Links between deprivation and risk of violence-related injury: a qualitative study to identify potential causal mechanisms.

Background: Deprivation has been shown to have a greater effect on risk of violent injury among adolescent girls than boys, but the mechanisms underlying this association have not been identified. Methods: In this qualitative study designed to identify causal mechanisms, focus groups involving girls aged 14-16 years attending secondary schools in South Wales, UK, were convened. Schools were recruited based on a measure of area-level deprivation. Discussions were audio-recorded and transcripts analysed thematically. Results: Girls from more deprived areas tended not to participate in organized activities, obtained alcohol from multiple sources, consumed alcoholic drinks of varying strengths in both supervised and unsupervised settings, and tended not to feel trusted by their parents; this led to poor adolescent-parent communication. Girls from less deprived areas tended to participate in organized activities, obtain alcohol from parents, consume low strength alcohol in supervised settings, and have a trusting and communicative relationship with their parents. Conclusion: Deprivation may increase risk of adolescent girls sustaining violence-related injury by increasing their time spent in unsupervised environments, with alcohol and without parental knowledge.

Student perceptions of exodontia competency assessment in a UK dental school.

INTRODUCTION: Modern medical and dental training has migrated from assessing only the quantity of procedures performed to a combined assessment of both competency and quantity. This study explores student perceptions of competency assessment in exodontia at a UK dental school. MATERIALS AND METHODS: Anonymous questionnaires were distributed to dental students in years three, four and five at the School of Dentistry, Cardiff University (n=149). Responses consisted of dichotomous tick boxes and 5-point Likert scales, with thematic analysis of free-text responses. Discrete variables were analysed using simple descriptive statistics. Recurring themes were identified from the responses. RESULTS: A total of 129 questionnaires were returned (response rate 87%). Feedback from students indicated that they felt well prepared to undertake the competency assessment, agreeing that year three is the most appropriate year to assess competency (69%; n=86). In 50% of cases (n=65), the clinical supervisor was not present for the duration of the assessment. The undergraduate student body would like further teaching in the use of elevators (89%; n=114). CONCLUSION: The competency assessment was deemed fit for purpose by the undergraduate student body. Further developments in the areas of clinical supervision and teaching on the use of elevators were considered and recommendations made to the School of Dentistry, Cardiff University. The current oral surgery course incorporates some of the recommendations.

The impact of deprivation on youth violence: a comparison of cities and their feeder towns.

BACKGROUND AND AIMS: 66,000 children and adolescents are treated at emergency departments (EDs) in England and Wales each year for assault injury. The aim of this study was to compare adolescent assault injury rates in cities and towns and determine how assault injury varies with deprivation and gender. METHODS: The study was set in three cities in Wales, UK, and their surrounding towns. Subjects were 11-17 year olds treated for assault injury at one of seven EDs from 1 October 2005 to 30 September 2006. Area of residence (electoral divisions, EDivs) was identified from patient postcode. EDivs were aggregated into deprivation fifths for males and females and cities and towns. Assault injury rates, rate ratios and 95% CIs were calculated. RESULTS: 1472 children and adolescents of 11-17 years old were treated for assault injury. Male city assault injury rates were 14.2/1000 11-17 year olds; and 13.1 in towns. Female city assault injury rates were 6.0; and 5.6 in towns. In the most deprived city areas males had assault injury rates 2.6 times (95% CI 1.85 to 3.59) that of the most affluent, compared with 2.0 times in towns (95% CI 1.39 to 2.86). For females, the most deprived city areas had assault injury rates 5.3 times that of the most affluent (95% CI 2.93 to 9.41), compared with 2.8 times in towns (95% CI 1.47 to 5.28). CONCLUSIONS: Injury in youth violence increased with increasing deprivation in cities and their feeder towns. This was true for boys and girls, though rates for boys were consistently higher. This link between assault injury and deprivation was stronger for girls in cities than in feeder towns. Strategies to prevent youth violence need to include improved safeguarding arrangements for girls living in the most deprived city areas.

A generic consensus assessment of undergraduate competence in forceps exodontia in the United Kingdom.

UNLABELLED: The assessment of competence in clinical skills has become more frequent in published healthcare curricula and syllabuses recently. There are agreed mechanisms for the assessment of competence in the post-graduate environment, but no consensus within the undergraduate curriculum. This paper seeks to develop an agreed generic checklist for the assessment of competence in forceps exodontia. MATERIALS AND METHODS: A modified Delphi process was undertaken with representatives from all UK dental schools (n = 13) to develop a generic checklist for the assessment of competence in forceps exodontia. A content analysis of the assessments employed by each school was used to help discussion and inform the Delphi process. RESULTS: Seven schools currently employ a summative assessment of competence in forceps exodontia, with the majority employing a structured clinical objective test (n = 6). From the seven assessments, there were a total of 29 putative items and 10 putative domains identified for a generic checklist. These were reduced to five domains and 19 items through the content analysis and Delphi process, and a generic overarching checklist was created. CONCLUSION: Using this generic checklist, it may now be possible to pool data inter-institution to perform more powerful analyses on how our students obtain, or fail to obtain competence in forceps exodontia.

Vulnerability to assault injury: an emergency department perspective.

OBJECTIVE: To evaluate risk and protective factors for violence-related injuries from an emergency department (ED) perspective. METHOD: Three study groups were recruited: (1) patients attending a major ED who had suffered an assault (n = 148), (2) patients attending a major ED who had not suffered an assault (n = 151) and (3) non-patients from public places in Cardiff (n = 171). Participants completed one of two proforma questionnaires: questions related to sociodemographic factors including their alcohol consumption and, for those in the assault group, the circumstances of the assault injury. RESULTS: The non-assault groups consumed more alcohol units per annum but fewer alcohol units per drinking session than the assault group. The assault group visited entertainment venues more frequently than the non-assault groups. The relationship between alcohol units consumed per drinking session and the risk of assault injury was non-linear. The risk of assault injury increased for both genders with alcohol consumption (up to 5 units for women and 11 units for men), but at a slower rate for women. The model predicted that, at zero alcohol consumption, the risk of assault injury in men and women was similar. CONCLUSIONS: In the context of the number of alcohol units consumed in a drinking session, the risk of sustaining injury in assault for men and women is different. The risk of injury in assault for men and women is the same when no alcohol is consumed. Alcohol consumption may lead to different risk-taking behaviour in men and women.

Confidential registration in health services: randomised controlled trial.

BACKGROUND: Human rights legislation safeguards the privacy and dignity of patients. OBJECTIVE: To assess the effectiveness in terms of patient assessed privacy of confidential registration. DESIGN: Randomised controlled trial. SETTING: Emergency Department, University Hospital of Wales. PARTICIPANTS: A total of 302 patients aged over 15 years. MAIN OUTCOME MEASURES: Binary choices and ordinal visual analogue scores from a validated questionnaire on self reported measures: patient ability and preference to speak to receptionists and disclose confidential information without being overhead and concern about disclosure of items of confidential personal information. RESULTS: Patients who registered in a screened area felt significantly more able to tell receptionists things they did not want others to hear. Control patients were significantly more concerned than intervention patients that others heard their name, address, date of birth, reason for emergency department attendance, and telephone number, but not their marital status. Overall, intervention patients were less concerned about disclosure of information and that they had been overheard. CONCLUSIONS: Patients value privacy when they register and are concerned if others can hear them tell receptionists who they are, how to contact them, and why they are there. Confidential registration should be instituted in health services. Confidential registration increased patient privacy and should be instituted in health services.

Telephone review after minor oral surgery.

An audit of outpatient clinic attendances at Cardiff Dental Hospital (between September 2009 and March 2010) showed that 30% of patients failed to attend review appointments after minor operations. To reduce rates of non-attendance we set up a system of telephone review in March 2010. Patients were given a telephone appointment two weeks after their minor operation (mainly removal of lower third molars), instead of an appointment at the outpatient clinic. A trained nurse contacted each patient to complete a structured questionnaire that included questions about numbness, pain, and swelling. During the first year of the project, 1020 patients were booked for telephone review and of these 90% were discharged. 674 (66%) were discharged after telephone review, and 245 (24%) were not contactable. A total of 101 patients (10%) were brought in for clinic review because they reported complications. Estimated staff costs per patient for telephone review and clinic review were £3.05 and £23.55 respectively. Telephone review resulted in a significant reduction in the number of patients who failed to attend the clinic (OR=0.88, 95% CI 0.81 to 0.96) and facilitated audit of complications. The use of telephone review in conjunction with clinical follow-up for those with postoperative problems allows for cost-effective care with reduced rates of non-attendance.

Measurements of human minor salivary gland secretions from different oral sites.

Unstimulated secretions from labial (upper and lower), buccal, lingual and palatal minor glands were measured with a Periotron 6000 model 2 (Proflow) in 99 non-medicated, healthy individuals aged from 17 to 81 yr (49 males and 50 females). The palatal minor glands had the lowest flow rates, buccal and anterior lingual glands the highest, and labial glands (upper and lower) intermediate secretory rates. Lower labial glands (p < 0.01) in both sexes and upper labial glands in females (p < 0.05) demonstrated a significant decrease in unstimulated output with age, while buccal glands in both sexes (p < 0.05) showed a significant decrease in flow rates only after the age of 50 yr. Thus minor glands show regional variation in their secretory rates and labial and buccal glands appear to show a decreased unstimulated flow in older individuals.

Bilateral reflex fracture of the coronoid process of the mandible. A case report.

Bilateral fractures of the coronoid process of the mandible occurred following a blow to the left temporal region in an assault. There was no evidence of direct trauma and the zygoma and other facial bones were intact. The probable cause was acute reflex contraction of the temporalis muscles leading to bilateral stress coronoid fractures. Conservative management was followed by complete resolution of symptoms.

Ultrasound-guided needle aspiration of lateral masticator space abscess.

Shortly after admission with facial space infection, ultrasound-guided needle aspiration of lateral masticator space abscess was carried out in 2 adult patients. One abscess was associated with pericoronitis and the other with post-extraction infection. Successful aspiration of pus was followed by an instantaneous improvement in the ability to open the mouth for a period of at least 24 hours. This obviated the need for conscious nasoendoscopic intubation and allowed orotracheal intubation for conventional drainage. We concluded that ultrasonography can be beneficial in the management of orofacial infections.

Hepatitis B vaccination: knowledge among clinical dental staff and students in Dundee.

It is now generally acknowledged that all health care workers should be vaccinated against hepatitis B. To this end, a questionnaire was sent to 132 clinical dental students and 70 staff in August 1993 at a British dental hospital, to assess their vaccination status. Approximately 10% of subjects had not completed their course of immunisation. Furthermore a significant number of subjects had failed to follow up their vaccination by an antibody titre test. Our results suggest that approximately 1 in 7 cases failed to seroconvert, emphasising that mere vaccination may not offer sufficient protection against hepatitis B. Thus adequate cross-infection control measures must be maintained in the interest of all patients.

A virus, the vice chancellors and principles of vaccination.

The Committee of Vice Chancellors and Principles have stated that from 1996, all students entering medical or dental school must show evidence of non-infectivity and satisfactory completion of immunisation against hepatitis B. This is believed to be the first time that immunisation status has been part of a requirement for admission to university. The problems associated with such a programme are discussed, not the least of which is the setting of a precedent that if followed to its logical conclusion, will eventually see screening for other viral infections such as HCV and HIV, but so it seems, only when we have a vaccine.

Thrombophilia and dental surgery: a report of dental extraction in a patient with protein S deficiency.

Most patients with thrombophilia are asymptomatic. A case is presented here of a young woman with protein S deficiency, one of the thrombophilias, who required dental extraction. Protein S deficiency predisposes a very small number of those affected to life-threatening thromboses and emboli, for which they are required to take lifelong prophylactic anticoagulation. This report emphasizes the need to liaise closely with haematology departments when deciding whether heparinization is required for patients already taking warfarin. The role of low-molecular-weight heparins is highlighted, a brief review of thrombophilia is given and the management of patients who are taking warfarin and need dental surgery is discussed.

Smoking cessation advice: knowledge, attitude and practice among clinical dental students.

OBJECTIVE: To examine knowledge, attitude and current practice among clinical dental students in giving smoking cessation advice (SCA) and to explore the barriers to this activity. DESIGN AND SETTING: A self-administered questionnaire survey of clinical dental students at Cardiff University School of Dentistry. MATERIALS AND METHODS: In 2008, clinical dental students were surveyed (n = 181). Information on smoking cessation practices, students' attitude, potential barriers and level of preparedness to deliver SCA, knowledge of association between tobacco use and various pathological conditions and demographics and tobacco use by clinical dental students were gathered. RESULTS: One hundred and sixty-one (89%) students responded. All students enquired about patient smoking habits in the previous three months but were inconsistent in providing SCA--only one third of students gave SCA all or nearly all the time. Students had good knowledge of the associated health risks with tobacco use. A majority of students perceived barriers in providing patients with SCA. Those who provided advice were more likely to have positive attitudes and reported feeling adequately prepared. CONCLUSIONS: Dental educators should address students' perceived barriers towards providing SCA when designing smoking cessation curricula in order to produce dentists who are confident and competent to provide this important health care intervention.

Winning, losing, and violence.

BACKGROUND: Although international sports events attract huge interest, and results can be a barometer of popular national standing, their impact on violent behaviour has not been investigated. METHODS: Associations between assault related emergency department (ED) attendances and international sporting events (home and away rugby and soccer matches) in a European capital city (Cardiff) served by one ED, between 1 May 1995 and 30 April 2002 were investigated. The frequency of assault related ED attendances were studied relative to whether the national team won or lost, controlling for potential covariates: match attendance, match location (home/away), results (win/lose), net scores, and day of match (weekend/weekday). Multiple linear regression was used to identify significant associations with ED assault related attendances. RESULTS: Matches which the Wales team won (p = 0.03), match attendance (p<0.001), and weekend matches (p<0.001) were positively associated with ED assault related injury attendances. Assault frequency measured in this way was no different for home and away matches. CONCLUSIONS: Assault injury resulting in ED treatment was more frequent when national teams won than when they lost. Sport type made no difference. Violence prevention efforts should be increased on international match days, when the national team is expected to win, when match attendance is large, and for away as well as home matches.

Effect of closed circuit television on urban violence.

OBJECTIVE: To evaluate the effect of city and town centre closed circuit television (CCTV) surveillance on violence in terms of accident and emergency (A&E) department and police assault data. METHODS: A&E department and local police assault data in three centres in Wales (Cardiff, Swansea, and Rhyl) two years before and two years after the installation of CCTV were studied. British Crime Survey and police crime statistics were used as control data. RESULTS: A&E records of 24,442 assault patients and 3228 violent offences recorded by the police were studied. Data from two A&E departments (Swansea (+3%) and Rhyl (+45%)) showed increases in recorded assaults after CCTV installation but a decrease (12%) in the largest centre, Cardiff. There was an overall reduction in town/city centre violence from the A&E department perspective of 1% in the two years after CCTV installation. In contrast, police data demonstrated changes in the opposite direction (-44%, -24%, and +20% respectively) contributing to an overall decrease of 9%. British Crime Survey and police statistics for England and Wales demonstrated no overall change and a 16% increase respectively. CONCLUSIONS: City centre CCTV installation had no obvious influence on levels of assaults recorded in A&E departments. There was a negative relationship between police and A&E recording in all three centres. A&E departments are important and unique sources of information about community violence.