Mental health in secondary school-aged children with epilepsy and their primary caregivers: A case control study.

PURPOSE: To describe the prevalence and associated factors of mental health problems in secondary school-aged (11-16 years) children with epilepsy and their primary caregivers compared to a control group without epilepsy. METHODS: Children with epilepsy (n = 60), controls (n = 49), and caregivers (n = 60 epilepsy and n = 49 control group) completed a measure of the child's mental health (Strengths and Difficulties Questionnaire; SDQ). Primary caregivers in both groups completed a measure of their own mental health (Depression, Anxiety, and Stress Scale-21; DASS-21). Factors associated with child and caregiver mental health in the epilepsy group were explored using linear regression. RESULTS: There were no significant differences between the epilepsy and control group regarding age, gender, ethnicity and socioeconomic status. A higher proportion of children with epilepsy scored in the at-risk range on the SDQ indicating more mental health problems than the control group, as reported by the children (45% vs. 24 %) (p = 0.026) and caregivers (52% vs. 14 %) (p < 0.001). Primary caregivers of children with epilepsy had more symptoms of depression (p = 0.001), anxiety (p = 0.028) and stress (p = 0.019) than caregivers in the control group. Children with epilepsy with greater motor coordination problems had greater mental health difficulties. Children with epilepsy with more mental health difficulties had caregivers with more difficulties and caregivers of children with earlier onset of seizures had more mental health difficulties. CONCLUSIONS: Epilepsy confers a high risk for mental health problems in adolescents and their primary caregivers. There is a need to better understand the relationship between caregiver and child mental health difficulties in epilepsy.

"One size does not fit all" - Barriers to and facilitators of physical activity in adolescents with epilepsy.

OBJECTIVE: To explore the barriers to physical activity and to identify the support needed to facilitate physical activity in adolescents with epilepsy (AWE). METHODS: AWE (aged 11-16 years) and their caregivers completed survey-based open questions regarding perceived barriers to, and facilitators of physical activity in young people with epilepsy. The responses were analysed using Thematic Analysis. RESULTS: Themes concerning barriers to physical activity included concerns about seizure safety, general anxiety and anxiety related to seizures, stigma/negative attitudes associated with having epilepsy, tiredness, and perceived lack of physical competence. Themes regarding the support needed to facilitate physical activity included better education amongst staff/coaches about epilepsy (e.g., seizure management/prevention, associated fatigue/tiredness), improvements in societal attitudes towards epilepsy, flexibility/tailoring of activities to the child's needs (e.g., need for breaks), and peer support for young people with epilepsy to encourage engagement in physical activity. CONCLUSIONS: There is a perception among AWE and caregivers, that significant barriers exist with regard to engaging in physical activity for young people with epilepsy. Barriers are related to concerns about seizure management but also wider safety and social issues. A number of facilitators were identified to promote physical activity engagement in AWE, including education for staff and caregivers, peer support, and tailoring activities to the adolescent's needs. There is a need to develop interventions to reduce barriers to physical activity in young people with epilepsy.

Cross-sectional associations of device-measured sedentary behaviour and physical activity with cardio-metabolic health in the 1970 British Cohort Study.

AIMS: This study aimed to examine the cross-sectional associations of thigh accelerometry-assessed sedentary behaviour and moderate-to-vigorous physical activity (MVPA) with cardio-metabolic health markers and prevalent diabetes in a population sample of middle-aged British adults. METHODS: Participants (n = 4892) from the age-46-to-48 wave of the 1970 British Cohort Study were fitted with a waterproofed activPAL3 micro device. Total/prolonged sedentary time, breaks and MVPA were the main exposures. We dichotomized prolonged sedentary time and MVPA based on the corresponding median, generating four combinations as categorical exposures. Outcomes comprised of diabetes and seven cardio-metabolic health markers. We used logistic regression and generalized linear models to examine independent/joint associations, conducting a minimally adjusted model including demographics and contextual covariates, and further adjusted for total sedentary time and/or MVPA as applicable. RESULTS: Each set of 10 sedentary breaks and 1 h of prolonged sedentary time were associated with HbA1c (mmol/mol) [B = -0.18 (-0.33, -0.03) and 2.35 (1.01, 3.69), respectively]. Each set of 10 sedentary breaks and 1 h of MVPA were favourably associated with diabetes [adjusted odds ratio (AOR): 0.80 (0.71, 0.99) and 0.42 (0.26, 0.67), respectively]. Joint analyses showed that only the low MVPA × long sedentary time combination had significantly higher odds for diabetes than the referent high MVPA × short sedentary time combination [AOR: 1.89 (1.17, 3.03)]. CONCLUSIONS: Each set of additional 10 sedentary breaks per day was associated with 20% lower odds for diabetes. A low physical activity level combined with long sedentary time might synergistically deteriorate cardio-metabolic health.

Parity-Protected Superconductor-Semiconductor Qubit.

Coherence of superconducting qubits can be improved by implementing designs that protect the parity of Cooper pairs on superconducting islands. Here, we introduce a parity-protected qubit based on voltage-controlled semiconductor nanowire Josephson junctions, taking advantage of the higher harmonic content in the energy-phase relation of few-channel junctions. A symmetric interferometer formed by two such junctions, gate-tuned into balance and frustrated by a half-quantum of applied flux, yields a cos(2φ) Josephson element, reflecting coherent transport of pairs of Cooper pairs. We demonstrate that relaxation of the qubit can be suppressed tenfold by tuning into the protected regime.

Assessment of nutrient quality, heavy metals and phytotoxic properties of chicken manure on selected commercial vegetable crops.

Due to rapid expansion in the poultry industry, production of poultry manure has also consequently increased, resulting in unplanned disposal of this manure to the soil in some cases, with possible negative environmental consequences. In this study, 10 separate poultry manure samples were collected from different sites located in the central Eastern Cape, South Africa and characterized for chemical and phytotoxic properties. The poultry manures had an average neutral pH (range 6.94 - 7.97) whilst the electrical conductivity was highly variable from 2.45 dS/m to 12.3 dS/m between the 10 sites. The high conductivity values recorded in some of the manures indicate that caution may need to be practiced when directly applying these manure to the soil, to avoid buildup of soluble salts. All samples showed a very high concentration of total P (1963.1 mg/kg - 2644.1 mg/kg) with the plant available fraction ranging from 21.3% - 37.7% of the total P. All the heavy metals measured (Cr, Cu, Ni, Pb and Zn) were below the maximum permissible limits set by the U.S. Environmental Protection Agency. However, some of the poultry manure showed some level of phytotoxicity based on the plant bioassay, with some samples, recording a germination index less than 50% for the different crops evaluated. However, this bioassay may not be conclusive and there is need to evaluate this phytotoxicity in real world field applications as there is paucity of information on this aspect regarding poultry manure. Such filed studies can be used to evaluate alternative strategies such as planting and harvest intervals between application of these manures and planting or harvesting. It is also suggested that further biodegradation through composting or vermicomposting may be required to improve nutrient content and reduce the presence of phytotoxic compounds in some of the poultry manures before use as soil amendments.

Detection of genetic incompatibilities in non-model systems using simple genetic markers: hybrid breakdown in the haplodiploid spider mite Tetranychus evansi.

When two related species interbreed, their hybrid offspring frequently suffer from reduced fitness. The genetics of hybrid incompatibility are described by the Bateson-Dobzhansky-Muller (BDM) model, where fitness is reduced by epistatic interactions between alleles of heterospecific origin. Unfortunately, most empirical evidence for the BDM model comes from a few well-studied model organisms, restricting our genetic understanding of hybrid incompatibilities to limited taxa. These systems are predominantly diploid and incompatibility is often complete, which complicates the detection of recessive allelic interactions and excludes the possibility to study viable or intermediate stages. Here, we advocate research into non-model organisms with haploid or haplodiploid reproductive systems and incomplete hybrid incompatibility because (1) dominance is absent in haploids and (2) incomplete incompatibility allows comparing affected with unaffected individuals. We describe a novel two-locus statistic specifying the frequency of individuals for which two alleles co-occur. This approach to studying BDM incompatibilities requires genotypic characterization of hybrid individuals, but not genetic mapping or genome sequencing. To illustrate our approach, we investigated genetic causes for hybrid incompatibility between differentiated lineages of the haplodiploid spider mite Tetranychus evansi, and show that strong, but incomplete, hybrid breakdown occurs. In addition, by comparing the genotypes of viable hybrid males and inviable hybrid male eggs for eight microsatellite loci, we show that nuclear and cytonuclear BDM interactions constitute the basis of hybrid incompatibility in this species. Our approach opens up possibilities to study BDM interactions in non-model taxa, and may give further insight into the genetic mechanisms behind hybrid incompatibility.

Stocking Density Optimization for Enhanced Bioconversion of Fly Ash Enriched Vermicompost.

Although it is widely agreed that stocking density critically affects the rate of vermicomposting, there is no established stocking density for mixtures of fly ash and other waste materials. This study sought to optimize (Savigny, 1826) stocking density for effective biodegradation and nutrient release in a fly ash-cow dung-waste paper (FCP) mixture. Four stocking densities of 0, 12.5, 25, and 37.5 g worms kg were evaluated. Although the 12.5, 25, and 37.5 g worms kg treatments all resulted in a mature vermicompost, stocking densities of 25 and 37.5 g worms kg resulted in faster maturity, higher humification parameters, and a significantly lower final C/N ratio (range 11.1-10.4). The activity of ß-glucosidase and fluorescein diacetate hydrolysis enzymes showed faster stabilization at stocking densities of 25 and 37.5 g worms kg, indicating compost stability and maturity. Similarly, a stocking density of 25 g worms kg resulted in the highest release of Olsen-extractable P and (NO + NO)-N contents. The 0-, 12.5-, 25-, and 37.5-g treatments resulted in net Olsen P increases of 16.3, 38.9, 61.0, and 53.0%, respectively, after 10 wk. Although compost maturity could be attained at stocking densities of 12.5 g worms kg, for faster production of humified and nutrient-rich FCP vermicompost, a stocking density of 25 g worms kg seems most appropriate.

Challenges identified in a pilot outreach dental service for Traveller children in Hackney, East London.

IMPETUS FOR ACTION: Inequity of dental health and dental service use for Travellers in the UK. National guidance on improving community oral health, stresses an imperative to involve and engage with "those whose economic, social and environmental circumstances or lifestyle place them at high risk of poor oral health or make it difficult for them to access dental services". SOLUTION: Oral health promotion and simple treatments were provided on two Traveller sites from a mobile dental unit (MDU) over a 5-day period and patients with extensive oral disease were referred to a fixed-site clinic for continued care. OUTCOMES: Most children, 60%, reportedly brushed once daily or less, only 40% brushed twice daily. Obvious visual caries were evident in 23 out of the 35 children (66%). A moderate to high risk of developing future caries was identified in 92% of Traveller children based on their existing diet, oral hygiene practices and caries experience. FUTURE: Oral care was successfully provided on an MDU, but this is an expensive resource and should not be considered a permanent solution. Oral health promotion messages delivered in the families' homes or local community settings through their established health services, such as health visitors or community nurses, may help to reinforce good oral hygiene and diet practices and needs robust evaluation.

Docosahexaenoic Acid Slows Visual Field Progression in X-Linked Retinitis Pigmentosa: Ancillary Outcomes of the DHAX Trial.

PURPOSE: Docosahexaenoic acid (DHA) was supplemented in a single-site, placebo-controlled, randomized clinical trial designed to slow vision loss associated with X-linked retinitis pigmentosa (XLRP); the DHAX Trial. We previously reported no significant differences between supplemented and placebo groups in intent-to-treat analysis of primary ERG outcomes. Assessed herein are hypothesis-generating measures of ancillary visual function outcomes in participants fully adhering to trial protocol. METHODS: Male participants with XLRP (range, 7-31 years) received 30 mg DHA/kg/d (n = 29) or placebo (n = 22) for 4 years. Visual outcomes were measured annually and red blood cell (RBC) DHA determined every 6 months. RESULTS: Oral DHA supplementation increased mean RBC-DHA levels by 4-fold (P < 0.0001) over placebo. No group differences in progression were found for visual acuity (P = 0.11), shape discrimination (P = 0.18), or fundus appearance (P = 0.70). Optical coherence tomography (OCT) became available during year 2 of the trial; no group differences were seen in ellipsoid zone constriction (P = 0.87) over 2 years. Yearly rates of progression were reduced for dark-adapted thresholds (P = 0.06) and visual field sensitivity for foveal, macular, peripheral, total, and ellipsoid zone regions by DHA supplementation (P = 0.039, P = 0.031, P < 0.0001, P < 0.0001, and P = 0.033). Rates of visual field sensitivity decline were dependent on RBC-DHA (P = 0.046 to <0.0001). CONCLUSIONS: Supplementation of DHA significantly elevated blood DHA levels and reduced the rate of progression in final dark-adapted thresholds and visual field sensitivity. From the relationship between RBC-DHA and the rate of field sensitivity loss, we can extrapolate that an RBC-DHA level of 17% could minimize the decline in field sensitivity. (ClinicalTrials.gov number, NCT00100230.)

Improving access to dental care for vulnerable children; further development of the Back2School programme in 2013.

This paper describes a service evaluation of a dental treatment programme providing care to children not normally taken to the dentist. It explains the extension of the Back2School programme from the pilot phase and assesses if a mobile dental unit (MDU) can provide a high quality service. The public health competencies it illustrates include oral health improvement, developing and monitoring quality dental services, and collaborative working.

Why are vulnerable children not brought to their dental appointments?

A considerable number of children under 16 years of age, with an oral healthcare need, are not brought to their Barts Health Special Care Community Dental Service (BHSCCDS) appointments. The BHSCCDS needed to understand more about why parents/carers (parents) were failing to bring their children, in order to identify appropriate strategies to reduce the non-attendance. Thus, an audit was conducted to assess the number, frequency and reasons for all missed appointments (MA); this included feedback conversations with dental staff and parents. Information obtained from this cohort of high-risk children's families through personal, respectful and supportive contact improved understanding of the parents' individual and collective issues and lead to recommendations that could reduce the number of MA in the future.

Optimization of fly ash incorporation into cow dung-waste paper mixtures for enhanced vermidegradation and nutrient release.

This study was conducted to establish an appropriate mixture ratio of fly ash (F) to optimized cow dung-waste paper mixtures (CP) to develop a high-quality vermicompost using earthworms (). Fly ash was mixed with cow dung-waste paper mixtures at ratios of (F:CP) 1:1, 1:2, 1:3, 2:1, and 3:1 or CP alone and composted for 14 wk. Olsen P, inorganic N (NO, NO, and NH), C:N ratio, ash content, microbial biomass C, and humification parameters were measured together with scanning electron micrograph images to determine compost maturity. Based on C:N ratio, the extent of vermidegradation of the waste mixtures followed the decreasing order (F:CP) of 1:3 > 1:2 > 1:1 > CP alone > 2:1 > 3:1. Similarly, Olsen P was significantly higher ( < 0.05) where earthworms were added. The mean percentage increase in extractable P was in the order CP alone > 1:2 > 1:3 > 1:1 > 2:1 > 3:1, with earthworm addition almost doubling P release across the 1:1, 1:2, and CP alone treatments. Fly ash incorporation enhanced conversion of organic N to the plant-available inorganic forms, with the 1:3 treatment resulting in the highest conversion. Scanning electron micrograph images confirmed the extent of vermidegradation reflected by the various humification parameters determined. Fly ash incorporation at the 1:2 ratio proved to be the most appropriate because it allows processing of more fly ash while giving a vermicompost with desirable maturity and nutritional properties.

Vaccine-associated varicella and rubella infections in severe combined immunodeficiency with isolated CD4 lymphocytopenia and mutations in IL7R detected by tandem whole exome sequencing and chromosomal microarray.

In areas without newborn screening for severe combined immunodeficiency (SCID), disease-defining infections may lead to diagnosis, and in some cases, may not be identified prior to the first year of life. We describe a female infant who presented with disseminated vaccine-acquired varicella (VZV) and vaccine-acquired rubella infections at 13 months of age. Immunological evaluations demonstrated neutropenia, isolated CD4 lymphocytopenia, the presence of CD8(+) T cells, poor lymphocyte proliferation, hypergammaglobulinaemia and poor specific antibody production to VZV infection and routine immunizations. A combination of whole exome sequencing and custom-designed chromosomal microarray with exon coverage of primary immunodeficiency genes detected compound heterozygous mutations (one single nucleotide variant and one intragenic copy number variant involving one exon) within the IL7R gene. Mosaicism for wild-type allele (20-30%) was detected in pretransplant blood and buccal DNA and maternal engraftment (5-10%) demonstrated in pretransplant blood DNA. This may be responsible for the patient's unusual immunological phenotype compared to classical interleukin (IL)-7Rα deficiency. Disseminated VZV was controlled with anti-viral and immune-based therapy, and umbilical cord blood stem cell transplantation was successful. Retrospectively performed T cell receptor excision circle (TREC) analyses completed on neonatal Guthrie cards identified absent TREC. This case emphasizes the danger of live viral vaccination in severe combined immunodeficiency (SCID) patients and the importance of newborn screening to identify patients prior to high-risk exposures. It also illustrates the value of aggressive pathogen identification and treatment, the influence newborn screening can have on morbidity and mortality and the significant impact of newer genomic diagnostic tools in identifying the underlying genetic aetiology for SCID patients.

Safety assessment of docosahexaenoic acid in X-linked retinitis pigmentosa: the 4-year DHAX trial.

PURPOSE: Docosahexaenoic acid (DHA) continues to be evaluated and recommended as treatment and prophylaxis for various diseases. We recently assessed efficacy of high-dose DHA supplementation to slow vision loss in patients with X-linked retinitis pigmentosa (XLRP) in a randomized clinical trial. Because DHA is a highly unsaturated fatty acid, it could serve as a target for free-radical induced oxidation, resulting in increased oxidative stress. Biosafety was monitored during the 4-year trial to determine whether DHA supplementation was associated with identifiable risks. METHODS: Males (n = 78; 7-31 years) meeting entry criteria were enrolled. The modified intent-to-treat cohort (DHA = 33; placebo = 27) adhered to the protocol ≥ 1 year. Participants were randomized to an oral dose of 30 mg/kg/d DHA or placebo plus a daily multivitamin. Comprehensive metabolic analyses were assessed for group differences. Treatment-emergent adverse events including blood chemistry metabolites were recorded. RESULTS: By year 4, supplementation elevated plasma and red blood cell-DHA 4.4- and 3.6-fold, respectively, compared with the placebo group (P < 0.00001). Over the trial duration, no significant differences between DHA and placebo groups were found for vitamin A, vitamin E, platelet aggregation, antioxidant activity, lipoprotein cholesterol, or oxidized LDL levels (all P > 0.14). Adverse events were transient and not considered severe (e.g., gastrointestinal [GI] irritability, blood chemistry alterations). One participant was unable to tolerate persistent GI discomfort. CONCLUSIONS: Long-term, high-dose DHA supplementation to patients with XLRP was associated with limited safety risks in this 4-year trial. Nevertheless, GI symptoms should be monitored in all patients taking high dose DHA especially those with personal or family history of GI disturbances. (ClinicalTrials.gov number, NCT00100230.).

Associations between sedentary behaviour and physical activity in children and adolescents: a meta-analysis.

Physical activity and sedentary behaviour are associated with metabolic and mental health during childhood and adolescence. Understanding the inter-relationships between these behaviours will help to inform intervention design. This systematic review and meta-analysis synthesized evidence from observational studies describing the association between sedentary behaviour and physical activity in young people (<18 years). English-language publications up to August 2013 were located through electronic and manual searches. Included studies presented statistical associations between at least one measure of sedentary behaviour and one measure of physical activity. One hundred sixty-three papers were included in the meta-analysis, from which data on 254 independent samples was extracted. In the summary meta-analytic model (k = 230), a small, but significant, negative association between sedentary behaviour and physical activity was observed (r = -0.108, 95% confidence interval [CI] = -0.128, -0.087). In moderator analyses, studies that recruited smaller samples (n < 100, r = -0.193, 95% CI = -0.276, -0.109) employed objective methods of measurement (objectively measured physical activity; r = -0.233, 95% CI = -0.330, -0.137) or were assessed to be of higher methodological quality (r = -0.176, 95% CI = -0.215, -0.138) reported stronger associations, although effect sizes remained small. The association between sedentary behaviour and physical activity in young people is negative, but small, suggesting that these behaviours do not directly displace one another.

Four-year placebo-controlled trial of docosahexaenoic acid in X-linked retinitis pigmentosa (DHAX trial): a randomized clinical trial.

IMPORTANCE: X-linked retinitis pigmentosa is a severe inherited retinal degenerative disease with a frequency of 1 in 100,000 persons. Because no cure is available for this orphan disease and treatment options are limited, slowing of disease progression would be a meaningful outcome. OBJECTIVE: To determine whether high-dose docosahexaenoic acid (DHA), an ω-3 polyunsaturated fatty acid, slows progression of X-linked retinitis pigmentosa measured by cone electroretinography (ERG). DESIGN, SETTING, AND PARTICIPANTS: A 4-year, single-site, randomized, placebo-controlled, double-masked phase 2 clinical trial at a research center specializing in medical retina. Seventy-eight male patients diagnosed as having X-linked retinitis pigmentosa were randomized to DHA or placebo. Data were omitted for 2 patients with non-X-linked retinitis pigmentosa and 16 patients who were unable to follow protocol during the first year. The remaining participants were tested annually and composed a modified intent-to-treat cohort (DHA group, n = 33; placebo group, n = 27). INTERVENTIONS: All participants received a multivitamin and were randomly assigned to oral DHA (30 mg/kg/d) or placebo. MAIN OUTCOMES AND MEASURES: The primary outcome was the rate of loss of cone ERG function. Secondary outcomes were rod and maximal ERG amplitudes and cone ERG implicit times. Capsule counts and red blood cell DHA levels were assessed to monitor adherence. RESULTS: Average (6-month to 4-year) red blood cell DHA levels were 4-fold higher in the DHA group than in the placebo group (P < .001). There was no difference between the DHA and placebo groups in the rate of cone ERG functional loss (0.028 vs 0.022 log µV/y, respectively; P = .30). No group differences were evident for change in rod ERG (P = .27), maximal ERG (P = .65), or cone implicit time (no change over 4 years). The rate of cone loss (ie, event rate) was markedly reduced compared with rates in previous studies. No severe treatment-emergent adverse events were found. CONCLUSIONS AND RELEVANCE: Long-term DHA supplementation was not effective in slowing the loss of cone or rod ERG function associated with X-linked retinitis pigmentosa. Participant dropout and lower-than-expected disease event rate limited power to detect statistical significance. A larger sample size, longer trial, and attainment of a target blood DHA level (13%) would be desirable. While DHA supplementation at 30 mg/kg/d does not present serious adverse effects, routine monitoring of gastrointestinal tolerance is prudent. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00100230.

A pilot of a school-based dental treatment programme for vulnerable children with possible dental neglect: the Back2School programme.

BACKGROUND: The general dental practitioners and community dental services of Barts Health NHS Trust in City and Hackney and Tower Hamlets PCTs in East London currently provide a school-based oral health prevention programme. The programme provides dental screening for three- to six-year-olds, fluoride varnish application twice during the school year and engaging with the families to encourage dental attendance. An evaluation of the programme suggested that children with a dental treatment need, identified by the screening, were not being taken for further dental care. OBJECTIVE: The aim of this 'Back2School' pilot was to evaluate the use of mobile dental units in the provision of care to this group of children. The objectives were to assess if this care was acceptable to the children and their families, to evaluate dental treatment provided, patient attendance, costs of the service and whether it would be a viable method to provide dental care. METHODS: The rotation of the mobile dental unit in this pilot offered ten sessions of dental care over five days in three different locations. The locations were chosen near the five schools covered by the community dental service. RESULTS: A total of 63 children were seen; 33 females and 30 males, which included 7 walk-in patients. Five children had extractions and the number of fillings ranged from one to six. Of the 63 children seen only 8 (13%) had attended a dentist before, 59 (93%) of the children were rated 'high risk' for dental disease, 61 (97%) of the children received a fluoride varnish application and 95.2 UDAs were achieved. Feedback was positive overall. CONCLUSIONS: The use of a community-based mobile dental unit has the potential to be a cost-effective method to remove barriers to dental care access, both for the treatment of vulnerable children and as a first point of contact in the dental care pathway.

A school-based oral health intervention in East London: the Happy Teeth fluoride varnish programme.

BACKGROUND: The Community Dental Services of Barts Health NHS Trust in City and Hackney and Tower Hamlets PCTs in East London have provided a school-based oral health intervention since 2009. OBJECTIVE: The aim of this paper is to present the programme development, outcomes and evaluation. SUBJECTS AND METHODS: The programme consists of fluoride varnish applications linked to school dental screenings for three to six-year-olds, combined with oral health promotion for parents/carers. An outreach linkworker works closely with schools to help identify and support vulnerable families into the programme. RESULTS: In the first year of the programme 160 of the target children (42%) had one FV application and 81 children (21%) had two applications. In the second year 149 children (39%) had one FV application, and 113 (29%) had two applications. Amendments to the protocol increased programme participation in the third year, with 1,822 of the target children (61%) having one FV application and 1,586 (53%) having two applications. CONCLUSIONS: The programme proved acceptable to the school staff, participating parents/carers and children. The Happy Teeth programme is proposed as a model for school-based fluoride varnish programmes.

Developing dental services for homeless people in East London.

OBJECTIVE: The aim of this study was to describe the dental services delivered by the Community Dental Service (CDS) of Tower Hamlets (TH) and City and Hackney (CH) for adult homeless people in 2009-2011, to assess if the service met its planned objectives and to report the outcomes of the dental care provided. METHOD: TH and CH CDS provided a nine tier dental service for homeless people during April 2009 to September 2011, in which the dedicated mobile dental service (MDS) and the dedicated dental clinic (DDS) provided 3,102 dental appointments for homeless people. Data collection from a random sample (n = 350) of record cards of adult patients who were homeless and offered oral care from these services was conducted, in collaboration with an analysis of appointment books, service delivery rotas and day sheets. Patients' oral findings, treatments, challenges as well as feedback received from the service users were recorded and evaluated against the planned objectives. RESULTS: One thousand two hundred and twelve (39.1%) of these appointments went to the 350 patients whose record cards were examined as part of this audit. One of the record cards randomly selected had incomplete date and was excluded from the results, so data was presented on the 349 complete record cards. The age range of these patients was 18-74 years, with a mean age of 38.46 years ± 9.1 standard deviation (SD) with 80% of the patients (n = 281) under 50 years of age. Forty percent of these patients presented in pain with a further 5% complaining of swelling and infection, 99% of people required treatment and only nine people had no decay, three of whom were edentulous. Two hundred and thirteen (61%) patients completed their treatments, which took between 1 to 18 appointments, but only 97 (27.8%) patients did so without any failed or cancelled appointments. Of the 128 (36.7%) patients who were lost after the first appointment, only 15 (11.7%) did not receive any treatment; most had been treated for pain with temporary fillings, extractions, permanent fillings and management of swelling. Sixty-seven band 1, 16 band 1.2 (emergency only), 148 band 2 and 52 band 3 courses of treatment were submitted. CONCLUSION: This study showed a significant need for services providing oral healthcare for this population and highlighted that flexibly delivered dental services, embedded in local health and social networks, seemed to promote uptake in these clients who normally find it extremely difficult to find dental care services elsewhere.