The effectiveness of school dental screening: dental attendance and treatment of those screened positive.

OBJECTIVE: To determine dental attendance and treatment outcomes following two models of dental screening. DESIGN: An observational prospective cohort study. SETTING: Infant, primary and junior schools in the North West of England. SUBJECTS: Children aged six to nine years at the start of the study. INTERVENTIONS: Subjects received a screening examination according to either a 'Traditional model' or 'New model' of school dental screening. MAIN OUTCOME MEASURES: Attendance at a dentist within four months of the intervention and treatment received by children referred via the 'New model' with caries in their permanent teeth. RESULTS: In the 'New model' of school dental screening 46% of screened positive and 41% of screened negative children attended a dentist during the study period. Some 44% of children referred with caries in permanent teeth attended a dentist and 53% of those attending received treatment for the referred condition. Larger proportions of children from disadvantaged backgrounds were screened positive but higher proportions of children from more affluent backgrounds attended the dentist and subsequently received treatment. CONCLUSION: School dental screening has a minimal impact on dental attendance and only a small proportion of screened positive children receive appropriate treatment. The programme fails to reduce inequalities in utilisation of dental services.

Differing perspectives on outcome after subarachnoid hemorrhage: the patient, the relative, the neurosurgeon.

OBJECTIVE: To better understand patients' and relatives' views of outcome after surgery for subarachnoid hemorrhage (SAH), we evaluated neurobehavioral changes, psychological distress, and family burden of patients who had been considered by their neurosurgeon as having a "good recovery" or a "moderate disability," as rated on the Glasgow Outcome Scale. METHODS: A heterogeneous sample of 28 patients treated surgically for SAH from an aneurysm or an arteriovenous malformation and their relatives separately underwent a semistructured interview. They also completed a revised version of the Adjective Checklist to assess their perceptions of the patient's neurobehavioral changes and the Brief Symptom Inventory as a measure of their own psychological distress. Levels of family burden on the relatives were evaluated with a Likert strain scale and the Zarit Burden Interview. RESULTS: Approximately 19 months after surgery for SAH, the majority of the patients reported significant negative neurobehavioral changes and negative changes in employment, energy levels, tolerance to mild stressors, leisure activities, and social and sexual relationships. Patients and relatives both reported elevated levels of psychological distress, and the relatives reported elevated levels of family burden. Patients' and relatives' perceptions differed, with the relatives reporting more problems; both viewed the patient's outcome more negatively than did the operating neurosurgeon. CONCLUSION: Despite the neurosurgeon's classification of patients as having a "good recovery" or "moderate disability," the majority of patients surgically treated for SAH reported psychosocial and neurobehavioral changes that were disabling for them and burdensome to their family. Patients and relatives who are interviewed separately by an experienced clinician may provide differing perspectives on SAH outcome that are not necessarily good.

Personality & behaviour changes following spinal cord injury: self perceptions--partner's perceptions.

There has been little specific investigation of personality and behaviour changes following spinal cord injury (SCI) and only limited consideration of the possible impact of concurrent traumatic brain injury (TBI). By mail-out questionnaire, we evaluated personality and behaviour changes in a married group (n = 9) with traumatic SCI, who knew their partners prior to injury, and who had not been identified as having concurrent TBI on referral to the Canadian Paraplegic Association. Both the person with SCI (and the partner) completed the revised Adjective Checklist and by their combined report, there were significant personality and behaviour changes. Unexpectedly, five individuals described post-traumatic amnesia (PTA) > or = 3 days. Subsequently, participants' reports were further divided into two groups--"longer PTA" and "shorter PTA". The "longer PTA" group self-reported less change and more positive change than did their partners. The "longer PTA" partners described changes that are consistent with the profile of TBI. The "shorter PTA" group described themselves more negatively than did their partners. Given the size of the groups (n = 5, n = 4), these findings are presented to illustrate trends and to stimulate further research.

Psychological distress and family burden following spinal cord injury: concurrent traumatic brain injury cannot be overlooked.

Although concurrent spinal cord injury (SCI) and traumatic brain injury (TBI) are recognized, there is little acknowledgement of SCI/TBI as a contributor to psychological distress and family burden. By mail-out questionnaire, we evaluated psychological distress and family burden in a married group (n = 12) with traumatic SCI who had not been identified as having concurrent TBI on referral to the Canadian Paraplegic Association. Both the person with SCI and the partner completed the Brief Symptom Inventory (BSI), the Adjective Checklist, and a Likert strain scale to measure the perception of the partner's strain. The partner also completed the Zarit Burden Interview. Despite screening criteria designed to selectively recruit individuals without TBI, seven individuals described post-traumatic amnesia (PTA) > or = 3 days. Subsequently, participants' reports were divided into two groups--"longer PTA" and "shorter PTA". On the Brief Symptom Inventory, the two SCI groups did not differ, but the partners of individuals with "longer PTA" had significantly elevated Global Severity Index scores compared to the other partners. The "longer PTA" partner group demonstrated more strain and more burden (as measured by the Likert strain scale and the Zarit Burden Interview). Given the size of the groups (n = 7, n = 5), these findings are presented to illustrate trends and to stimulate further research.

The performance of a screening test for urgent dental treatment need in a prison population.

OBJECTIVE: To compare the performance of a questionnaire-based assessment of dental pain delivered by non-dental prison nursing staff against a clinical examination performed by an experienced prison dentist (gold standard). SETTING: The research fieldwork took place in the healthcare department at HMP Brixton located in South London. METHODS: The cohort were those who had complained of dental/facial pain to the prison authorities and were therefore placed on the waiting list for emergency dental care. Subjects were asked to complete the screening test and were then clinically examined by trained and calibrated dentists. The screening test was in the form of a 12-item questionnaire designed to categorise a population reporting dental pain into one of three groups. The screening test results were compared with the diagnosis of a clinical examination. RESULTS: Ninety-six subjects were recruited during the 16-week study period. Of the 96 prisoners recruited, 27 of those failed to complete the screening test and/or the diagnostic examination even though they had reported pain previously. When sensitivity and specificity values were calculated for the 96 prisoners recruited, the sensitivity was fairly high (81%) and the specificity was poor (33%). However, when these values were calculated for the sub-population, those that completed both the screening test and diagnostic examination (n = 69), the sensitivity did not improve particularly (83%) but the specificity value fell substantially to 13%. CONCLUSIONS: This study highlighted the problems of conducting research in the prison environment, for example increased security preventing researchers from gaining access into the prison and general pressures on prison staff. Additionally, the study demonstrated that screening is not effective in local prisons with a high turnover of prisoners.