Additional Roles Reimbursement Scheme commissioning 2020-2023: associations with patient experience and QOF.

BACKGROUND: The Additional Roles Reimbursement Scheme (ARRS) was introduced by NHS England in 2020 alongside Primary Care Networks (PCNs) with aims of increasing the workforce and improving patient outcomes. AIM: Describe the uptake of direct-patient care (DPC)-ARRS roles and its impact on patients' experiences. DESIGN AND SETTING: Ecological study using 2020-2023 PCN and Practice workforce data, registered patient characteristics, the General Practice Patient Survey, and the Quality and Outcomes Framework (QOF). METHODS: Descriptive statistics with associations examined using quantile and linear regression. RESULTS: By March 2023, 17,714 FTE DPC-ARRS roles were commissioned by 1,223 PCNs. PCNs with fewer constituent practices had more DPC-ARRS roles per population (p<0.001) as did PCNs with more FTE GPs per population (p=0.012). DPC-ARRS commissioning did not vary with age, proportion female or deprivation of practice populations. DPC-ARRS roles were associated with small increases in patient satisfaction (0.8 percentage points increase in patients satisfied per one DPC-ARRS FTE) and perceptions of access (0.7 percentage points increase in patients reporting 'good' experience of making an appointment per one DPC-ARRS FTE), but not with overall QOF achievement. CONCLUSIONS: The commissioning of DPC-ARRS roles was associated with small increases in patient satisfaction and perceptions of access, but not with QOF achievement. DPC-ARRS roles were employed in areas with more GPs rather than compensating for a shortage of doctors. Single practice PCNs commissioned more roles per registered population, which may be advantageous to single practice PCNs. Further evaluation of the scheme is warranted.

A Bio-Inspired Probabilistic Neural Network Model for Noise-Resistant Collision Perception.

Bio-inspired models based on the lobula giant movement detector (LGMD) in the locust's visual brain have received extensive attention and application for collision perception in various scenarios. These models offer advantages such as low power consumption and high computational efficiency in visual processing. However, current LGMD-based computational models, typically organized as four-layered neural networks, often encounter challenges related to noisy signals, particularly in complex dynamic environments. Biological studies have unveiled the intrinsic stochastic nature of synaptic transmission, which can aid neural computation in mitigating noise. In alignment with these biological findings, this paper introduces a probabilistic LGMD (Prob-LGMD) model that incorporates a probability into the synaptic connections between multiple layers, thereby capturing the uncertainty in signal transmission, interaction, and integration among neurons. Comparative testing of the proposed Prob-LGMD model and two conventional LGMD models was conducted using a range of visual stimuli, including indoor structured scenes and complex outdoor scenes, all subject to artificial noise. Additionally, the model's performance was compared to standard engineering noise-filtering methods. The results clearly demonstrate that the proposed model outperforms all comparative methods, exhibiting a significant improvement in noise tolerance. This study showcases a straightforward yet effective approach to enhance collision perception in noisy environments.

A Bibliometric Mapping Study of the Literature on Oral Health-related Quality of Life.

BACKGROUND: Oral health is an indispensable component of overall health, and oral health status significantly influences people's physical, mental, and social well-being. Oral health-related quality of life (OHRQoL), an important and widely used dental patient-reported outcome (dPRO), is attracting more and more researchers' attention and interest. This study aimed to analyze and map the existing scientific literature regarding OHRQoL through a bibliometric approach, including a summary of the characteristics of OHRQoL-related publications, the identification of prolific entities, high-frequency keywords analysis, and research trend analysis via periodic high-impact keywords. METHODS: A literature search was conducted in the Web of Science Core Collection to collect OHRQoL-related original research and review articles. After examination and deduplication, the following bibliometric information was extracted from each article: title, abstract, keywords, authors, affiliations, geographic origin (countries/regions), year of publication, journal name, and references. Various scientometric mapping tools including Microsoft Office spreadsheet, VOSviewer, Biblioshiny R-package software, and Scimago Graphica were used to analyze basic bibliometric parameters, leading producers, high-impact keywords, and research trends. RESULTS: A total of 3324 OHRQoL-related articles (3119 original research articles and 205 review papers) were collected, which received 65,704 citations. A total of 9950 authors from 2429 organizations contributed to this body of research. Prolific authors from Europe, USA, Brazil, New Zealand, China, and Canada were identified, and they also centered collaboration clusters in the co-author network. Community Dentistry and Oral Epidemiology was the most prolific journal. Twenty-one keywords with more than 200 occurrences, and 23 keywords with more than 150 occurrences, were identified for publications of 1994-2021 and 2012-2021, respectively. Keyword analysis revealed hot topics such as instrument development and validation, studies targeting children and adolescents, as well as clinical studies in operative dentistry, implantology, orthodontics, and community dentistry. Oral Health Impact Profile is the most commonly used instrument in OHRQoL-related research. CONCLUSIONS: OHRQoL is an impactful topic in dental health care as it is not only useful in dental research and patient-centered clinical outcome measures but also provides valuable guidance in dental public health administration and policy making. OHRQoL-related research presents a dynamic landscape and is expected to continue presenting high productivity and broad application in the future.

Association between socioeconomic status and dental caries among Chinese preschool children: a cross-sectional national study.

OBJECTIVES: Socioeconomic inequalities in oral health are often neglected in oral health promotion. This cross-sectional study assessed the association between dental caries and socioeconomic status (SES) among preschool children in China. DESIGN: Cross-sectional study. SETTING: Data from the Fourth National Oral Health Survey of China (2015), comprising of 40 360 children aged 3-5 years was used. METHODS: Dental caries indicators including prevalence of dental caries, dental pain experience and number of decayed, missing and filling teeth (dmft). SES indicators included parental education and household income. The associations between SES and dental caries were analysed by using negative binomial regression or Poisson regression models according to data distribution. Relative and absolute inequalities in dental caries were quantified by using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII), respectively. RESULTS: There were significant associations between SES and prevalence of dental caries and dmft (p<0.001). Children from lower educated (RII 1.36, 95% CI 1.3 to 1.43; SII 0.97, 95% CI 0.81 to 1.13) and lower household income (RII 1.17, 95% CI 1.11 to 1.24; SII 0.55, 95% CI 0.35 to 0.75) families had higher dmft than those from well-educated and most affluent families. Relative and absolute inequalities in dental caries were larger in urban areas by household income, and in rural areas by parental education. CONCLUSIONS: Association between dental caries and SES was demonstrated and socioeconomic inequalities in dental caries existed among Chinese preschool children.

The additional benefit of professional fluoride application for children as an adjunct to regular fluoride toothpaste: a systematic review and meta-analysis.

OBJECTIVE: To assess whether professional fluoride application (PFA) used in addition to regular fluoride toothpaste (RFT, ≥ 1,000 ppm) is more effective than RFT alone in children. MATERIALS AND METHODS: A systematic search was conducted using the PubMed, Embase, Google Scholar and CENTRAL databases. Randomized controlled trials (RCTs) comparing the effectiveness of RFT + PFA and RFT alone were included. Meta-analyses with random-effects models were performed. The certainty of evidence was assessed using the GRADE approach. RESULTS: A total of 2,729 records were identified from electronic and manual searches, which were screened by two reviewers independently and in duplicate. Six RCTs (5,034 participants) were included, of which four had high risk of bias and two had unclear risk of bias. The PFA used in all these trials was fluoride varnish (FV). In meta-analyses, no significant difference was observed between participants receiving FV + RFT and RFT alone of d(m/e)fs increment (mean difference (MD) - 0.17, 95% confidence interval (CI) - 0.60 to 0.26, P = 0.43, I2 = 38%; 6 trials, 5,034 participants, moderate certainty evidence), incidence of caries (risk ratio (RR) 0.91, 95% CI 0.80 to 1.05, P = 0.21, I2 = 41%; 4 trials, 4,487 participants, moderate certainty evidence) or changes in prevalence of caries (RR 0.89, 95% CI 0.78 to 1.01, P = 0.07, I2 = 0%, 4 trials, 4,189 participants, low certainty evidence). CONCLUSIONS: Low to moderate certainty evidence suggests that FV does not have significant additional caries-preventive benefit for children (under 8 years old) when provided as an adjunct to daily tooth brushing with RFT (≥ 1,000 ppm). There is insufficient evidence regarding the additional benefit of other PFA interventions. CLINICAL RELEVANCE: The decision to apply FV to children needs to be made in light of their actual usage of RFT. TRIAL REGISTRATION: PROSPERO (CRD42020165270).

Are parents' education levels associated with either their oral health knowledge or their children's oral health behaviors? A survey of 8446 families in Wuhan.

BACKGROUND: Children aged 6-7 years are in the early mixed dentition, which is a period of high prevalence of dental caries and other dental diseases and a critical period for the formation of oral health behaviors. Therefore, good oral hygiene habits of children and oral health knowledge of parents are very important. This study sought to explore the relationship between children's oral health behaviors, parental oral health knowledge, parental choices of pit and fissure sealants, and parents' education levels based on a large-scale sample size for the first time, and to compare the influences of parental education levels between parents. METHODS: Families of the first and second graders of primary schools in Wuhan Hongshan District were included in this study. A total of 8446 questionnaires were collected to obtain comprehensive information on children's oral health behaviors, parents' oral health knowledge and parents' pit and fissure sealants-related choices. The relationship between these outcome variables and parents' education levels were studied using logistic regression analysis and chi-square test. RESULTS: Parents who reported good educational background had more favorable oral health knowledge than those of other parents, and their children had better oral hygiene behaviors. Four indicators of five measures to children's oral health behaviors were significantly associated with mother's education level (P < 0.05), and three of them were related to father's education level (P ≤ 0.01). Moreover, seven indicators of eight measures to parents' oral health knowledge were significantly related to mother's education level (P < 0.05) and four of them were affected by the father's (P < 0.05). In addition, parents with higher educational attainments paid more attention to the completeness of medical facilities, the environment of dental practice, the distance to treatment sites, and took less concern of children's willingness when choosing the pit and fissure sealants sites. CONCLUSIONS: In families with children at the early mixed dentition stage, parents with higher education levels tend to have better oral health knowledge and more oral health care needs, such as pit and fissure sealants. In addition, children of parents who have better educated parents tend to perform better oral hygiene practices.

Consumption frequency of added sugars and UK children's dental caries.

OBJECTIVES: To examine the association between consumption frequency of foods and drinks with added sugar and dental caries experience in the permanent teeth of 12- and 15-year-old children in England, Wales and Northern Ireland, using the Children's Dental Health Survey 2013 (CDHS) data. METHODS: Four thousand nine hundred and fifty children aged 12 and 15 have the following information available: daily consumption frequency of foods and drinks with added sugar, tooth-brushing frequency, dental attendance, and water-drinking frequency. The children's dental caries experience was available as a DMFT score (number of decayed, missing, filled permanent teeth). A zero-inflated negative binomial model (ZINB) was used to fit the DMFT score. RESULTS: Lower socioeconomic status (SES), nonregular dental check-ups, and low water-drinking frequency were associated with higher consumption frequency of added sugar (all P < 0.05). The consumption frequency of both drinks and foods with added sugar also differed by region (P < 0.001), and children who more frequently consumed foods with added sugars also consumed drinks with added sugars more often (P < 0.001). Using the Zero-Inflated Negative Binomial model, DMFT scores were not associated with consumption frequency of added sugars for children with caries (DMFT > 0), but the chance of being free of obvious caries (DMFT = 0) was lower for children with high frequency (≥4) of sugar-added foods than for children reported to have a sugar-free diet (OR = 0.5, 95% CI [0.3, 0.8]). CONCLUSIONS: Consumption frequency of added sugars was associated with dental caries and a number of child demographic and lifestyle characteristics. Children who consume foods and drinks with added sugar more frequently are more likely to develop dental caries, but higher consumption frequency of drinking water in fluoridated areas might reduce dental caries. The findings add to the evidence for the association between children's dental caries and added sugar consumption.