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Piloting the Interprofessional Narrative-Based Active Working area regarding End-of-Life Discussions: Significance for Mastering and Practice.
OBJECTIVE To investigate the method, learning and challenges of using an enhanced sample to provide small area data for the dental survey of five-year-old children in England. DESIGN Pilot in six London local authorities, of increased sample size during a national survey to enable a more precise sample size calculation to deliver information accurate at electoral ward level. Challenges were explored through interviews with the teams who either planned or conducted the survey. MAIN OUTCOME MEASURES A revised sample size recommendation for the national guidance on carrying out dental surveys of five-year-old children in England, where caries levels are similar to those seen in the pilot areas; the challenges identified were gaining access to schools and consent from parents, making the calculation for the additional sample and securing sufficient workforce. CONCLUSION This paper has described a method for delivering small area caries data by increasing the size of the sample. Learning, and understanding the outcomes and challenges from this work can inform planning and delivery of future surveys using an enhanced sample at ward level. Copyright© 2020 Dennis Barber Ltd.OBJECTIVE To determine the association between maternal oral health and Early Childhood Caries (ECC) and discover the role of maternal and child behaviours in explaining this association. BASIC RESEARCH DESIGN A cross-sectional analytic study. CLINICAL SETTING Public Healthcare Services in Pasto, Colombia. PARTICIPANTS 384 mothers and their 2-5-year-old children. click here METHODS Mothers completed a questionnaire to provide information on sociodemographic and behavioural factors and were examined for caries experience (DMFS index) and periodontal status (Community Periodontal Index, CPI). Children were examined for dental caries (dmfs index). The association between maternal dental indicators and child dmfs was assessed in negative binomial regression adjusting for confounders. RESULTS About 96% and 33% of mothers had caries experience and periodontal disease, respectively. The mean dmfs was 7.4 (SD 9.5, range 0-71). Maternal DMFS, but not CPI, was positively associated with children's dmfs (Rate Ratio 2.51, 95%CI 1.59-3.97) after adjustments for sociodemographic and behavioural factors. CONCLUSIONS Maternal caries experience, but not periodontal status, was positively associated with ECC in their children. Maternal and child behaviours explained little of this association. Copyright© 2020 Dennis Barber Ltd.OBJECTIVE Assess interventions and health outcomes in studies giving data on economic evaluation (EE) of school-based caries prevention. BASIC RESEARCH DESIGN Systematic review. Both partial EE that included cost description, cost-outcome description, cost analysis and full EE that included both cost and outcome of at least 2 interventions were included. Quality assessment used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. RESULTS An electronic search of 6 databases identified 558 titles and abstracts. Paper eligibility screening identified 32 full papers which met the inclusion criteria. Most were conducted in the United States and cost effectiveness analysis was the most common type of EE. Nine were model-based studies and 17 derived their data from single studies. Sealants were most frequently evaluated followed by fluoride mouthrinse. Many CHEERS criteria were not met in the included studies. The following were found to be cost-effective school-based, under general supervision, longer duration of program and targeting high caries risk groups. CONCLUSIONS The deficiencies in the existing studies warrant more investigations of the economic aspects of school-based activities interventions to prevent caries. Copyright© 2020 Dennis Barber Ltd.OBJECTIVE To describe the shape of the relationship between area deprivation and dental attendance (DA) in children aged 5 years and under in England and the modifying effect of caries prevalence, ethnicity, family profile and dentist-to-population ratio. BASIC RESEARCH DESIGN DA rates were calculated at lower-tier local authority level (LA, n=326) using NHS data for the year to March 2017. LA deprivation was determined by Index of Multiple Deprivation 2015. Caries prevalence was retrieved from the 2016/17 National Dental Epidemiology Programme; ethnicity and family profile from Census 2011 and dentist-to-population ratio from NHS statistics. Fractional polynomial (FP) models explored the shape of the relationship. Multivariable regression models were adjusted for covariates. The effect of moderators was estimated by adjusted marginal effects. CLINICAL SETTING English Lower-tier LAs. MAIN OUTCOME MEASURE Shape of the relationship between DA and deprivation and its moderators. RESULTS Best-fitting second-order FP model (p=0.582) did not provide a better fit for the relationship than the linear model. Therefore, the linear model was selected for final analysis. Deprivation was associated with decreased DA rates (Coefficient=-0.39, 95%CI=-0.53,-0.24; p=⟨0.001); while White ethnicity (Coefficient=0.35, 95%CI=0.29, 0.41; p=⟨0.001), single parenthood (Coefficient = 2.21, 95%CI=0.91,3.51; p=0.001) and caries prevalence (Coefficient =0.34, 95%CI=0.25,0.44; p=⟨0.001) with increased rates. These moderated the relationship. CONCLUSIONS We hypothesised that the shape of the relationship between deprivation and DA could be curvilinear with higher rates in the extreme ends of deprivation. However, the analysis showed a linear association, moderated by the effect of ethnicity, single parenthood and disease level. Copyright© 2020 Dennis Barber Ltd.BACKGROUND According to the latest recommendation for patients with hyperuricemia and high cardiovascular risk, the serum uric acid (SUA) concentration should be lower than 5 mg/dL ( less then 298 μmol/L). Additionally, studies have shown that SUA concentration in participants with hyperuricemia correlates with some dietary factors. The aim of this study was to assess the relationship between SUA concentration and some cardiovascular risk factors. METHODS Fifty-six postmenopausal women with dyslipidemia and without hypertension were assigned to 2 groups based on SUA concentration. The first group consisted of women with a SUA concentration ≥5 mg/dL and without gout, and the second group comprised women with a SUA concentration less then 5 mg/dL. Anthropometric parameters, nutrition, structure of consumption, dietary potential renal acid load (PRAL), lipid profile parameters and blood pressure were evaluated. RESULTS Postmenopausal women with a SUA ≥5 mg/dL had statistically significant higher values of serum triglyceride (TG) concentration, waist-to-hip ratio (WHR) and diastolic blood pressure than women with a SUA concentration less then 5 mg/dL.
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