A scoping review of interventions to improve oral health in prison settings

OBJECTIVE: To describe the characteristics of oral health interventions implemented in prison settings and explore the barriers and facilitators towards implementation. METHODS: Following Joanna Briggs Institute scoping review methodology, six databases were searched including Medline (R), Emcare, Embase, AMED, Cochrane and PsycINFO. A total of 978 studies were returned and screened. The inclusion criteria were those studies conducted in a prison population, with an intervention to address oral health and published since 2000. RESULTS: Ten studies published between 2008 and 2021 were included. All were conducted in high-income countries. Three intervention types were identified: health education (n = 5), teledentistry (n = 3) and screening or triaging (n = 2). The barriers and facilitators to successful implementation were grouped into a framework of four overarching concepts. These included prison environment, population makeup, compliance and staffing. CLINICAL SIGNIFICANCE: Evidence suggests that oral health interventions in prisons are focused on improving access to services and oral health messages. A range of drivers including the prison environment, staffing levels, recruitment and intervention compliance influence implementation and the success of interventions

A multi-program analysis of cleft lip with cleft palate prevalence and mortality using data from 22 International Clearinghouse for Birth Defects Surveillance and Research programs, 1974-2014

Background Cleft lip with cleft palate (CLP) is a congenital condition that affects both the oral cavity and the lips. This study estimated the prevalence and mortality of CLP using surveillance data collected from birth defect registries around the world. Methods Data from 22 population- and hospital-based surveillance programs affiliated with the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) in 18 countries on live births (LB), stillbirths (SB), and elective terminations of pregnancy for fetal anomaly (ETOPFA) for CLP from 1974 to 2014 were analyzed. Prevalence and survival (survival for LB only) estimates were calculated for total and subclassifications of CLP and by pregnancy outcome. Results The pooled prevalence of total CLP cases was 6.4 CLP per 10,000 births. The prevalence of CLP and all of the pregnancy outcomes varied across programs. Higher ETOPFA rates were recorded in most European programs compared to programs in other continents. In programs reporting low ETOPFA rates or where there was no ascertainment of ETOPFA, the rate of CLP among LB and SB was higher compared to those where ETOPFA rates were ascertained. Overall survival for total CLP was 91%. For isolated CLP, the survival was 97.7%. CLP associated with multiple congenital anomalies had an overall survival of 77.1%, and for CLP associated with genetic/chromosomal syndromes, overall survival was 40.9%. Conclusions Total CLP prevalence reported in this study is lower than estimates from prior studies, with variation by pregnancy outcomes between programs. Survival was lower when CLP was associated with other congenital anomalies or syndromes compared to isolated CLP

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Sustainable PPI:Empowering the public in oral and dental research, education and NHS Service

Aim: Highlight why the project was undertaken and the key aim/objectivesTo convene an oral and dental Patient and Public Involvement (PPI) group, with a focus on under-represented patient groups.Methods: A more detailed account of the methods usedA Short Life Working Group (SLWG) formed and met regularly over 18 months to develop governance, training, and recruitment functions for Dundee Dental Hospital and Research School (DDHR&amp;S). DDH&amp;RS is a collaboration between NHS Tayside, NHS Education for Scotland, and University of Dundee. National Institute for Health and Care Research (NIHR) PPI briefing notes for researchers underpinned the approach. An initial data risk assessment guided data collection and handling, ensuring compliance with GDPR. Initial activity focused on adults. A series of Public Engagement (PE) events were organised to raise interest and initiate a PPI group. Locations included a shopping centre and DDHR&amp;S. Outreach to under-represented groups took place via 3rd sector organisations including Brittle Bone Society and Trussell Trust. Social media was used to showcase involvement opportunities. PPI Lead Roles were created and administrative support provided.Results: Present examples of the main results of the work.Three public engagement events took place including an interactive event in a shopping centre, a tour of DDH&amp;RS facilities, and a science fayre. Fifty-seven members of the public have joined the PPI group. Members of the group have indicated interest in head and neck cancer, substance misuse, homelessness, general oral health, and dental services. Training resources and an online staff handbook have been created to support staff in DDH&amp;RS. Resultant PPI activity has been initiated in design of dental education, informing grant applications, and research design. Involvement opportunities are shared via email, post, and telephone dependent on member preferences. PPI Staff Lead roles have been formalised in DDH&amp;RS with ongoing admin support to sustain activity.Patient and Public Involvement: Detail work you have undertaken to involve patients, public or carers in the development of your projectPPI activity took place during an initial PE event with members asked to provide feedback on the group name, meeting format, communication preferences, and reimbursement expectations. Content for the community-based PE event was discussed with an existing lay rep to shape event content and resources required. A final event included focus on refining the approach to PPI in DDH&amp;RS by asking members in more depth about themes of interest and methods for involvement.Conclusions: List the main implications of your findingsA PPI function to support dental education, oral health related research, and dental services has been created. The time taken to develop supporting structures and resources for PPI activity has resulted in a sustainable function that is embedded in DDH&amp;RS. Next steps include extension of the work to develop a function for child oral health.References: Acknowledge any other individuals, funders or specific programmes associated with your work.Acknowledgement: With thanks to Lorna McPherson, University of Dundee for input to the initial grant application. With thank to Jill Sutherland and Shambhunath R for administrative support. We would also like to thank our PPI members for their input to shaping the PPI function.<br/

Sustainable PPI:Empowering the public in oral and dental research, education and NHS Service

Aim: Highlight why the project was undertaken and the key aim/objectivesTo convene an oral and dental Patient and Public Involvement (PPI) group, with a focus on under-represented patient groups.Methods: A more detailed account of the methods usedA Short Life Working Group (SLWG) formed and met regularly over 18 months to develop governance, training, and recruitment functions for Dundee Dental Hospital and Research School (DDHR&amp;S). DDH&amp;RS is a collaboration between NHS Tayside, NHS Education for Scotland, and University of Dundee. National Institute for Health and Care Research (NIHR) PPI briefing notes for researchers underpinned the approach. An initial data risk assessment guided data collection and handling, ensuring compliance with GDPR. Initial activity focused on adults. A series of Public Engagement (PE) events were organised to raise interest and initiate a PPI group. Locations included a shopping centre and DDHR&amp;S. Outreach to under-represented groups took place via 3rd sector organisations including Brittle Bone Society and Trussell Trust. Social media was used to showcase involvement opportunities. PPI Lead Roles were created and administrative support provided.Results: Present examples of the main results of the work.Three public engagement events took place including an interactive event in a shopping centre, a tour of DDH&amp;RS facilities, and a science fayre. Fifty-seven members of the public have joined the PPI group. Members of the group have indicated interest in head and neck cancer, substance misuse, homelessness, general oral health, and dental services. Training resources and an online staff handbook have been created to support staff in DDH&amp;RS. Resultant PPI activity has been initiated in design of dental education, informing grant applications, and research design. Involvement opportunities are shared via email, post, and telephone dependent on member preferences. PPI Staff Lead roles have been formalised in DDH&amp;RS with ongoing admin support to sustain activity.Patient and Public Involvement: Detail work you have undertaken to involve patients, public or carers in the development of your projectPPI activity took place during an initial PE event with members asked to provide feedback on the group name, meeting format, communication preferences, and reimbursement expectations. Content for the community-based PE event was discussed with an existing lay rep to shape event content and resources required. A final event included focus on refining the approach to PPI in DDH&amp;RS by asking members in more depth about themes of interest and methods for involvement.Conclusions: List the main implications of your findingsA PPI function to support dental education, oral health related research, and dental services has been created. The time taken to develop supporting structures and resources for PPI activity has resulted in a sustainable function that is embedded in DDH&amp;RS. Next steps include extension of the work to develop a function for child oral health.References: Acknowledge any other individuals, funders or specific programmes associated with your work.Acknowledgement: With thanks to Lorna McPherson, University of Dundee for input to the initial grant application. With thank to Jill Sutherland and Shambhunath R for administrative support. We would also like to thank our PPI members for their input to shaping the PPI function.<br/