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Erwin J, Horrell J, Wheat H, Axford N, Burns L, Booth J, Witton R, Shawe J, Doughty J, Kaddour S, Boswell S, Devalia U, Nelder A, Paisi M. Access to Dental Care for Children and Young People in Care and Care Leavers: A Global Scoping Review. Dent J (Basel) 2024; 12:37. [PMID: 38392241 PMCID: PMC10887801 DOI: 10.3390/dj12020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
AIMS This scoping review aimed to explore three research questions: 1. What is the dental care access for children and young people (CYP) in care and care leavers? 2. What factors influence CYP in care and care leavers' access to dental care? 3. What pathways have been developed to improve access to oral health care for CYP in care and care leavers? METHODS Five databases (Ovid MEDLINE, Ovid Embase, CINAHL, SocINDEX and Dentistry and Oral Sciences Source) and grey literature sources were systematically searched. Articles relating to CYP in care or care leavers aged 0-25 years old, published up to January 2023 were included. Abstracts, posters and publications not in the English language were excluded. The data relating to dental care access were analysed using thematic analysis. RESULTS The search identified 942 articles, of which 247 were excluded as duplicates. A review of the titles and abstracts yielded 149 studies. Thirty-eight were eligible for inclusion in the review: thirty-three peer-reviewed articles, one PhD thesis and four grey literature sources. All papers were published from very high or medium Human Development Index countries. The studies indicate that despite having higher treatment needs, CYP in care and care leavers experience greater difficulty in accessing dental services than those not care-experienced. Organisational, psycho-social and logistical factors influence their access to dental care. Their experience of dental care may be impacted by adverse childhood events. Pathways to dental care have been developed, but little is known of their impact on access. There are very few studies that include care leavers. The voices of care-experienced CYP are missing from dental access research. CONCLUSIONS care-experienced CYP are disadvantaged in their access to dental care, and there are significant barriers to their treatment needs being met.
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Affiliation(s)
- Jo Erwin
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Jane Horrell
- Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Hannah Wheat
- Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Nick Axford
- Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Lorna Burns
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Joelle Booth
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
- Centre for Dental Public Health and Primary Care, Queen Mary University of London, Turner Street, London E1 2AD, UK
| | - Robert Witton
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
- Peninsula Dental Social Enterprise, Plymouth PL6 8BT, UK
| | - Jill Shawe
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Janine Doughty
- School of Dentistry, Royal Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS, UK
| | - Sarah Kaddour
- Pathway Oral Health Fellow, Pathway, 250 Euston Road, London NW1 2PG, UK
| | - Skye Boswell
- Patient and Public Involvement Member, Plymouth County Council, Plymouth PL1 3BJ, UK
| | - Urshla Devalia
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals, London NW1 2BU, UK
| | - Abigail Nelder
- Peninsula Dental Social Enterprise, Plymouth PL6 8BT, UK
| | - Martha Paisi
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
- Patient and Public Involvement Member, Plymouth County Council, Plymouth PL1 3BJ, UK
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Bradford DRR, Allik M, McMahon AD, Brown D. Assessing the risk of endogeneity bias in health and mortality inequalities research using composite measures of multiple deprivation which include health-related indicators: A case study using the Scottish Index of Multiple Deprivation and population health and mortality data. Health Place 2023; 80:102998. [PMID: 36921377 DOI: 10.1016/j.healthplace.2023.102998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
The inclusion of health-related indicators in composite measures of multiple deprivation introduces a risk of endogeneity bias when using the latter in health inequalities research. This bias may ultimately result in the inappropriate allocation of healthcare resources and maintenance of preventable health inequalities. Mitigation strategies to avoid this bias include removing the health-related indicators or using single constituent domains (such as income or employment class) in isolation. These strategies have not been widely validated. This study used population-level health and mortality data with a contemporary composite measure of multiple deprivation (Scottish Index of Multiple Deprivation; SIMD) to assess these mitigation strategies. The differences between deprivation methods (original, health excluded, and income domain) were negligible. The results of quantitative research on health inequalities are unlikely to be affected by endogeneity bias.
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Affiliation(s)
- D R R Bradford
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8TB, United Kingdom.
| | - M Allik
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8TB, United Kingdom
| | - A D McMahon
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, G2 3JZ, United Kingdom
| | - D Brown
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8TB, United Kingdom
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Ross AJ, Sherriff A, Kidd J, Deas L, Eaves J, Blokland A, Wright B, King P, McMahon AD, Conway DI, Macpherson LMD. Evaluating childsmile, Scotland's National Oral Health Improvement Programme for children. Community Dent Oral Epidemiol 2023; 51:133-138. [PMID: 36753390 DOI: 10.1111/cdoe.12790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/08/2022] [Accepted: 08/15/2022] [Indexed: 02/09/2023]
Abstract
In the early 2000s, a Scottish Government Oral Health Action Plan identified the need for a national programme to improve child oral health and reduce inequalities. 'Childsmile' aimed to improve child oral health in Scotland, reduce inequalities in outcomes and access to dental services, and to shift the balance of care from treatment to prevention through targeted and universal components in dental practice, community and educational settings. This paper describes how an embedded, theory-based research and evaluation arm with multi-disciplinary input helps determine priorities and provides important strategic direction. Programme theory is articulated in dedicated, dynamic logic models, and evaluation themes are as follows: population-level data linkage; trials and economic evaluations; investigations drawing from behavioural and implementation science; evidence reviews and updates; and applications of systems science. There is also a growing knowledge sharing network internationally. Collaborative working from all stakeholders is necessary to maintain gains and to address areas that may not be working as well, and never more so with the major disruptions to the programme from the COVID-19 pandemic and response. Conclusions are that evaluation and research are synergistic with a complex, dynamic programme like Childsmile. The evidence obtained allows for appraisal of the relative strengths of component interventions and the reach and impact of Childsmile to feed into national policy.
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Affiliation(s)
- Alastair J Ross
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Andrea Sherriff
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Jamie Kidd
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Leigh Deas
- Public Dental Service, NHS Lanarkshire, Glasgow, UK
| | - Jenny Eaves
- Public Dental Service, NHS Lanarkshire, Glasgow, UK
| | - Alex Blokland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Bill Wright
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Peter King
- Public Dental Service, NHS Lanarkshire, Glasgow, UK
| | - Alex D McMahon
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - David I Conway
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Lorna M D Macpherson
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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Slack-Smith L, Arena G. Why and how we can use data linkage in oral health research: a narrative review. Community Dent Oral Epidemiol 2023; 51:75-78. [PMID: 36749677 DOI: 10.1111/cdoe.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 08/30/2022] [Accepted: 11/09/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Poor oral health, impacting health and wellbeing across the life-course, is a costly and wicked problem. Data (or record) linkage is the linking of different sets of data (often administrative data gathered for non-research purposes) that are matched to an individual and may include records such as medical data, housing information and sociodemographic information. It often uses population-level data or 'big data'. Data linkage provides the opportunity to analyse complex associations from different sources for total populations. The aim of the paper is to explore data linkage, how it is important for oral health research and what promise it holds for the future. METHODS This is a narrative review of an approach (data linkage) in oral health research. RESULTS Data linkage may be a powerful method for bringing together various population datasets. It has been used to explore a wide variety of topics with many varied datasets. It has substantial current and potential application in oral health research. CONCLUSIONS Use of population data linkage is increasing in oral health research where the approach has been very useful in exploring the complexity of oral health. It offers promise for exploring many new areas in the field.
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Affiliation(s)
- Linda Slack-Smith
- School of Population and Global Health M431, The University of Western Australia, Perth, Western Australia, Australia
| | - Gina Arena
- School of Population and Global Health M431, The University of Western Australia, Perth, Western Australia, Australia
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Tsakos G, Watt RG, Guarnizo-Herreño CC. Reflections on oral health inequalities: Theories, pathways and next steps for research priorities. Community Dent Oral Epidemiol 2023; 51:17-27. [PMID: 36744970 DOI: 10.1111/cdoe.12830] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 02/07/2023]
Abstract
Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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Sherriff A, Stewart R, Macpherson LMD, Kidd JBR, Henderson A, Cairns D, Conway DI. Child oral health and preventive dental service access among children with intellectual disabilities, autism and other educational additional support needs: A population‐based record linkage cohort study. Community Dent Oral Epidemiol 2022; 51:494-502. [PMID: 36354158 DOI: 10.1111/cdoe.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/25/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Inequalities in child oral health are a global challenge and the intersection of socioeconomic factors with educational additional support needs (ASN), including children with intellectual disabilities or autism, have thus far received limited attention in relatively small clinical studies. We aimed to address this evidence gap by investigating oral health and access to preventive dental services among children with ASN compared to the general child population. METHODS Cohort study linking data from six Scotland-wide health and education databases compared: dental caries experience and tooth extraction via general anaesthetic; receipt of school-based dental inspection; access to primary care and hospital dental services; and access to the Childsmile national oral health improvement programme between children with a range of ASN (intellectual disabilities, autism, social and other) and their peers for the school years 2016/17-2018/19 (n = 166 781). RESULTS Children with any ASN had higher rates of caries experience than those with no ASN, however, after adjustment for socioeconomic deprivation, sex, year, and school type only those with a social or other ASN remained at increased risk. Rates of tooth extraction under general anaesthesia in hospital were higher among children with intellectual disabilities (aRR = 1.67;95% CI = [1.16-2.37]). School-based dental inspection access improved for children with intellectual disability and/or autism from 2016/17 onwards, although higher rates of child refusal on the day were observed in these groups (no ASN refusal: 5.4%; intellectual disability: 35.8%; autism: 40.3%). Children with any ASN were less likely to attend primary dental-care regularly, and in those who attended, children with intellectual disability or autism were less likely than their peers to receive prevention (fluoride varnish, oral-hygiene instruction, or dietary advice). Childsmile nursery-supervised toothbrushing programme access among children with any ASN was similar to children with no ASN and children with intellectual disability (aRR = 1.27;95% CI = [1.12-1.45]) or autism (aRR = 1.32;95% CI = [1.19-1.45]) were more likely to receive support from Childsmile dental health support worker. CONCLUSIONS We have identified inequalities in oral health and dental care for children with different ASN in Scotland with both a greater burden of disease among some groups and higher complexity of care; compounded by reduced and variable access to preventive dental services. Further efforts are needed to develop and improve preventive care pathways for children with ASN and integrate oral health to wider healthcare systems for these children to mitigate against oral health inequalities.
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Affiliation(s)
- Andrea Sherriff
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Ryan Stewart
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Lorna M. D. Macpherson
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Jamie B. R. Kidd
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Angela Henderson
- Scottish Learning Disabilities Observatory, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Gartnavel Royal Hospital University of Glasgow Glasgow UK
| | - Deborah Cairns
- Scottish Learning Disabilities Observatory, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Gartnavel Royal Hospital University of Glasgow Glasgow UK
| | - David I. Conway
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
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Bradford DRR, Allik M, McMahon AD, Brown D. Physical health of care-experienced young children in high-income countries: a scoping review protocol. BMJ Open 2022; 12:e063648. [PMID: 36691175 PMCID: PMC9454045 DOI: 10.1136/bmjopen-2022-063648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/25/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Care-experienced children have poorer health, developmental, and quality of life outcomes across the lifespan compared to children who are not in care. These inequities begin to manifest in the early years. The purpose of the proposed scoping review is to collate and synthesise studies of the physical health of young care-experienced children. The results of the review will help map the distribution of health outcomes, identify potential targets for intervention, and assess gaps in the literature relating to this group. METHODS AND ANALYSIS We will carry out a scoping review of the literature to identify studies of physical health outcomes in care-experienced children. Systematic literature searches will be carried out on the MEDLINE, CINAHL and Web of Science Core Collection databases for items indexed on or before 31 August 2022. Studies will be included where the participants are aged 3 months or greater and less than 6 years. Data elements extracted from included studies will include study objectives, health outcomes, participant demographics, care setting characteristics and bibliographic information. The results of the review will be synthesised and reported using a critical narrative approach. Comparisons between care and non-care populations will be reported if sufficient studies are identified. ETHICS AND DISSEMINATION Data will be extracted from publicly available sources, so no additional ethical approval is required. Results will be published in a peer-reviewed journal article. Furthermore, they will be shared in summary reports and presented to local authorities, care organisations and other relevant stakeholders that can influence healthcare policy and procedure relating to young children in care.
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Affiliation(s)
- Daniel R R Bradford
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Mirjam Allik
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alex D McMahon
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Denise Brown
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Göransson L, Ekermann S, Dovik C, Klingberg G, Ridell K, Laurell L. Children's advocacy centre fails to respond to dental, mental and physical ill-health in abused children. Acta Paediatr 2022; 111:1186-1193. [PMID: 35279867 PMCID: PMC9314582 DOI: 10.1111/apa.16328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/29/2022] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
Aim Sweden´s first multidisciplinary children's advocacy centre (CAC) was founded in 2005 as a collaborative practice between child protection services, the legal system and health care in response to police‐reported child abuse. CACs were introduced in the county of Skåne in 2007. The aim of the study was to describe the health of children investigated at the CAC in Lund, and to examine whether the CAC model of collaboration responded to the healthcare needs of these children. Methods All children aged 0–17 years investigated at the CAC in 2015 were included in this retrospective study. We reviewed the CAC files and the children's medical and dental records from one year prior to, until one year after their assessment at the CAC. Results Our review of the medical and dental records (n = 298) showed a high prevalence of mental, dental and physical ill‐health. After the CAC joint meeting, only 1% of the children were referred for a medical examination and 4% for a focused forensic evaluation. Conclusion Our study demonstrates limitations in the CAC process in responding to extensive health issues of the young victims of crime. We suggest mental, dental and physical health assessments to be statutory in CACs.
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Affiliation(s)
- Linn Göransson
- Department of Gynaecology and Obstetrics Eksjö Hospital Eksjö Sweden
| | | | - Christoffer Dovik
- Department of Internal Medicine and Emergency Care Skåne University Hospital Lund Sweden
| | | | - Karin Ridell
- Faculty of Odontology Malmö University Malmö Sweden
| | - Louise Laurell
- Department of Paediatrics Skåne University Hospital Lund University, Faculty of Medicine, Department of Clinical Sciences Lund Sweden
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Moore D, Allen T, Boyers D, McKenzie K, Thompson W, Nyakutsikwa B, Pretty I, Tickle M. Unlocking the potential of NHS primary care dental datasets. Br Dent J 2022; 232:241-250. [PMID: 35217745 DOI: 10.1038/s41415-022-3987-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/25/2021] [Indexed: 11/09/2022]
Abstract
Introduction Maximising the use of routinely collected health data for research is a key part of the UK Government's Industrial Strategy. Rich data are generated by NHS primary care dental services, but the extent of their use in research is unknown.Aims To profile the utility of the post-2006 NHS dental datasets for research, map how they have been used to date and develop recommendations to maximise their utility.Methods The content of and access to the four UK NHS dental datasets was collated using publicly available information and a free-text questionnaire, completed by the relevant data controllers. A scoping review was carried out to identify and map literature that has utilised NHS dental activity data.Results The contents of the UK NHS dental activity datasets are described, alongside how they may be accessed for research. Strengths and weaknesses of these datasets for research are highlighted. The scoping review identified 33 studies which had utilised NHS dental activity data since 2006. We classified 15 as public health practice, 11 as service evaluation and 7 as research.Conclusion In comparision to other NHS activity datasets, it appears that the UK dental datasets have been underutilised for research. We make 11 recommendations on how their utility for research may be increased.
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Affiliation(s)
- Deborah Moore
- Research Associate, Dental Public Health, The University of Manchester, Division of Dentistry, Dental Health Unit, Lloyd Street North, Manchester Science Park, M15 6SE, UK.
| | - Thomas Allen
- Research Fellow, Health Economics, Danish Centre for Health Economics, University of Southern Denmark, Denmark; The University of Manchester, Manchester Centre for Health Economics, Room 4.305 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Dwayne Boyers
- Research Fellow, Health Economics Research Unit, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Kate McKenzie
- Research Assistant, Dental Public Health, The University of Manchester, Division of Dentistry, Dental Health Unit, Lloyd Street North, Manchester Science Park, M15 6SE, UK
| | - Wendy Thompson
- NIHR Clinical Lecturer, The University of Manchester, Division of Dentistry, Coupland 3, M13 9PL, UK
| | - Blessing Nyakutsikwa
- Research Associate, Dental Public Health, The University of Manchester, Division of Dentistry, Dental Health Unit, Lloyd Street North, Manchester Science Park, M15 6SE, UK
| | - Iain Pretty
- Professor of Public Health Dentistry, The University of Manchester, Division of Dentistry, Dental Health Unit, Lloyd Street North, Manchester Science Park, M15 6SE, UK
| | - Martin Tickle
- Professor of Dental Public Health and Primary Care, The University of Manchester, Division of Dentistry, Coupland 3, M13 9PL, UK
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Fleming M, McLay JS, Clark D, King A, Mackay DF, Minnis H, Pell JP. Educational and health outcomes of schoolchildren in local authority care in Scotland: A retrospective record linkage study. PLoS Med 2021; 18:e1003832. [PMID: 34767555 PMCID: PMC8589203 DOI: 10.1371/journal.pmed.1003832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Looked after children are defined as children who are in the care of their local authority. Previous studies have reported that looked after children have poorer mental and physical health, increased behavioural problems, and increased self-harm and mortality compared to peers. They also experience poorer educational outcomes, yet population-wide research into the latter is lacking, particularly in the United Kingdom. Education and health share a bidirectional relationship; therefore, it is important to dually investigate both outcomes. Our study aimed to compare educational and health outcomes for looked after children with peers, adjusting for sociodemographic, maternity, and comorbidity confounders. METHODS AND FINDINGS Linkage of 9 Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions, unemployment, and looked after children provided retrospective data on 715,111 children attending Scottish schools between 2009 and 2012 (13,898 [1.9%] looked after). Compared to peers, 13,898 (1.9%) looked after children were more likely to be absent (adjusted incidence rate ratio [AIRR] 1.27, 95% confidence interval [CI] 1.24 to 1.30) and excluded (AIRR 4.09, 95% CI 3.86 to 4.33) from school, have special educational need (SEN; adjusted odds ratio [AOR] 3.48, 95% CI 3.35 to 3.62) and neurodevelopmental multimorbidity (AOR 2.45, 95% CI 2.34 to 2.57), achieve the lowest level of academic attainment (AOR 5.92, 95% CI 5.17 to 6.78), and be unemployed after leaving school (AOR 2.12, 95% CI 1.96 to 2.29). They were more likely to require treatment for epilepsy (AOR 1.50, 95% CI 1.27 to 1.78), attention deficit hyperactivity disorder (ADHD; AOR 3.01, 95% CI 2.76 to 3.27), and depression (AOR 1.90, 95% CI 1.62 to 2.22), be hospitalised overall (adjusted hazard ratio [AHR] 1.23, 95% CI 1.19 to 1.28) for injury (AHR 1.80, 95% CI 1.69 to 1.91) and self-harm (AHR 5.19, 95% CI 4.66 to 5.78), and die prematurely (AHR 3.21, 95% CI 2.16 to 4.77). Compared to children looked after at home, children looked after away from home had less absenteeism (AIRR 0.35, 95% CI 0.33 to 0.36), less exclusion (AIRR 0.63, 95% CI 0.56 to 0.71), less unemployment (AOR 0.53, 95% CI 0.46 to 0.62), and better attainment (AIRR 0.31, 95% CI 0.23 to 0.40). Therefore, among those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes. The main limitations of this study were lack of data on local authority care preschool or before 2009, total time spent in care, and age of first contact with social care. CONCLUSIONS Looked after children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and SEN. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system.
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Affiliation(s)
- Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - James S. McLay
- Department of Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - David Clark
- Public Health Scotland, Edinburgh, United Kingdom
| | - Albert King
- ScotXed, Scottish Government, Edinburgh, United Kingdom
| | - Daniel F. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Allik M, Brown D, Taylor Browne Lūka C, Macintyre C, Leyland AH, Henderson M. Cohort profile: The 'Children's Health in Care in Scotland' (CHiCS) study-a longitudinal dataset to compare health outcomes for care experienced children and general population children. BMJ Open 2021; 11:e054664. [PMID: 34521682 PMCID: PMC8442099 DOI: 10.1136/bmjopen-2021-054664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The Children's Health in Care in Scotland Cohorts were set up to provide first population-wide evidence on the health outcomes of care experienced children (CEC) compared with children in the general population (CGP). To date, there are no data on how objective health outcomes, mortality and pregnancies for CEC are different from CGP in Scotland. PARTICIPANTS The CEC cohort includes school-aged children who were on the 2009/2010 Scottish Government's Children Looked After Statistics (CLAS) return and on the 2009 Pupil Census (PC). The children in the general population cohort includes those who were on the 2009 PC and not on any of the CLAS returns between 1 April 2007 and 31 July 2016. FINDINGS TO DATE Data on a variety of health outcomes, including mortality, prescriptions, hospitalisations, pregnancies, and Accident & Emergency attendances, were obtained for the period 1 August 2009 to 31 July 2016 for both cohorts. Data on socioeconomic status (SES) for both cohorts were available from the Birth Registrations and a small area deprivation measure was available from the PC. CEC have, on average, lower SES at birth and live in areas of higher deprivation compared with CGP. A higher proportion of CEC have recorded events across all health data sets, and they experienced higher average rates of mortality, prescriptions and hospitalisations during the study period. The reasons for contacting health services vary between cohorts. FUTURE PLANS Age-standardised rates for the two cohorts by sex and area deprivation will be calculated to provide evidence on population-wide prevalence of main causes of death, reasons for hospitalisation and types of prescription. Event history analysis will be used on matched cohorts to investigate the impact of placement histories and socioeconomic factors on health.
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Affiliation(s)
- Mirjam Allik
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Denise Brown
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | | | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Marion Henderson
- School of Social Work & Social Policy, University of Strathclyde, Glasgow, UK
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12
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Stein C, Cunha-Cruz J, Hugo FN. Is dietary pattern a mediator of the relationship between socioeconomic status and dental caries? Clin Oral Investig 2021; 25:5441-5447. [PMID: 33825968 DOI: 10.1007/s00784-021-03852-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate whether a healthy diet and added sugar mediate the relationship between socioeconomic status and oral health status in adults. METHODS This is a secondary cross-sectional analysis of adult participants from the 2015-2016 National Health and Nutrition Examination Survey from the United States (n=3367). Structural equation modeling tested direct and indirect pathways from a latent variable for socioeconomic status to oral health via healthy eating (Health Eating Index) and added sugar in a multiple-mediator multiple-outcome model. RESULTS Added sugar was directly associated with untreated dental caries [Standardized coefficient (SC)=0.10], and healthy eating was directly associated with both untreated dental caries (SC=-0.11) and tooth loss (SC=-0.05). Higher socioeconomic status was associated with lower untreated dental caries through direct (SC =-0.246) and small indirect paths via healthy diet (SC= -0.026), lower consumption of added sugar (SC=-0.007), and dental visits (SC=-0.162). Higher socioeconomic status was associated with fewer teeth lost through direct (SC =-0.306) and very small indirect paths via healthy diet (SC=-0.016), added sugar consumption (SC=-0.001), and untreated dental caries (SC=-0.094). CONCLUSIONS Both socioeconomic status and dietary pattern independently contributed to tooth loss and dental caries. The contribution of dietary factors as a mediator to socioeconomic inequities in oral health was small, and statistically significant. CLINICAL RELEVANCE A systems approach to socioeconomic inequities in oral health takes into account the complex relationships between socioeconomics, dietary patterns, oral health and health. Socioeconomic conditions and nutrition, as common risk factors to noncommunicable disorders, should be tackled in programs to improve oral health.
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Affiliation(s)
- Caroline Stein
- Postgraduate Program in Dentistry, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2492, Santa Cecília, Porto Alegre, RS, Brazil.
| | - Joana Cunha-Cruz
- Department of Oral Health Sciences, School of Dentistry and Department of Health Services, School of Public Health University of Washington, Seattle, WA, USA
| | - Fernando Neves Hugo
- Postgraduate Program in Dentistry, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2492, Santa Cecília, Porto Alegre, RS, Brazil.,Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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13
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Broomhead T, Rodd HD, Baker SR, Jones K, Davies G, White S, Marshman Z. A rapid review of variation in the use of dental general anaesthetics in children. Br Dent J 2020; 229:31-39. [PMID: 32651519 DOI: 10.1038/s41415-020-1846-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction The use of dental general anaesthetics (DGAs) remains a cause for concern due to additional strains placed on health services. There are numerous factors influencing the prevalence and use of DGAs, and understanding these is an important first step in addressing the issue.Aim Conduct a rapid review of current peer-reviewed and grey literature on the variation in the use of DGAs in children.Methods Electronic searching using Medline via Ovid covering DGA articles from 1998 onwards, written in English. Publication types included primary and secondary sources from peer-reviewed journals and reports, as well as grey literature.Results From 935 results, 171 articles were included in the final review. Themes emerging from the literature included discussions of DGA variation, variations in standards of service provision by health services, and the socio-demographic and geographical characteristics of children. Prominent socio-demographic and geographical characteristics included age, other health conditions, ethnic and cultural background, socioeconomic status and deprivation, and geographical location.Conclusions This review identified numerous variations in the patterns associated with DGA provision and uptake at both a health service and individual level. The findings demonstrate the complicated and multifaceted nature of DGA practices worldwide.
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Affiliation(s)
- Tom Broomhead
- Unit of Oral health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK.
| | - Helen D Rodd
- Unit of Oral health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK
| | - Sarah R Baker
- Unit of Oral health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK
| | - Kate Jones
- Consultant in Dental Public Health, Health Improvement Directorate, Health Intelligence, Public Health England, 5th Floor North, Wellington House,133-155 Waterloo Road, London, SE1 8UG, UK
| | - Gill Davies
- Consultant in Dental Public Health, Health Improvement Directorate, Health Intelligence, Public Health England, 5th Floor North, Wellington House,133-155 Waterloo Road, London, SE1 8UG, UK
| | - Sandra White
- National Lead for Dental Public Health, Health Improvement Directorate, Health Intelligence, Public Health England, 5th Floor North, Wellington House,133-155 Waterloo Road, London, SE1 8UG, UK
| | - Zoe Marshman
- Unit of Oral health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK
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14
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Janus M, Reid-Westoby C, Lee C, Brownell M, Maguire JL. Association between severe unaddressed dental needs and developmental health at school entry in Canada: a cross-sectional study. BMC Pediatr 2019; 19:481. [PMID: 31810457 PMCID: PMC6898915 DOI: 10.1186/s12887-019-1868-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/02/2019] [Indexed: 11/24/2022] Open
Abstract
Background Dental problems are the most prevalent chronic disease worldwide, with up to half of all kindergarten children having tooth decay. However, there is a lack of evidence of whether unaddressed dental needs (UDNs) are associated with children’s developmental health, a concept reflecting holistic child development - encompassing physical, emotional, and cognitive development. The objective of the current study was to evaluate the relationship between UDNs and developmental health among kindergarten children using the Early Development Instrument (EDI). Methods We examined associations between teacher reported UDNs and developmental vulnerability on the EDI. Children were included in the study if they were enrolled in kindergarten in publicly-funded schools in Canada between 2010 and 2015, had been in the classroom for at least one month, and had no more than 25% of missing items on the questionnaire. Results Among 576,264 children who met inclusion criteria (95.4% of eligible children), 2465 (0.4%) were identified as having UDNs by their teachers. Children with UDNs had 4.58 to 8.27 times higher odds of being vulnerable on any of the five developmental domains (physical health and well-being, social competence, emotional maturity, language and cognitive development, communication skills and general knowledge), compared to children without UDNs. Conclusion In this study, teacher-reported UDNs were associated with developmental vulnerability in kindergarten children. Teacher reported unmet dental needs in kindergarten children may be a proxy for poor developmental health at school entry, and thus a marker for supporting both children’s oral health and early developmental needs.
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Affiliation(s)
- Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, McMaster Innovation Park, 175 Longwood Rd South, Suite 201A, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
| | - Caroline Reid-Westoby
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, McMaster Innovation Park, 175 Longwood Rd South, Suite 201A, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Catherine Lee
- Bachelor of Health Sciences (Honours), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathon L Maguire
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Nutritional Sciences, Faculty of Medicine, Universtiy of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Paediatrics, St. Michael's Hospital, Toronto, ON, Canada
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15
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Macpherson LMD, Rodgers J, Conway DI. Childsmile after 10 years part 2: programme development, implementation and evaluation. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/denu.2019.46.3.238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lorna MD Macpherson
- Professor of Dental Public Health, School of Medicine, Dentistry and Nursing, University of Glasgow, UK
| | | | - David I Conway
- Professor of Dental Public Health, School of Medicine, Dentistry and Nursing, University of Glasgow, UK
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Verd S, Aguiló G, Kraemer M, Fernández M, Servera C, Colom M, Palmer P, López-Sureda M, Juan M, Ripoll J, Llobera J. Past medical history: A comparison between children at the point of entry into the care system and children at home. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/15379418.2018.1521761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sergio Verd
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Gloria Aguiló
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Milanka Kraemer
- Family Medicine Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Mercedes Fernández
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Catalina Servera
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Marina Colom
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Patricia Palmer
- Family Medicine Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Mar López-Sureda
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Marta Juan
- Child Protection Department, Majorcan Local Authority, Palma de Mallorca, Spain
| | - Joana Ripoll
- Research Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Juan Llobera
- Research Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
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17
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Harris JC. The mouth and maltreatment: safeguarding issues in child dental health. Arch Dis Child 2018; 103:722-729. [PMID: 29472196 DOI: 10.1136/archdischild-2017-313173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Jenny C Harris
- Charles Clifford Dental Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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