Geographic and socioeconomic variations in adolescent toothbrushing: a multilevel cross-sectional study of 15 year olds in Scotland

Background: This study examined urban–rural and socioeconomic differences in adolescent toothbrushing. Methods: The data were modelled using logistic multilevel modelling and the Markov Chain Monte Carlo method of estimation. Twice-a-day toothbrushing was regressed upon age, family affluence, family structure, school type, area-level deprivation and rurality, for boys and girls separately. Results: Boys’ toothbrushing was associated with area-level deprivation but not rurality. Variance at the school level remained significant in the final model for boys' toothbrushing. The association between toothbrushing and area-level deprivation was particularly strong for girls, after adjustment for individuals’ family affluence and type of school attended. Rurality too was independently significant with lower odds of brushing teeth in accessible rural areas. Conclusion: The findings are at odds with the results of a previous study which showed lower caries prevalence among children living in rural Scotland. A further study concluded that adolescents have a better diet in rural Scotland. In total, these studies highlight the need for an examination into the relative importance of diet and oral health on caries, as increases are observed in population obesity and consumption of sugars

Use of the out-of-hours emergency dental service at two south-east London hospitals

Abstract Background Prior to the introduction of the 2006 NHS dental contract in England and Wales, general dental practitioners (GDPs) were responsible for the provision of out-of-hours (OOH) emergency dental services (EDS); however there was great national variation in service provision. Under the contractual arrangements introduced 1st April 2006, local commissioning agencies became formally responsible for the provision of out-of-hours emergency dental services. This study aimed to examine patients' use of an out-of-hours emergency dental service and to determine whether the introduction of the 2006 national NHS dental contract had resulted in a change in service use, with a view to informing future planning and commissioning of care. Methods A questionnaire was administered to people attending the out-of-hours emergency dental service at two inner city London hospitals over two time periods; four weeks before and six months after the introduction of the dental contract in April 2006. The questionnaire explored: reasons for attending; dental registration status and attendance; method of access; knowledge and use of NHS Direct; satisfaction with the service; future preferences for access and use of out-of-hours dental services. Data were compared to determine any impact of the new contract on how and why people accessed the emergency dental service. Results The response rate was 73% of attendees with 981 respondents for the first time period and 546 for the second. There were no significant differences between the two time periods in the gender, age, ethnic distribution or main language of service users accessing the service. Overall, the main dental problem was toothache (72%) and the main reason for choosing this service was due to the inability to access another emergency dental service (42%). Significantly fewer service users attended the out-of-hours emergency dental service during the second period because they could not get an appointment with their own dentist (p = 0.002 from 28% to 20%) and significantly more service users in the second period felt the emergency dental service was easier to get to than their own dentist (P = 0.003 from 8% to 14%). Service users found out about the service from multiple sources, of which family and friends were the most common source (30%). In the second period fewer service users were obtaining information about the service from dental receptionists (P = 0.002 from 14% to 9%) and increased use of NHS Direct for a dental problem was reported (P = 0.002 from 16% to 22%) along with more service users being referred to the service by NHS Direct (P = 0.02 from 19% to 24%). The most common preference for future emergency dental care was face-to-face with a dentist (79%). Conclusion This study has provided an insight into how and why people use an out-of-hours emergency dental service and has helped to guide future commissioning of these services. Overall, the service was being used in much the same way both before and after the 2006 dental contract. Significantly more use was being made of NHS Direct after April 2006; however, informal information networks such as friends and family remain an important source of information about accessing emergency dental services.</p

Developing and applying a disaggregated retail location model with extended retail demand estimations

The spatial interaction model (SIM) is an important tool for retail location analysis and store revenue estimation, particularly within the grocery sector. However, there are few examples of SIM development within the literature that capture the complexities of consumer behavior or discuss model developments and extensions necessary to produce models which can predict store revenues to a high degree of accuracy. This article reports a new disaggregated model with more sophisticated demand terms which reflect different types of retail consumer (by income or social class), with different shopping behaviors in terms of brand choice. We also incorporate seasonal fluctuations in demand driven by tourism, a major source of non-residential demand, allowing us to calibrate revenue predictions against seasonal sales fluctuations experienced at individual stores. We demonstrate that such disaggregated models need empirical data for calibration purposes, without which model extensions are likely to remain theoretical only. Using data provided by a major grocery retailer, we demonstrate that statistically, spatially, and in terms of revenue estimation, models can be shown to produce extremely good forecasts and predictions concerning store patronage and store revenues, including much more realistic behavior regarding store selection. We also show that it is possible to add a tourist demand layer, which can make considerable forecasting improvements relative to models built only with residential demand

Core equivalence in presence of satiation and indivisibilities

Equivalence between rejective core and set of dividend equilibria allocations is studied in finite economy and double infinity economy frameworks in presence of indivisibilities of commodities while also allowing the presence of satiated agents. It is further shown that in the finite economy and the double infinity economy, the core of every renegotiation core, the rejective core of every replica economy and the set of dividend equilibria are identical. Hence, core equivalence is demonstrated in both frameworks

Visitor expenditure estimation for grocery store location planning: a case study of Cornwall

Visitor expenditure is an important driver of demand in many local economies, supporting a range of services and facilities which may not be viable based solely on residential demand. In areas where self-catering accommodation is prevalent visitor demand makes up a considerable proportion of sales and revenue within grocery stores, yet this form of visitor consumption is commonly overlooked in supply and demand-side estimates of visitor spend. As such, store location planning in tourist resorts, decisions about local service provision and the local economic impacts of tourism are based on very limited demand-side estimates of visitor spend. Using Cornwall, South West England as a study area, we outline a methodology and data sources to estimate small-area visitor grocery spend. We use self-catering accommodation provision, utilisation and visitor expenditure rates as key factors driving visitor spend. We identify that the use of visitor accommodation accounts for the spatial and temporal complexities of visitor demand that may be overlooked when using alternative approaches, such as the up-scaling of residential demand. Using a spatial interaction model, we demonstrate that our expenditure estimates can be used to generate store level revenue estimation within tourist resorts, and we make a number of recommendations for service provision and store location planning in these areas

Measles-containing vaccines in Brazil: Coverage, homogeneity of coverage and associations with contextual factors at municipal level

We aimed to (i) describe both the coverage and the homogeneity of coverage of the first and second doses of measles-containing vaccines (MCV) in Brazil in 2017, and (ii) to investigate the potential influence of contextual factors at municipal level. All 5570 Brazilian municipalities were included. The North and Center-West regions presented the lowest coverages of the first and second doses of MCV, respectively. We found significant associations of both first and second doses of MCV with population size, coverage of Family Health Strategy (FHS) and other indicators of living conditions and inequalities. Monitoring the homogeneity of MCV coverage at national, regional and state levels is essential, as it allows identifying areas at higher risk of measles spread that should be targeted for vaccination. Targeting large cities i.e. 100,000 or more inhabitants, especially poor neighborhoods and areas with low FHS coverage, could lead to improvements in coverage homogeneity

A qualitative exploration of preventive dental advice for parents of children with congenital heart disease

Background/Aims Children with congenital heart disease are at an increased risk of developing oral disease, which can negatively impact their general health and increase the risk of infective endocarditis. This study explored the preventive oral health advice given to parents of children with congenital heart disease and any barriers that exist to the implementation of this advice. Methods Four semi-structured interviews were conducted with parents of children with congenital heart disease, which followed a topic guide that explored personal experiences of oral healthcare provision and the advice received. Interviews were audio recorded and transcribed verbatim. Thematic analysis was undertaken by one researcher, with themes reviewed by a second. Results Improving awareness of oral health was highlighted as being important to participants. The prioritisation of the child's heart condition was also discussed, and participants felt that there were opportunities to develop the multidisciplinary collaboration between dental and cardiac teams. The consistency of messages could also be enhanced, as health advice sometimes contradicted oral health guidance, which could unintentionally increase the child's risk of tooth decay. Conclusions Enhancing collaboration between the various disciplines involved in the care of children with congenital heart disease is needed to ensure that appropriate advice and support is given to parents regarding oral health

Remuneration of primary dental care in England: a qualitative framework analysis of perspectives of a new service delivery model incorporating incentives for improved access, quality and health outcomes

Objective: This study aimed to describe stakeholder perspectives of a new service delivery model in primary care dentistry incorporating incentives for access, quality and health outcomes. Design: Data were collected through observations, interviews and focus groups. Setting: This was conducted under six UK primary dental care practices, three working under the incentive-driven contract and three working under the traditional activity-based contract. Participants: Observations were made of 30 dental appointments. Eighteen lay people, 15 dental team staff and a member of a commissioning team took part in the interviews and focus groups. Results: Using a qualitative framework analysis informed by Andersen’s model of access, we found oral health assessments influenced patients’ perceptions of need, which led to changes in preventive behaviour. Dentists responded to the contract, with greater emphasis on prevention, use of the disease risk ratings in treatment planning, adherence to the pathways and the utilisation of skill-mix. Participants identified increases in the capacity of practices to deliver more care as a result. These changes were seen to improve evaluated and perceived health and patient satisfaction. These outcomes fed back to shape people’s predispositions to visit the dentist. Conclusion: The incentive-driven contract was perceived to increase access to dental care, determine dentists’ and patients’ perceptions of need, their behaviours, health outcomes and patient satisfaction. Dentists face challenges in refocusing care, perceptions of preventive dentistry, deployment of skill mix and use of the risk assessments and care pathways. Dentists may need support in these areas and to recognise the differences between caring for individual patients and the patient-base of a practice

Using High Fluoride Concentration Products in Public Policy – A Rapid Review of Current Guidelines for High Fluoride Concentration products

Despite improvements in dental caries levels since the widespread introduction of fluoride toothpastes, it is still a disease which is considered to be a priority in many countries around the world. Individuals at higher risk of caries can be targeted with products with a high fluoride concentration to help reduce the amount and severity of the disease. This paper compares guidance from around the world on the use of products with a high fluoride concentration and gives examples of how guidance has been translated into activity in primary care dental practice. A rapid review of electronic databases was conducted to identify the volume and variation of guidance from national or professional bodies on the use of products with a high fluoride concentration. Fifteen guidelines published within the past 10 years and in English were identified and compared. The majority of these guidelines included recommendations for fluoride varnish use as well as for fluoride gels, while a smaller number offered guidance on high fluoride strength toothpaste and other vehicles. Whilst there was good consistency in recommendations for fluoride varnish in particular, there was sometimes a lack of detail in other areas of recommendation for other vehicles with a high fluoride concentration. There are good examples within the UK, such as the Childsmile project and Delivering Better Oral Health, which highlight that the provision of evidence-based guidance can be influential in directing scarce resources towards oral health improvements. Policy can be influenced by evidence-based national recommendations and used to help encourage dental professionals and commissioners and third-party payers to adopt higher levels of practices aimed at oral health improvement

Cost-effectiveness of child caries management: a randomised controlled trial (FiCTION trial)

Background: A three-arm parallel group, randomised controlled trial set in general dental practices in England, Scotland, and Wales was undertaken to evaluate three strategies to manage dental caries in primary teeth. Children, with at least one primary molar with caries into dentine, were randomised to receive Conventional with best practice prevention (C + P), Biological with best practice prevention (B + P), or best practice Prevention Alone (PA). Methods: Data on costs were collected via case report forms completed by clinical staff at every visit. The coprimary outcomes were incidence of, and number of episodes of, dental pain and/or infection avoided. The three strategies were ranked in order of mean cost and a more costly strategy was compared with a less costly strategy in terms of incremental cost-effectiveness. Costs and outcomes were discounted at 3.5%. Results: A total of 1144 children were randomised with data on 1058 children (C + P n = 352, B + P n = 352, PA n = 354) used in the analysis. On average, it costs £230 to manage dental caries in primary teeth over a period of up to 36 months. Managing children in PA was, on average, £19 (97.5% CI: -£18 to £55) less costly than managing those in B + P. In terms of effectiveness, on average, there were fewer incidences of, (− 0.06; 97.5% CI: − 0.14 to 0.02) and fewer episodes of dental pain and/or infection (− 0.14; 97.5% CI: − 0.29 to 0.71) in B + P compared to PA. C + P was unlikely to be considered cost-effective, as it was more costly and less effective than B + P. Conclusions: The mean cost of a child avoiding any dental pain and/or infection (incidence) was £330 and the mean cost per episode of dental pain and/or infection avoided was £130. At these thresholds B + P has the highest probability of being considered cost-effective. Over the willingness to pay thresholds considered, the probability of B + P being considered cost-effective never exceeded 75%. Trial registration: The trial was prospectively registered with the ISRCTN (reference number ISRCTN77044005) on the 26th January 2009 and East of Scotland Research Ethics Committee provided ethical approved (REC reference: 12/ES/0047)