Access to oral health care for undocumented migrants: Perspectives of actors involved in a voluntary dental network in the Netherlands.

OBJECTIVE: Undocumented migrants in Europe face multiple barriers in access to oral health care. This study aimed to explore the accessibility of a voluntary dental network providing dental treatments to undocumented migrants in the Netherlands, from the perspectives of patients, dentists and staff members of nongovernmental organizations involved. METHODS: This qualitative study used semi-structured interviews (n = 21) with undocumented migrants (n = 12), dentists (n = 7) and staff members of nongovernmental organizations (n = 2) during the implementation of a voluntary dental network. Interviews were analysed using a framework analysis method. RESULTS: As a temporary answer to problems in access to oral health for undocumented migrants, the voluntary dental network targeted initial barriers to dental care. Main challenges within the network were conflicting expectations and perceived treatment outcomes by patients, dentist and NGO staff members, limited financial resources, logistic and communication barriers and an increasing administrative burden. Furthermore, feelings of compassion for and trust of the patient affected the ethics of the professional relationship and influenced treatment decisions of dentists. CONCLUSION: Through the implementation of a voluntary dental network, treatments could be provided to undocumented migrants as a temporary solution. However, the voluntary nature of dental care in the network resulted in a fragmented provision of oral health care among undocumented migrants. To reduce inequalities in oral health on the long term, systemic barriers in access to oral health care need to be addressed.

A Prediction Model for Types of Treatment Indicated for Patients with Temporomandibular Disorders.

AIMS: To identify potential predictors of types of treatment indicated for patients with temporomandibular disorders (TMD) and to develop, validate, and calibrate a prediction model for type of treatment. METHODS: The derivation cohort at baseline was comprised of 356 adult patients with TMD. Patient and disease characteristics were recorded at baseline as potential predictors. Types of treatment indicated for TMD patients were the end points of the model, classified into no treatment, physical treatment only (including splint and/or physiotherapy), and combined physical and psychological treatment. Multinomial logistic regression analysis was used to develop the prediction model. The internal validation, calibration, discrimination, and external validation of the model were determined. For practical use, the prediction model was converted into score charts and line charts. The score of each included predictor was produced based on the shrunken regression coefficients. RESULTS: Patient age, gender, anxiety, sleep bruxism, pain-related TMD, function-related TMD, stress, passive stretch of maximum mouth opening, and depression were significantly associated with the type of treatment indicated for TMD patients. The multinomial model showed reasonable calibration and good discrimination, with area under the curve values of 0.76 to 0.86. The internal validity of the model was good, with a shrinkage factor of 0.89. The external validity of the model was acceptable. CONCLUSION: Potential predictors in patient profiles for prediction of type of treatment indicated for TMD patients were identified. The internal validity, calibration, discrimination, and external validity of the model were acceptable.

Subgroup effects despite homogeneous heterogeneity test results.

BACKGROUND: Statistical tests of heterogeneity are very popular in meta-analyses, as heterogeneity might indicate subgroup effects. Lack of demonstrable statistical heterogeneity, however, might obscure clinical heterogeneity, meaning clinically relevant subgroup effects. METHODS: A qualitative, visual method to explore the potential for subgroup effects was provided by a modification of the forest plot, i.e., adding a vertical axis indicating the proportion of a subgroup variable in the individual trials. Such a plot was used to assess the potential for clinically relevant subgroup effects and was illustrated by a clinical example on the effects of antibiotics in children with acute otitis media. RESULTS: Statistical tests did not indicate heterogeneity in the meta-analysis on the effects of amoxicillin on acute otitis media (Q = 3.29, p = 0.51; I2 = 0%; T2 = 0). Nevertheless, in a modified forest plot, in which the individual trials were ordered by the proportion of children with bilateral otitis, a clear relation between bilaterality and treatment effects was observed (which was also found in an individual patient data meta-analysis of the included trials: p-value for interaction 0.021). CONCLUSIONS: A modification of the forest plot, by including an additional (vertical) axis indicating the proportion of a certain subgroup variable, is a qualitative, visual, and easy-to-interpret method to explore potential subgroup effects in studies included in meta-analyses.

Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing--a randomized controlled trial.

BACKGROUND: Surgical repair of acute Achilles tendon ruptures is considered superior to nonoperative treatment, but complications other than rerupture range up to 34%. Nonoperative treatment by functional bracing seems a promising alternative. HYPOTHESIS: Nonoperative treatment of acute Achilles tendon rupture with functional bracing reduces the number of complications compared with surgical treatment with a minimally invasive technique. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 2. METHOD: Using concealed random allocation, 83 patients with acute Achilles tendon rupture were assigned to nonoperative treatment by functional bracing or minimally invasive surgical treatment followed by tape bandage. Patients were allowed full weightbearing, and follow-up was 1 year. RESULTS: Complications risk other than rerupture by intention-to-treat basis was 9 in 42 patients (21%) for surgical treatment and 15 in 41 patients (36%) for nonoperative treatment (risk ratio, 0.59; 95% confidence interval, 0.29-1.19). Reruptures risk was 5 in 41 patients after nonoperative treatment and 3 in 42 patients for surgical treatment (risk ratio, 0.59; 95% confidence interval, 0.15-2.29). The mean time to work was 59 days (SD, 82) after surgical treatment and 108 days (SD, 115) after nonoperative treatment (difference, 49 days; 95% confidence interval, 4-94; P < .05). The difference between treatments for return to sports (risk ratio, 0.55; 95% confidence interval, 0.23-1.29), pain, and treatment satisfaction did not reach statistical significance. CONCLUSION: There appears to be a clinically important difference in the risk of complications between minimally invasive surgical treatment and nonoperative treatment for acute Achilles tendon ruptures, but this was not statistically significant.