Material, behavioural, cultural and psychosocial factors in the explanation of socioeconomic inequalities in oral health

Background: This study aimed to assess the contribution of material, behavioural, cultural and psychosocial factors in the explanation of socioeconomic inequalities (education and income) in oral health of Dutch adults. Methods: Cross-sectional data from participants (25-75 year

A Prognostic Model for the Thirty-day Mortality Risk after Adult Heart Transplantation

Objective: To develop a prognostic model for the thirty-day mortality risk after adult heart transplantation. Methods: In this report we developed a prediction model for the 30-day mortality risk after adult heart transplantation. Logistic regression analysis was used to develop the model in 1,262 adult patients undergoing primary heart transplantation. We evaluated the accuracy of the prediction model; the agreement between the predicted probability and the observed mortality (calibration); and the ability of the model to correctly discriminate between the discordant survival pairs (discrimination). The internal validity of the prediction model was evaluated using the bootstrapping procedures. Results: Recipients age and sex, pre-transplant diagnosis, transplant status, waiting time, cardiopulmonary bypass time, donors age and sex, donor-recipient mismatch for BMI and blood type were independent predictors for 30-day mortality risk after adult heart transplantation. The model showed a good calibration and reasonable discrimination (the corrected area under the receiver operating characteristic curve was 0.71). The internal validity of the prediction model was acceptable. For practical use, we converted the prediction model to score chart. Conclusion: The accuracy and the validity of the prediction model were acceptable. This easy-to-use instrument for predicting the 30-day mortality risk after adult heart transplantation would benefit decision-making by classifying recipients according to their mortality risk and allowing optimal allocation of a donor to a recipient for heart transplantation

Research priorities for oral healthcare: agenda setting from the practitioners’ perspective

Objectives: The aim of this study was to develop a research agenda based on the most important information needs concerning the effects and outcomes of oral healthcare provided by oral healthcare professionals (OHPs). Methods: A two-stage survey study was used to identify and prioritise topics for future research. The first survey generated topics based on information needs by OHPs. Topics were clustered thematically and overlapping topics were merged in 84 research themes. In the second survey, respondents selected their top 5 from the 84 research themes. Themes were sorted by the rank number based on rank sum. Results: In the first survey, 937 topics were suggested. Almost half (n = 430, 46%) were identified as topics related to endodontology, cariology, oral medicine/surgery or tooth restoration. Topics were grouped in 84 research themes, covering 10 research domains. These were prioritised by 235 OHPs. Behaviour change for oral health and oral healthcare for geriatric patients ranked as most important. Conclusions: Consultation of OHPs has resulted in a research agenda, which can be used to inform programming future oral health research. The highest prioritised research themes have an interdisciplinary nature, mainly concern oral disease prevention and are under-represented in the current oral healthcare research portfolio

A research agenda on oral health care as a boundary object that unites the perspectives of patients and practitioners

Abstract Context A research agenda for oral health care was established in the Netherlands using the Dialogue Model. This project served as a case study in which we applied boundary‐work theory as a framework to understand boundaries (ie demarcations) between and within groups, and how these boundaries can be overcome. Objective To gain insights into the boundaries encountered when setting a research agenda, we analysed how this agenda served as a boundary object (ie circumstances, situations or material that connect actor groups and allow boundary crossing) that facilitated crossing boundaries and uniting the perspectives of patients and practitioners. Methods We used a thematic approach to analyse researchers' observations, meeting materials, emails, interviews with patients (n = 11) and a survey among patients and practitioners (n = 18). Results Setting the research agenda helped to cross boundaries in oral health care, which demonstrates its role as a boundary object. First, this made it possible to integrate research topics representing the perspectives and priorities of all patients and also to unite those perspectives. It was essential to involve practitioners at an early stage of the project so that they could better accept the patients' perspectives. This resulted in support for an integrated research agenda, which facilitated the crossing of boundaries. Conclusions The research agenda‐setting project was found to serve as a boundary object in uniting the perspectives and priorities of patients and practitioners. Patient contribution Patient involvement in this case study was structured in the process of research agenda setting using the Dialogue Model

Assessment of Spin in the Abstracts of Randomized Controlled Trials in Dental Caries with Statistically Nonsignificant Results for Primary Outcomes:A Methodological Study

The study aimed to assess the prevalence of spin in the titles and abstracts of randomized controlled trials (RCTs) in dental caries with statistically nonsignificant primary outcomes and to assess the risk indicators which may be associated with spin. Any original publication reporting a two-arm RCT in dental caries with clearly identified statistically nonsignificant primary outcomes published from January 1, 2015, until October 28, 2022, were included. PubMed was searched electronically to identify the eligible publications. The prevalence of spin in titles and abstracts were assessed and categorized into spin patterns based on a predetermined classification scheme. The association between spin and the potential risk indicators at study, author, journal, institutional, and national levels was assessed. A total of 234 eligible RCT publications were included. The prevalence of spin in the titles and abstracts was 3% (95% confidence interval [CI]: 2-6%) and 79% (95% CI: 74-84%), respectively. The most common spin patterns in the results and conclusion sections, respectively, were results focusing on statistically significant within-group comparisons (23%), and conclusions focusing only on statistically significant results without acknowledgment of statistically nonsignificant results for the primary outcomes (26%). The spin was significantly associated with number of study centers (single-center vs. multicenter) (OR = 2.131; 95% CI: 1.092-4.158; p = 0.03), trial designs (nonparallel designs vs. parallel designs) (OR = 0.395; 95% CI: 0.193-0.810; p = 0.01), and overall H index of institutions for last authors (OR = 0.998; 95% CI: 0.996-0.999; p &lt; 0.01), while it was not significantly associated with the other indicators. In the RCT publications with statistically nonsignificant results for primary outcomes in dental caries, the prevalence of spin may be low in the titles but high in the abstracts. Single-center studies with parallel designs and a lower overall H index of institutions for last authors may be more likely to have spin in the abstracts.</p

Oral Health Coaches at Well-Baby Clinics to Promote Oral Health in Preschool Children from the First Erupted Tooth: Protocol for a Multisite, Pragmatic Randomized Controlled Trial

Background: Early childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children. Objective: Within the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months. Methods: This pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared. Results: The first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads. Conclusions: All follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication

Parents’ willingness to invest in primary oral health prevention for their preschool children

There is growing evidence for the beneficial effects of starting oral health prevention early in life. Preventing dental caries in very young children requires considerable investment from parents. Therefore, this cross-sectional study aimed to explore parents’ willingness to pay (WTP) and willingness to invest in time (WTIT) for primary oral health prevention in preschool children and describe whether these are related to the parents’ demographic, socio-economic and behavioural characteristics. In a convenience sample of parents of preschool children aged six months to four years (n = 142), data were collected with questionnaires. On average, parents were willing to pay EUR15.84 per month, invest time for 1.9 dental visits per year, and spend 2.4 min per day brushing their child’s teeth. A higher education level of the mother and having a child older than two were associated with a higher WTIT in brushing minutes per day (p = 0.03). In addition, parents who brushed their child’s teeth more frequently were also more willing to invest in brushing minutes (p < 0.01) and money (p < 0.01). Findings emphasise the importance of early oral health interventions and the need to increase awareness of primary prevention’s importance in maintaining healthy teeth and reducing possibly oral health inequalities

Spinal manipulation for low back pain: An updated systematic review of randomized clinical trials

Study Design. Systematic review of randomized clinical trials. Objectives. To assess the efficacy of spinal manipulation for patients with low back pain. Summary of Background Data. The management of low back pain remains controversial. Spinal manipulation is a widely used treatment option for low back pain. Recently issued clinical guidelines suggest that spinal manipulation may be effective for patients with acute low back pain. Methods. A computer-aided search for published papers was conducted, and the methods of the studies identified were assessed. Scores were assigned for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation and analysis), the conclusion of authors regarding spinal manipulation, and the results based on the main outcome measure. Results. Thirty-six randomized clinical trials comparing spinal manipulation with other treatments were identified. The highest score of a trial was 60 points (maximum score was set at 100 points), indicating that most were of poor quality. Nineteen studies (53%) showed favorable results for manipulation. In addition, five studies (14%) reported positive results in one or more subgroups only. Among the five studies with 50-60 points, three were positive, and two were positive only for a subgroup of the study population. Eleven trials compared manipulation with some placebo therapy, with inconsistent results. There appeared to be no clear relation between the methodologic score and the overall outcome of the studies. Twelve trials included patients with acute low back pain only. Of these, five reported positive results, four reported negative results, and three reported positive results in a subgroup of the study population only. There were eight trials comparing manipulation with other conservative treatment modalities, focusing on patients with subacute or chronic low back pain. Of these, five reported positive results, two reported negative results, and in one study no conclusion was presented. There were only 16 studies that included an effect measurement of at least 3 months. In only six of these do the authors report positive effects of manipulation. Conclusions. The efficacy of spinal manipulation for patients with acute or chronic low back pain has not been demonstrated with sound randomized clinical trials. There certainly are indications that manipulation might be effective in some subgroups of patients with low back pain. These impressions justify additional research efforts on this topic. Methodologic quality remains e critical aspect that should be dealt with in future studies

Steroid injections for shoulder disorders: A systematic review of randomized clinical trials

Background. Patients with shoulder disorders are believed to benefit considerably from steroid injections. However, the controversy about their efficacy persists. Aim. The study was designed to assess the efficacy of steroid injections for shoulder disorders. Method. A systematic computerized literature search in Medline and Embase was conducted, supplemented with citation tracking of all relevant publications. Studies published before November 1995 were selected if steroid injections were randomly allocated to patients with shoulder disorders and when clinically relevant outcome measures were reported. Because the validity of study outcomes depends heavily on the strength of methodological quality, the methods were assessed systematically by two 'blinded' independent reviewers. This resulted in a method score (maximum 100 points) that was based on four categories: study population, interventions, measurement of effect, and data presentation and analysis. Confidence intervals for the differences between groups in success rates were calculated in order to summarize the efficacy of steroid injections. Results. Only three out of the 16 studies scored more than 50 points, indicating a generally poor quality of methods. Most studies reported small sample sizes. The flaws most often found were incomparability of co-interventions and poor blinding of therapist. The methods assessment was frequently hampered by incomplete information about randomization, prognostic comparability, compliance, outcome measures included, blinding of patients and blinding of outcome measurement. Conclusions. The evidence in favour of the efficacy of steroid injections for shoulder disorders is scarce. The methods of most studies appear to be of poor quality. The few studies that appear to be credible do not provide conclusive evidence about which patients at what time in the course of shoulder disorders benefit most from steroid injections