A systematic review of interventions to link families with preschool children from healthcare services to community-based support.

BACKGROUND: Supporting patients to access community-based support may be a key intervention to address the wider determinants of health. There is a lack of evidence synthesis around the most effective methods for linking individuals from health services to organizations within communities, especially those aimed at supporting families with young children. METHODS: Papers were identified from seven databases covering peer-reviewed and grey literature. The Effective Public Health Practice Project and the Critical Appraisal Skills Programme Qualitative quality appraisal tools were used to assess methodological quality. Thematic narrative data synthesis based on study quality was performed. RESULTS: Twenty-four unique publications were included in the review with a range of study designs and variable methodological quality. A broad typology of intervention processes for undertaking linking was developed defining three distinct approaches: signposting, referral and facilitation. Active processes, such as facilitation, appeared more successful at linking families to community support. CONCLUSIONS: This was the first systematic review to focus on interventions that link families with young children to community-based support organizations. It identified a typology for linking interventions, and whilst there were limitations in the quality of evidence available, it showed a tendency for more active interventions to be more effective in linking families to community support.

Oral care and nursing home-acquired pneumonia.

Data sources Cochrane Oral Health Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Chinese Biomedical Literature Database, China National Infrastructure, US National Institutes of Health Ongoing Trials Registry, WHO Clinical Trials Registry, Sciencepaper Online, 19 Chinese dental and nursing journals. Reference lists of included studies were also screened.Study selection Studies were included if they explored oral care with the purpose of reducing pneumonia compared to no oral care, usual care or other oral care measures. Only randomised controlled trials were included which could be either parallel design or cluster RCTs with randomisation by care facility. No restrictions were placed on language, year of publication or publication status.Data extraction and synthesis Two independent reviewers undertook screening for inclusion, data extraction and assessment of risk of bias. The Cochrane tool for risk of bias was used to assess quality of the studies. Synthesis was mainly narrative, though numerical results were combined where feasible.Results Four studies were included, all of which were parallel RCTs. All were judged to be at high risk of bias due to lack of blinding. One study suggested that oral care may reduce pneumonia associated death, though evidence was low quality and should be treated with caution. There was no high quality evidence available to indicate which oral care methods may be most effective in reducing pneumonia.Conclusions It was not possible to establish the effects of professional oral care on nursing home-acquired pneumonia due to the limited number of studies and low quality evidence. Further trials are needed to draw reliable conclusions.

Is there an association between prenatal oral healthcare and early childhood caries prevention?

Data sources Database searches included Pubmed, Embase, Scopus, Web of Science, LILACS, Cochrane Library and ClinicalTrials.gov.Study selection This review included studies that assessed the impact of pre-natal oral health care on early childhood caries experience and/or oral carriage of S. mutans. The review included case control studies, retrospective or prospective cohort studies, randomised or non-randomised controlled trials. In vitro studies, animal studies, literature reviews, cross sectional studies and literature reviews were excluded.Data extraction and synthesis Two calibrated and independent reviewers screened the literature using a data extraction form based on defined inclusion and exclusion criteria. A PRISMA flow diagram is presented showing the process of reviewing the literature. The Cochrane Risk of Bias Tool for Randomised Trials and an adapted version of the Downs and Black score were used to assess the quality of the included studies. A qualitative synthesis of five included studies is presented. A Forest Plot then presents quantitative data from four of the studies. A meta analysis did not take place. A generalised linear mixed effects model was applied to results from four of the studies.Results Five studies were included in the qualitative syntheses, three of the studies were randomised controlled trials, one was a prospective cohort study and one was a nested case-control in a cohort study. Two of the studies were assessed as high quality with three assessed as moderate quality. Odds ratios of children experiencing early childhood caries are reported for four studies demonstrating a reduced risk of early childhood caries in intervention groups compared to controls. A generalised linear mixed effects model using combined results from the four studies shows a reduced risk of developing early childhood caries in children up to the age of three years old whose mothers receive pre natal oral care. Above age three years the results of the modelling become non-significant. Based on the results of two studies the authors report a reduction in levels of S. mutans in the oral cavity of children whose mother had prenatal oral care.Conclusions The authors conclude that prenatal oral healthcare has a positive effect on incidence of early childhood caries and S. mutans carriage in children.

Oral health literacy, oral health behaviours and dental outcomes.

Data sourcesEight electronic databases were searched: Medline (through PubMed), ISI Web of Science, Scopus, The Cochrane Library, National Institute for Health and Clinical Excellence, Lilacs and the Brazilian Library of Dentistry, Controlled-trials database of Clinical Trials and Clinical Trials-US National Institute of Health. A grey literature search was also conducted and reference lists of included studies were interrogated.Study selectionInclusion criteria were studies which examined the relationship between oral health literacy and one of the pre-defined outcomes including oral health behaviours, perception, knowledge and dental treatment outcomes. Epidemiological studies (such a case-control, cohort, cross-sectional and clinical trials) were included but qualitative studies, systematic reviews and those which examined unrelated outcomes were excluded.Data extraction and synthesisTwo independent reviewers carried out screening, risk of bias assessment and data extraction for all studies against pre-agreed inclusion and exclusion criteria. The Newcastle-Ottawa Scale (a modified version for cross-sectional studies) and the Cochrane Risk of Bias tool were used for quality appraisal. A narrative synthesis was presented, with meta-analysis of a small sub-group of studies relating to one outcome.ResultsTwenty-five studies were included in the final review; 21 cross-sectional, two cohort, one case-control and one clinical trial. Most (17) were considered to be at high risk of bias and there was a high degree of clinical and methodological heterogeneity. No evidence was found of a significant association between oral health literacy and the outcomes considered.ConclusionsThe authors concluded that the current scientific evidence suggests that no association exists between oral health literacy and any of the outcomes investigated. Further prospective studies with high methodological quality are needed.

Nano Silver Fluoride for preventing caries.

DESIGN: Randomised controlled trial, double blind, in a community setting. INTERVENTION: School children with active caries in primary teeth and no pulpal exposure, fistula or decay in permanent teeth were chosen. Caries and unsupported enamel were left as found and cotton wool rolls were used for isolation. Two drops of NSF or one drop of water were applied to the tooth with a microbrush for two minutes, once in a 12-month period. OUTCOME MEASURE: At one week, five months and 12 months the presence of active caries, as classified using International Caries Detection and Assessment System (ICDAS II) criteria, was measured. If a blunt probe easily penetrated dentine with light force, active caries was recorded and taken to be a failure. RESULTS: One hundred and thirty primary teeth in 60 children with a mean age of 6.31 (± 0.60) were randomised. Sixty-three teeth were in the NSF group and 67 in the control group. After one week there were no losses, at the five-month follow up eight teeth were lost from the NSF group due to exfoliation or extraction and five from the control group. At twelve months a further five teeth were lost from the NSF group and 13 from the control group.At the one week follow up there was a 19% failure rate in the NSF group compared to 100% in the control group. At the five month recall this was 27.3% NSF compared to 72.6% water and at the final recall there was a 33.3% NSF failure rate and 65.3% control failure rate. The preventative fraction at this point was 50% and the NNT 3.12. All were statistically significant results (p= <0.05). CONCLUSIONS: The annual application of NSF solution was more effective in hardening and arresting dentine caries in primary teeth than the placebo. The effectiveness of NSF was found to be similar to silver diamine fluoride when applied once a year, but did not stain the dental tissue black and had no metallic taste. The application is simple, does not require a clinical setting and is inexpensive. NSF was demonstrated to be effective in arresting caries in children in poor communities, but further studies are required to investigate alternative protocols and for use in tooth sensitivity and root caries.

Linking families with pre-school children from healthcare services to community resources: a systematic review protocol.

BACKGROUND: Poor health and health inequalities persist despite increasing investment in health improvement programmes across high-income countries. Evidence suggests that to reduce health inequalities, a range of activities targeted at different levels within society and throughout the life course should be employed. There is a particular focus on addressing inequalities in early years as this may influence the experience of health in adulthood. To address the wider determinants of health at a community level, a key intervention which can be considered is supporting patients to access wider community resources. This can include processes such as signposting, referral and facilitation. There is a lack of evidence synthesis in relation to the most effective methods for linking individuals from health services to other services within communities, especially when considering interventions aimed at families with young children. METHOD/DESIGN: The aim of this study is to understand the way health services can best help parents, carers and families with pre-school children to engage with local services, groups and agencies to address their wider health and social needs. The review may inform future guidance to support families to address wider determinants of health. The study is a systematic review, and papers will be identified from the following electronic databases: Web of Science, Embase, MEDLINE and CINAHL. A grey literature search will be conducted using an internet search engine and specific grey literature databases (TRiP, EThOS and Open Grey). Reference lists/bibliographies of selected papers will be searched. Quality will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies and the CASP tool for qualitative studies. Data will be synthesised in a narrative form and weighted by study quality. DISCUSSION: It is important to understand how health services can facilitate access to wider services for their patients to address the wider determinants of health. This may impact on the experience of health inequalities. This review focuses on how this can be achieved for families with pre-school children, and the evidence obtained will be useful for informing future guidance on this topic. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016034066.