fever in the child were more strongly associated with severe wheeze [OR 3.28(1.49-7.23) vs. OR 1.84(1.31-2.60)]. In the MTW group, this association was noticeably higher than in the WB group, but did not differ much between non-severe and severe wheeze [OR 5.46(3.70-7.20) and OR 6.01(4.1-8.75) respectively]. The presence of any allergic diseases in either parent increased the odds for non-severe and severe MTW at the same level of magnitude [OR 1.92(1.38-2.68) and OR 1.92(1.34-2.76) respectively], and statistically non-significantly for severe WB [OR 1.75(0.78-3.94)]. Living in a deprived area increased both severe WB and severe MTW, reaching statistical significance only for severe MTW [OR 1.96(1.39-2.78)]. Smoking in the house was associated with increased risk of WB and MTW of any severity. WB and MTW differ in prevalence trends and severity. Within severity levels, the influence of age, allergic diseases in children and parents also differed between these two wheezing subtypes

Occupational exposure to asthmagens and adult onset wheeze and lung function in people who did not have childhood wheeze: A 50-year cohort study

BACKGROUND: There are few prospective studies that relate the development of adult respiratory disease with exposure to occupational asthmagens. OBJECTIVE: To evaluate the risk of adult onset wheeze (AOW) and obstructive lung function associated with occupational exposures over 50years. METHODS: A population-based randomly selected cohort of children who had not had asthma or wheezing illness, recruited in 1964 at age 10-15years, was followed-up in 1989, 1995, 2001 and 2014 by spirometry and respiratory questionnaire. Occupational histories were obtained in 2014 and occupational exposures determined with an asthma-specific job exposure matrix. The risk of AOW and lung function impairment was analysed in subjects without childhood wheeze using logistic regression and linear mixed effects models. RESULTS: All 237 subjects (mean age: 61years, 47% male, 52% ever smoked) who took part in the 2014 follow-up had completed spirometry. Among those who did not have childhood wheeze, spirometry was measured in 93 subjects in 1989, in 312 in 1995 and in 270 subjects in 2001 follow-up. For longitudinal analysis of changes in FEV1 between 1989 and 2014 spirometry records were available on 191 subjects at three time points and on 45 subjects at two time points, with a total number of 663 records. AOW and FEV1<LLN were associated with occupational exposure to food-related asthmagens (adjusted odds ratios (adjORs) 95% CI: 2.7 [1.4, 5.1] and 2.9 [1.1, 7.7]) and biocides/fungicides (adjOR 95% CI: 1.8 [1.1, 3.1] and 3.4 [1.1, 10.8]), with evident dose-response effect (p-trends<0.05). Exposure to food-related asthmagens was also associated with reduced FEV1, FVC and FEF25-75% (adjusted regression coefficients 95% CI: -7.2 [-12.0, -2.4], -6.2 [-10.9, -1.4], and -13.3[-23.4, -3.3]). Exposure to wood dust was independently associated with AOW, obstructive lung function and reduced FEF25-75%. Excess FEV1 decline of 6-8ml/year was observed with occupational exposure to any asthmagen, biocides/fungicides and food-related asthmagens (p<0.05). CONCLUSIONS: This longitudinal study confirmed previous findings of increased risks of adult onset wheezing illness with occupational exposure to specific asthmagens. A novel finding was the identification of food-related asthmagens and biocides/fungicides as potential new occupational risk factors for lung function impairment in adults without childhood wheeze

Changing trends in asthma in 9-12 year olds between 1964 and 2009

Introduction Childhood asthma is a common condition and the prevalence has increased in many countries during the late 20th century. The Aberdeen schools asthma surveys reported rising lifetime prevalence of asthma between 1964 and 2004 in children aged 9–12 years, but a fall in wheeze in the last 3 years between 1999 and 2004. The present study tested the hypothesis that lifetime childhood asthma prevalence has fallen since 2004. Methods Children aged 9–12 years who attended the same schools surveyed since 1964 were invited to participate. A lifetime history of asthma or eczema and also wheeze in the past 3 years and 12 months was ascertained from a questionnaire. Trends over 1999, 2004 and 2009 were analysed with adjustment for age, gender and an index of deprivation. Results There were 2253 eligible children and 1196 (53%) questionnaires were returned. The lifetime prevalence of asthma rose from 24.3% in 1999 to 28.4% in 2004 but fell to 22.1% in 2009 (p<0.001), while wheeze in the last 3 years fell from 27.9% in 1999 to 25.2% in 2004 and fell further to 22.2% in 2009 (p<0.001). The lifetime prevalence of eczema among 9–12 year olds was 21.4% in 1999, 34.1% in 2004 and 30.7% in 2009 (p<0.001). Reductions in symptom prevalences between 2004 and 2009 were significant for girls but not boys. Conclusion The prevalence of lifetime asthma and wheeze appear to have fallen in school children, especially girls, although the low response rate means some caution is required when interpreting the results. Asthma prevalence remains high and the underlying mechanisms remain incompletely understood