What factors affect the ability of refugees to access dental care services?

DESIGN: This was a systematic review of the quantitative evidence for which factors influence the ability of refugee populations to access dental care services. DATA SOURCES: Searches were performed using broad search terms on the electronic databases MEDLINE (via Ovid), Embase (via Ovid), Web of Science (all databases) and American Psychology Association PsycINFO with no time, language, or regional restrictions. STUDY SELECTION: Studies examining factors associated with access to dental care amongst refugees were eligible. Outcomes relating to any aspect of access were included. Quantitative observational or intervention studies including quantitative components of mixed method studies, were eligible for inclusion. Studies not published in English were excluded. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed by a single author, with a random sample of 10% reviewed by a second. Quality was assessed utilising the National institute for Health's Quality Assurance tool for observational studies and were identified as being either fair (n = 7) or poor (n = 2). Factors identified as influencing access were synthesised using the Behavioural Model of Health Services Use. RESULTS: In total, 69 full-text articles were screened. Nine were included in the final narrative synthesis, including refugee populations across 10 countries (5 individual countries and one including multiple countries). Designs were cross sectional (n = 6) or retrospective (n = 3). Different populations were investigated, including children (n = 4) and adults (n = 5). Refugee populations included Somali (n = 2), Tibetan (n = 1), Palestinian (n = 1), Bhutanese (n = 1), Burmese (n = 1) and mixed groups (n = 4). Common measurements of access included self-reported past dental visits (n = 5), use of dental services (n = 1), perceived barriers to access (n = 1) and missed appointments (n = 1). Untreated decay was used as a proxy measure (n = 1). Common factors identified influencing access related to demography, socio-economic status, acculturation, health and dental literacy and oral health status of refugees. At an individual level, English language proficiency was associated with increased access to dental care. CONCLUSIONS: There is limited evidence on the effects of various factors on influencing access to dental services for refugees. The authors suggest that on an individual level, English language proficiency, acculturation, health and dental literacy and oral health status of refugees may influence access to dental services.

Standard- versus intermediate-dose enoxaparin for anti-factor Xa guided thromboprophylaxis in critically ill patients with COVID-19.

The prevalence of venous thromboembolism (VTE) is high in critically ill patients with COVID-19. Dosing of Low Molecular Weight Heparin (LMWH) for thromboprophylaxis in patients with severe COVID-19 is subject to ongoing debate.In this brief report, we describe our study where we retrospectively examined the efficacy of standard- versus intermediate-dosing of enoxaparin in attaining and maintaining accepted prophylactic levels of anti-Factor Xa (anti-FXa) in critically ill patients with COVID-19.We collected data for all patients with confirmed COVID-19 who were treated with enoxaparin for thromboprophylaxis in a single Intensive Care Unit (ICU) in the United Kingdom between 31st March and 16th November 2020. Standard-dose of enoxaparin was 40 mg subcutaneously once daily for patients with normal renal function and body weight between 50 and 100 kg; the intermediate-dose was 40 mg subcutaneously twice daily. Anti-FXa peak concentrations between 0.2-0.4 IU/ml were considered appropriate for thromboprophylaxis.Age, sex, weight, Body Mass Index, APACHE II score, ICU length of stay, initial P/F ratio and creatinine were not statistically significantly different between standard- and intermediate-dose thromboprophylaxis cohorts. In the standard-dose group, the median initial anti-FXa level was 0.13 (interquartile range 0.06-0.18) compared to 0.26 (0.21-0.33) in the intermediate-dose cohort (p < 0.001). On repeated measurement, in the standard dose cohort, 44 of 95 (46%) anti-FXa levels were < 0.2 IU/ml compared with 24 of 132 (18%) levels in the intermediate-dose cohort even after dose-adjustment. There was one radiologically confirmed pulmonary embolism (PE) on computed tomography pulmonary angiogram during hospital admission in each cohort.Our study supports starting intermediate-dose thromboprophylaxis for critically ill patients with COVID-19 to achieve anti-FXa levels in the accepted thromboprophylactic range although further study is required to investigate whether anti-FXa guided thromboprophylaxis is safe and effective in reducing the incidence of VTEs in critically ill patients with COVID-19.

Oral health experiences of people living with Parkinson's disease: a scoping review.

Background and aim Parkinson's disease is the fastest growing and second most common progressive neurodegenerative condition in the UK; poised to represent a major societal and health care challenge. The scoping review aims to provide an overview of the literature on the oral health (OH) experiences of people living with Parkinson's, identifying current research gaps and future priorities.Method Search strategies included three electronic databases, two grey literature databases, relevant organisations, specialist journals and hand searching of the reference lists. A data extraction tool was developed and piloted.Results A total of 121 items were included in the review. Four themes were identified: OH impact, education and training, service delivery and wider impacts of OH for people with Parkinson's (PwP). The majority of studies included were cross-sectional in design, describing the OH status of PwP.Conclusion The majority of research to date has focused on OH impact. Areas for future research include use of qualitative studies exploring the experiences, attitudes and priorities of PwP and their care partners. Inclusion of medical, dental and allied health care professionals, together with people with lived experience, is required to develop, implement and evaluate interventions to support OH.

Flexibility and access to dental postgraduate speciality training.

Increasingly, there is a clear emphasis on the need for improved access to flexible training. This reflects changing societal attitudes and expectations towards work-life balance and increasing demand for flexible working. The recently published Advancing dental care review: final report (2021) reflects these same demands within dental postgraduate training. Increasing flexible training options has the potential for far-reaching beneficial effects for dental speciality training. There are barriers to accessing speciality training for specific applicant groups and this risks potentially excluding excellent-quality candidates from pursuing speciality training. There is opportunity in utilising and developing flexible training options to support widening access to dental speciality training. Recruitment and working pattern arrangements should reflect these aspirations, ensuring that the best trainees are successful irrespective of their personal circumstances.

An overview of digital readiness in dentistry - are we ready?

Digital technology is transforming how dentistry will be delivered in the future. Adopting digital opportunities will enable staff and patients to confidently navigate this new digital environment. We need to consider how dentistry is identifying and developing digital talent, building digital competence and future-proofing our teams. It also implies there must be a fundamental culture change in the way the profession collaborates with patients, clinicians, service commissioners and policymakers to deliver a sustainable digital transformation.

A case report of oral nicotine-associated keratosis and a review of oral mucosal changes in tobacco and similar products.

There is a strong association between tobacco use and the development of oral mucosal lesions, often with malignant potential. Nicotine is the primary component of tobacco responsible for addiction. The use of nicotine replacement therapy (NRT) aims to replace nicotine from cigarettes, allowing smoother transition to complete smoking cessation and greatly reducing risks of tobacco-related disease. The role of nicotine as a potential carcinogen is unknown. Use of NRT is associated with development of oral disorders, although it is rarely published. We detail the development of oral hyperkeratotic lesions directly associated with chronic overuse of nicotine replacement products. We also consider the current state of knowledge regarding development of oral lesions associated with other similar products. It is important for dental practitioners to be aware of oral effects associated with recommended nicotine replacement products, especially when offering smoking cessation advice to patients. It is vital that dental practitioners are aware of other potential risk factors for development of potentially malignant oral disorders, in order to make timely referrals of suspected lesions for appropriate investigation and review.