Linking families with pre-school children from healthcare services to community resources: a systematic review protocol

Background: Poor health and health inequalities persist despite increasing investment in health improvement programmes across high-income countries. Evidence suggests that to reduce health inequalities, a range of activities targeted at different levels within society and throughout the life course should be employed. There is a particular focus on addressing inequalities in early years as this may influence the experience of health in adulthood. To address the wider determinants of health at a community level, a key intervention which can be considered is supporting patients to access wider community resources. This can include processes such as signposting, referral and facilitation. There is a lack of evidence synthesis in relation to the most effective methods for linking individuals from health services to other services within communities, especially when considering interventions aimed at families with young children. Method/design: The aim of this study is to understand the way health services can best help parents, carers and families with pre-school children to engage with local services, groups and agencies to address their wider health and social needs. The review may inform future guidance to support families to address wider determinants of health. The study is a systematic review, and papers will be identified from the following electronic databases: Web of Science, Embase, MEDLINE and CINAHL. A grey literature search will be conducted using an internet search engine and specific grey literature databases (TRiP, EThOS and Open Grey). Reference lists/bibliographies of selected papers will be searched. Quality will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies and the CASP tool for qualitative studies. Data will be synthesised in a narrative form and weighted by study quality. Discussion: It is important to understand how health services can facilitate access to wider services for their patients to address the wider determinants of health. This may impact on the experience of health inequalities. This review focuses on how this can be achieved for families with pre-school children, and the evidence obtained will be useful for informing future guidance on this topic

A protocol for a systematic review of clinical guidelines and published systematic reviews on the early detection of oral cancer

Background: The predicted increase in incidence of oral cavity cancer (OCC) coupled with high mortality and poor prognosis – particularly when diagnosed at a late/advanced stage – highlights the need for prevention and early detection/screening to reverse these trends. Dental healthcare professionals in primary care settings have a pivotal role in this effort. Aim: The aim of this protocol is to detail the process for assessing the evidence for the best practice and methods of early detection/screening for OCC in primary care dental settings by undertaking a systematic review of global clinical guidelines and published systematic reviews. Method: Searches for clinical guidelines and systematic reviews will be conducted in the following databases: Cochrane library, Medical Literature Analysis and Retrieval System Online (Ovid), Excerpta Medical dataBASE, PubMed, Turning Research into Practice, SCOPUS and Web of Science Core Collection. Our search will extend to include Google Scholar and international professional organizations/associations websites. In addition, we will handsearch the bibliographies and undertake citation searches of the selected papers. Quality appraisal will be undertaken using the Appraisal of Guidelines for Research and Evaluation version II instrument for the clinical guidelines and both A MeaSurement Tool to Assess Systematic Reviews and Risk of Bias in Systematic Reviews tools for the systematic reviews. A narrative synthesis approach will be used to assess the evidence of extracted data, primarily taking account of quality appraisal and recency of publication. Discussion: The synthesis of evidence will determine best practice for OCC early detection/screening by primary care dental healthcare professionals and will evaluate the relationship between clinical guidelines and the evidence base available from systematic reviews in this area

Inequalities in the dental health needs and access to dental services among looked after children in Scotland: a population data linkage study

Background: There is limited evidence on the health needs and service access among children and young people who are looked after by the state. The aim of this study was to compare dental treatment needs and access to dental services (as an exemplar of wider health and well-being concerns) among children and young people who are looked after with the general child population. Methods: Population data linkage study utilising national datasets of social work referrals for ‘looked after’ placements, the Scottish census of children in local authority schools, and national health service’s dental health and service datasets. Results: 633 204 children in publicly funded schools in Scotland during the academic year 2011/2012, of whom 10 927 (1.7%) were known to be looked after during that or a previous year (from 2007–2008). The children in the looked after children (LAC) group were more likely to have urgent dental treatment need at 5 years of age: 23%vs10% (n=209/16533), adjusted (for age, sex and area socioeconomic deprivation) OR 2.65 (95% CI 2.30 to 3.05); were less likely to attend a dentist regularly: 51%vs63% (n=5519/388934), 0.55 (0.53 to 0.58) and more likely to have teeth extracted under general anaesthesia: 9%vs5% (n=967/30253), 1.91 (1.78 to 2.04). Conclusions: LAC are more likely to have dental treatment needs and less likely to access dental services even when accounting for sociodemographic factors. Greater efforts are required to integrate child social and healthcare for LAC and to develop preventive care pathways on entering and throughout their time in the care system

The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland:a natural experiment

Background: Financial incentives are often used to influence professional practice, yet the factors which influence their effectiveness and their behavioural mechanisms are not fully understood. In keeping with clinical guidelines, Childsmile (Scotland’s oral health improvement programme) advocates twice yearly fluoride varnish application (FVA) for children in dental practice. To support implementation Childsmile offered dental practitioners a fee-per-item payment for varnishing 2–5-year-olds’ teeth through a pilot. In October 2011 payment was extended to all dental practitioners. This paper compares FVA pre- and post-roll-out and explores the financial incentive’s behavioural mechanisms. Methods: A natural experimental approach using a longitudinal cohort of dental practitioners (n = 1090) compared FVA pre- (time 1) and post- (time 2) financial incentive. Responses from practitioners who did not work in a Childsmile pilot practice when considering their 2–5-year-old patients (novel incentive group) were compared with all other responses (continuous incentive group). The Theoretical Domains Framework (TDF) was used to measure change in behavioural mechanisms associated with the incentive. Analysis of covariance was used to investigate FVA rates and associated behavioural mechanisms in the two groups. Results: At time 2, 709 74%, of eligible responders, were followed up. In general, FVA rates increased over time for both groups; however, the novel incentive group experienced a greater increase (β [95% CI] = 0.82 [0.72 to 0.92]) than the continuous incentive group. Despite this, only 33% of practitioners reported ‘always’ varnishing increased risk 2–5-year-olds’ teeth following introduction of the financial incentive, 19% for standard risk children. Domain scores at time 2 (adjusting for time 1) increased more for the novel incentive group (compared to the continuous incentive group) for five domains: knowledge, social/professional role and identity, beliefs about consequences, social influences and emotion. Conclusions: In this large, prospective, population-wide study, a financial incentive moderately increased FVA in dental practice. Novel longitudinal use of a validated theoretical framework to understand behavioural mechanisms suggested that financial incentives operate through complex inter-linked belief systems. While financial incentives are useful in narrowing the gap between clinical guidelines and FVA, multiple intervention approaches are required

Lung cancer and socioeconomic status in a pooled analysis of case-control studies

This study was supported by (...) Grant sponsor: European Commission's INCO Copernicus program; Grant number: IC15-CT96-0313; Grant sponsor: European Union Nuclear Fission Safety Program; Grant number: F14P-CT96-0055; Grant sponsors: Institute Universitario de Oncologia, Universidad de Oviedo, Asturias, Fondo de Investigacion Sanitaria (FIS) and Ciber de Epidemiologia y Salud Publica (CIBERESP).Hovanec, J., Siemiatycki, J., Conway, D.I., Olsson, A., Stücker, I., Guida, F., Jockel, K.-H., Pohlabeln, H., Ahrens, W., Brüske, I., Wichmann, H.-E., Gustavsson, P., Consonni, D., Merletti, F., Richiardi, L., Simonato, L., Fortes, C., Parent, M.-E., McLaughlin, J., Demers, P., Landi, M.T., Caporaso, N., Tardón, A., Zaridze, D., Szeszenia-Dabrowska, N., Rudnai, P., Lissowska, J., Fabianova, E., Field, J., Dumitru, R.S., Bencko, V., Foretova, L., Janout, V., Kromhout, H., Vermeulen, R., Boffetta, P., Straif, K., Schüz, J., Kendzia, B., Pesch, B., Brüning, T., Behrens, T

Cancer-Associated Fibroblasts Neutralize the Anti-tumor Effect of CSF1 Receptor Blockade by Inducing PMN-MDSC Infiltration of Tumors.

Tumor-associated macrophages (TAM) contribute to all aspects of tumor progression. Use of CSF1R inhibitors to target TAM is therapeutically appealing, but has had very limited anti-tumor effects. Here, we have identified the mechanism that limited the effect of CSF1R targeted therapy. We demonstrated that carcinoma-associated fibroblasts (CAF) are major sources of chemokines that recruit granulocytes to tumors. CSF1 produced by tumor cells caused HDAC2-mediated downregulation of granulocyte-specific chemokine expression in CAF, which limited migration of these cells to tumors. Treatment with CSF1R inhibitors disrupted this crosstalk and triggered a profound increase in granulocyte recruitment to tumors. Combining CSF1R inhibitor with a CXCR2 antagonist blocked granulocyte infiltration of tumors and showed strong anti-tumor effects

The WiggleZ Dark Energy Survey: the selection function and z=0.6 galaxy power spectrum

We report one of the most accurate measurements of the three-dimensional large-scale galaxy power spectrum achieved to date, using 56,159 redshifts of bright emission-line galaxies at effective redshift z=0.6 from the WiggleZ Dark Energy Survey at the Anglo-Australian Telescope. We describe in detail how we construct the survey selection function allowing for the varying target completeness and redshift completeness. We measure the total power with an accuracy of approximately 5% in wavenumber bands of dk=0.01 h/Mpc. A model power spectrum including non-linear corrections, combined with a linear galaxy bias factor and a simple model for redshift-space distortions, provides a good fit to our data for scales k < 0.4 h/Mpc. The large-scale shape of the power spectrum is consistent with the best-fitting matter and baryon densities determined by observations of the Cosmic Microwave Background radiation. By splitting the power spectrum measurement as a function of tangential and radial wavenumbers we delineate the characteristic imprint of peculiar velocities. We use these to determine the growth rate of structure as a function of redshift in the range 0.4 < z < 0.8, including a data point at z=0.78 with an accuracy of 20%. Our growth rate measurements are a close match to the self-consistent prediction of the LCDM model. The WiggleZ Survey data will allow a wide range of investigations into the cosmological model, cosmic expansion and growth history, topology of cosmic structure, and Gaussianity of the initial conditions. Our calculation of the survey selection function will be released at a future date via our website wigglez.swin.edu.au.Comment: 21 pages, 22 figures, accepted for publication in MNRA

Human Papilloma Virus (HPV) Oral Prevalence in Scotland (HOPSCOTCH):a feasibility study in dental settings

The purpose of this study was to test the feasibility of undertaking a full population investigation into the prevalence, incidence, and persistence of oral Human Papilloma Virus (HPV) in Scotland via dental settings. Male and female patients aged 16-69 years were recruited by Research Nurses in 3 primary care and dental outreach teaching centres and 2 General Dental Practices (GDPs), and by Dental Care Teams in 2 further GDPs. Participants completed a questionnaire (via an online tablet computer or paper) with socioeconomic, lifestyle, and sexual history items; and were followed up at 6-months for further questionnaire through appointment or post/online. Saline oral gargle/rinse samples, collected at baseline and follow-up, were subject to molecular HPV genotyping centrally. 1213 dental patients were approached and 402 individuals consented (participation rate 33.1%). 390 completed the baseline questionnaire and 380 provided a baseline oral specimen. Follow-up rate was 61.6% at 6 months. While recruitment was no different in Research Nurse vs Dental Care Team models the Nurse model ensured more rapid recruitment. There were relatively few missing responses in the questionnaire and high levels of disclosure of risk behaviours (99% answered some of the sexual history questions). Data linkage of participant data to routine health records including HPV vaccination data was successful with 99.1% matching. Oral rinse/gargle sample collection and subsequent HPV testing was feasible. Preliminary analyses found over 95% of samples to be valid for molecular HPV detection prevalence of oral HPV infection of 5.5% (95%CI 3.7, 8.3). It is feasible to recruit and follow-up dental patients largely representative / reflective of the wider population, suggesting it would be possible to undertake a study to investigate the prevalence, incidence, and determinants of oral HPV infection in dental settings