RESUMO
BACKGROUND: The COVID-19 pandemic forced a UK-wide closure of dental services. An understanding of public concerns about dental care was urgently needed to inform careful resumption of paused dental services. AIM: To describe public concerns about dental care during lockdown. BASIC RESEARCH DESIGN: Framework analysis of relevant Twitter posts identified collected using the Awario tool. RESULTS: Of 1863 tweets manually screened for eligibility, 285 were relevant, as they contained views expressed by the public. The number of tweets by country were proportionate to the population size. The key views expressed in tweets focused on: 'oral health impact' ('oral health and self-care', 'types of dental problems', 'managing symptoms at home', 'views on consequences of delaying treatment') and 'dental service or care provision' ('views on managing dental care response', 'experiences with access to dental care'). CONCLUSIONS: The impact of COVID-19 on dental services raised many physical and mental health concerns for the public, highlighting their importance. Online profiles and social media communication platforms can be used to provide convenient, and timely information on public perceptions of dental care.
Assuntos
COVID-19 , Mídias Sociais , Controle de Doenças Transmissíveis , Odontólogos , Humanos , Pandemias , SARS-CoV-2 , Reino UnidoRESUMO
Scale and polish (SP) and oral hygiene advice (OHA) are commonly provided in primary care dental practice to help prevent periodontal disease. These services are widely consumed by service users, incurring substantial cost, without any clear evidence of clinical benefit. This article aims to elicit general population preferences and willingness to pay (WTP) for preventative dental care services and outcomes. An online discrete-choice experiment (DCE) was completed by a nationally representative sample of the UK general population. Respondents each answered 10 choice tasks that varied in terms of service attributes (SP, OHA, and provider of care), outcomes (bleeding gums and aesthetics), and cost. Choice tasks were selected using a pivoted segmented experimental design to improve task realism. An error components panel logit model was used to analyze the data. Marginal WTP (mWTP) for each attribute and level was calculated. In total, 667 respondents completed the DCE. Respondents valued more frequent SP, care provided by a dentist, and personalized OHA. Respondents were willing to pay for dental packages that generated less frequent ("never" or "hardly ever") bleeding on brushing and teeth that look and feel at least "moderately clean." Respondents were willing to pay more (+£145/y) for improvements in an aesthetic outcome from "very unclean" (-£85/y) to "very clean" (+£60/y) than they were for reduced bleeding frequency (+£100/y) from "very often" (-£54/y) to "never" (+£36/y). The general population value routinely provided SP, even in the absence of reductions in bleeding on brushing. Dental care service providers must consider service user preferences, including preferences for both health and nonhealth outcomes, as a key factor in any service redesign. Furthermore, the results provide mWTP estimates that can be used in cost-benefit analysis of these dental care services.
Assuntos
Assistência Odontológica , Estética Dentária , Atenção à Saúde , Humanos , Higiene Bucal , Preferência do Paciente , Inquéritos e QuestionáriosRESUMO
The Meridional Overturning Circulation (MOC) is a primary mechanism driving oceanic heat redistribution on Earth, thereby affecting Earth's climate and weather. However, the full-depth structure and variability of the MOC are still poorly understood, particularly in the South Atlantic. This study presents unique multiyear records of the oceanic volume transport of both the upper (<~3100 meters) and abyssal (>~3100 meters) overturning cells based on daily moored measurements in the South Atlantic at 34.5°S. The vertical structure of the time-mean flows is consistent with the limited historical observations. Both the upper and abyssal cells exhibit a high degree of variability relative to the temporal means at time scales, ranging from a few days to a few weeks. Observed variations in the abyssal flow appear to be largely independent of the flow in the overlying upper cell. No meaningful trends are detected in either cell.
RESUMO
Providing best clinical care involves using the best available evidence of effectiveness to inform treatment decisions. Producing this evidence begins with trials and continues through synthesis of their findings towards evidence incorporation within comprehensible, usable guidelines, for clinicians and patients at the point of care. However, there is enormous wastage in this evidence production process, with less than 50% of the published biomedical literature considered sufficient in conduct and reporting to be fit for purpose. Over the last 30 years, independent collaborative initiatives have evolved to optimise the evidence to improve patient care. These collaborations each recommend how to improve research quality in a small way at many different stages of the evidence production and distillation process. When we consider these minimal improvements at each stage from an 'aggregation of marginal gains' perspective, the accumulation of small enhancements aggregates, thereby greatly improving the final product of 'best available evidence'. The myriad of tools to reduce research quality leakage and evidence loss should be routinely used by all those with responsibility for ensuring that research benefits patients, that is, those who pay for research (funders), produce it (researchers), take part in it (patients/participants) and use it (clinicians, policy makers and service commissioners).
Assuntos
Odontologia Baseada em EvidênciasRESUMO
There is increasing importance placed on conducting clinical trials in dentistry to provide a robust evidence base for the treatment provided, and models of care delivered. However, providing the evidence upon which to base such decisions is not straightforward, as the conduct of these trials is complex. Currently, only limited information is available about the strategies to deliver successful clinical trials in primary care settings, and even less available on dental clinical trials. Considerable knowledge and experience is lost once a trial is completed as details about effective management of a trial are generally not reported or disseminated to trial managers and researchers. This leads to loss of vital knowledge that could assist with the effective delivery of new trials. The aim of this study is to examine the conduct and delivery of five dental clinical trials across both Australia and the UK and identify the various factors that impacted upon their implementation. Findings suggest that early stakeholder engagement, and well-designed and managed trials, lead to improved outcomes for researchers, clinic staff and patients, and increases the potential for future dissemination and translation of information into practice.
Assuntos
Assistência Odontológica , Pesquisa em Odontologia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Austrália , Assistência Odontológica/métodos , Assistência Odontológica/organização & administração , Instrumentos Odontológicos , Pesquisa em Odontologia/organização & administração , Humanos , Estudos Multicêntricos como Assunto/métodos , Seleção de Pacientes , Atenção Primária à Saúde/métodos , Alocação de Recursos , EscóciaRESUMO
Since 1991 the NHS has attempted to identify and prioritise its needs for research and development in a systematic manner. This has not been done before and there is little evidence on which to draw. Multidisciplinary expert groups have identified priorities in different topics using explicit criteria and after widespread consultation within the NHS and research community to identify pressing problems and opportunities for research. This paper focuses on a review completed in 1993 to identify research and development priorities for the NHS in relation to the interface between primary and secondary care. The review covered several recent developments which require evaluation. The authors describe the process used to identify research and development priorities in this complex subject and examine the strengths and weaknesses of the approach. This case study should help to stimulate a wider debate on methods of identifying priorities, particularly those using participatory approaches, in research and non-research contexts.
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Prioridades em Saúde , Pesquisa sobre Serviços de Saúde , Medicina Estatal/organização & administração , Hospitalização , Humanos , Atenção Primária à Saúde , Reino UnidoRESUMO
OBJECTIVE: To assess the effectiveness of decontamination procedures in general practice. DESIGN: Anonymous postal questionnaire survey of 600 general practitioners randomly selected from the national register. SETTING: General practices throughout the United Kingdom. SUBJECTS: 382 General practitioners, a response rate of 65%. RESULTS: 186 General practitioners had autoclaves but 125 used hot water disinfectors or chemical disinfectants to reprocess instruments. 22% (474/2132) Of high risk instruments were inadequately decontaminated. Decontamination was performed by the practice nurse or receptionist in 306 practices. Knowledge of treatment of spillages of blood fluids was uncertain, and only 114 general practitioners used effective methods for dealing with spillages. CONCLUSIONS: A comprehensive central code of practice for control of infection is needed for primary health care staff.
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Infecção Hospitalar/prevenção & controle , Contaminação de Equipamentos/prevenção & controle , Medicina de Família e Comunidade , Esterilização/métodos , Descontaminação , Desinfecção , Humanos , Fatores de Risco , Reino UnidoAssuntos
Médicas/história , Sociedades Médicas/história , Feminino , História do Século XIX , Humanos , Reino UnidoAssuntos
Diabetes Mellitus/tratamento farmacológico , Insulina/administração & dosagem , Insulina/efeitos adversos , Erros de Medicação , Gestão da Segurança , Relação Dose-Resposta a Droga , Escrita Manual , Humanos , Erros de Medicação/prevenção & controle , Padrões de Prática Médica , Reino UnidoRESUMO
In South Carolina between 1971 and 1975, authors evaluated the occurrence of organochlorine residues in the laughing gull (Larus atricilla), white ibis (Eudocimus albus), glossy ibis (Plegadis falcinellus), American oystercatcher (Haematopus palliatus), willet (Catoptrophorus semipalmatus), and ruddy turnstone (Arenaria interpres). Tissues of birds found dead and eggs were analyzed, eggshell thicknesses were measured, and incidental observations were made of reproductive success and population status. Eggshell thickness of the white bis, American oystercatcher, and laughing gull were not significantly different (P less than 0.05) from the pre-1947 norms. DDE and polychlorinated biphenyls (PCBs) were found most frequently and at the highest concentration in eggs. DDE residues declined significantly in oystercatcher eggs, and declined slightly in laughing gull eggs; no change was noted in white ibis eggs. No consistent trends were found for dieldrin and PCBs. Authors found no obvious problems with reproductive success of any species. Populations of the five species breeding in South Carolina appear stable. The white ibis and laughing gull in South Carolina have experienced population explosions over the past 50 years; the glossy ibis has increased substantially since the first documented breeding records in 1947.
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Aves/metabolismo , Inseticidas/análise , Resíduos de Praguicidas/análise , Animais , Casca de Ovo , Ovos/análise , Bifenilos Policlorados/análise , South CarolinaRESUMO
Shells of brown pelican (Pelecanus occidentalis) eggs collected in South Carolina from 1969 through 1975 and in Florida during 1969, 1970, and 1974 were significantly thinner (P greater than 0.05) than eggshells collected before 1947. Thickness of South Carolina eggshells increased in 1975, and mean thickness of eggshells collected in Florida during 1974 was greater than that of eggshells collected during 1969 and 1970, primarily in Gulf Coast colonies. Residues of 13 organochlorines were found in eggs and tissues of pelicans found dead during 1974 and 1975, although residues in brains of these specimens were not high enough to cause death. Residues of organochlorines, except PCBs, declined through 1975. PCBs increased in eggs from Atlantic Coast colonies. Reproductive success and population status of brown pelicans in South Carolina have improved markedly since authors began their studies in 1969. Good reproductive success was reported in 3 of 5 years from 1973 through 1977.
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Aves/fisiologia , Casca de Ovo , Hidrocarbonetos Clorados , Inseticidas/farmacologia , Resíduos de Praguicidas/farmacologia , Reprodução/efeitos dos fármacos , Animais , Doenças das Aves/patologia , Ovos/análise , Feminino , Florida , Inseticidas/análise , Masculino , Resíduos de Praguicidas/análise , População , South CarolinaRESUMO
Although Cl difficile bacteremia and the presence of antibodies to toxin A (TxA) have been reported, little information is available at present on TxA effect on the functional properties of various visceral organs. We have, therefore, examined the in vitro effects of TxA on amylase and trypsin secretion from rat isolated pancreatic acini. Dispersed rat pancreatic acini were exposed for 60 min to different concentrations of highly purified TxA and the rate of amylase, trypsin and LDH release were monitored. Free cytosolic calcium release in pancreatic acini after toxin A (10(-10)M to 10(-8)M) treatment was measured with Fura-2/AM, Ca-indicator dye. TxA (10(-10) to 10(-8)M) increased significantly the rate of both the amylase and trypsin secretion without any membrane damage, with toxin A exerting its action via calcium dependent pathway as suggested by intracellular calcium release measured with Fura-2/AM.
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Enterotoxinas/farmacologia , Pâncreas/enzimologia , Amilases/metabolismo , Animais , Toxinas Bacterianas/farmacologia , Cálcio/metabolismo , Clostridioides difficile , L-Lactato Desidrogenase/metabolismo , Ratos , Ratos Sprague-Dawley , Tripsina/metabolismoRESUMO
UNLABELLED: AIMS OF THE AUDIT COMMISSION: The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies. METHODS: Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self-nomination. RESULTS: Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self-management. CONCLUSION: As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs.
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Diabetes Mellitus/terapia , Medicina de Família e Comunidade/normas , Auditoria Médica , Atenção Primária à Saúde/normas , Custos de Cuidados de Saúde , Humanos , Medicina Estatal/normas , Reino UnidoRESUMO
Shells of brown pelican (Pelecanus occidentalis) eggs collected in South Carolina from 1969 through 1973 were significantly thinner than shells of those collected before 1947. Residues of 10 organochlorine pollutants and 10 heavy metals were found in these eggs. Total organochlorine residues were apparently magnified 23 times from fish to pelican eggs, but interpretation of biomagnification was complicated by the migratory habits of both the pelicans and their chief prey fish. Residues of organochlorine pollutants and heavy metals were also found in tissues of brown pelicans. Dieldrin was probably involved in the death of a pelican that exhibited myocardial necrosis. Other pelicans died from gunshot wounds, various diseases, or unknown causes. From 1969 through 1973, there was a significant decline in residues of p-p'-DDE, p-p'-TDE, p-p'DDT, and dieldrin in eggs of the brown pelican in South Carolina, but the rate of decline was different for each pollutant. PCB's peaked in 1972 and then declined in 1973 to the lowest level in 5 years. In 1973, the first time in many years, South Carolina brown pelicans reproduced very well. The excellent reproductivity seemed related to lowered organochlorine residues and favorable tides, weather, and food supply.
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Aves/metabolismo , Ovos/análise , Hidrocarbonetos Clorados , Inseticidas/análise , Metais/análise , Resíduos de Praguicidas/análise , Animais , Casca de Ovo , Feminino , Peixes/metabolismo , Masculino , South CarolinaRESUMO
The mechanism by which Clostridium difficile toxin B causes cells in culture to round was investigated. Cultured human lung fibroblasts and rabbit aortic smooth muscle cells were treated with partially purified or purified toxin B and monitored by light and transmission electron microscopy (TEM). Both preparations caused progressive cell rounding which correlated with disorganization of actin-containing myofilament bundles. Thin myofilaments became fragmented and finally disappeared (after 24 h) and dense bodies became more prominent, while all other organelles appeared unaffected.
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Proteínas de Bactérias , Toxinas Bacterianas/toxicidade , Pulmão/ultraestrutura , Músculo Liso Vascular/ultraestrutura , Animais , Aorta/ultraestrutura , Linhagem Celular , Células Cultivadas , Fibroblastos/efeitos dos fármacos , Fibroblastos/ultraestrutura , Humanos , Microscopia Eletrônica , Músculo Liso Vascular/efeitos dos fármacos , CoelhosRESUMO
Adult cricket frogs (Acris crepitans) were held individually for 96 h in static systems containing initial concentrations of either 0, 0.1, 1.0, or 10 ppm parathion in 10 ml water. Mortality of cricket frogs was directly related to the parathion concentration in the water. Frogs from the 1.0- and 10-ppm groups accumulated 0.08 and 4.6 ppm parathion, respectively. One of four American kestrels (Falco sparverius) fed frogs from the 10-ppm group died from organophosphate poisoning less than 3 h after consuming five frogs. Mortality did not occur in kestrels fed frogs from the other treatment groups, which represented more environmentally realistic levels of exposure.