Anticipatory guidance and children's oral health: A scoping review.

BACKGROUND: Anticipatory guidance (AG) involves providing parents with information about developmental milestones and promoting optimal development. Oral AG was first introduced as a comprehensive approach to provide age-appropriate oral health information and preventive interventions. The literature regarding this important topic has not yet been reviewed and summarised. AIM: To describe the literature on AG provided to parents about their children's oral health and identify gaps in the current research. METHOD: The scoping review mapped the existing peer-reviewed and guideline documents about AG and children's oral health using the framework established by Arksey and O'Malley (2005) and modified by Levac et al. (2010). Firstly, we defined our research questions and searched the literature using Medline, Web of Science and Scopus. Secondly, we selected all types of literature and then applied the inclusion and exclusion criteria, and finally, we analysed and summarised the information using thematic analysis. RESULTS: Forty-three peer-reviewed articles and six guidelines were included. There was variation in how AG was described and defined. While some studies have evaluated the effectiveness of AG, most have investigated its short-term effectiveness only, with few interventional studies assessing this approach in the long-term. CONCLUSION: While the concept of AG shows promise, there is no consensus within the current literature on a defined definition and there is a lack of long-term evaluation.

A systematic review of the quality and scope of economic evaluations in child oral health research.

BACKGROUND: Economic evaluations provide policy makers with information to facilitate efficient resource allocation. To date, the quality and scope of economic evaluations in the field of child oral health has not been evaluated. Furthermore, whilst the involvement of children in research has been actively encouraged in recent years, the success of this movement in dental health economics has not yet been explored. This review aimed to determine the quality and scope of published economic evaluations applied to children's oral health and to consider the extent of children's involvement. METHODS: The following databases were searched: CINAHL, Cochrane Library, Econlit, EThOS, MEDLINE, NHS EED, OpenGrey, Scopus, Web of Science. Full economic evaluations, relating to any aspect of child oral health, published after 1997 were included and appraised against the Drummond checklist and the Consolidated Health Economic Evaluation Reporting Standards by a team of four calibrated reviewers. Data were also extracted regarding children's involvement and the outcome measures used. RESULTS: Two thousand seven hundred fifteen studies were identified, of which 46 met the inclusion criteria. The majority (n = 38, 82%) were cost-effectiveness studies, with most focusing on the prevention or management of dental caries (n = 42, 91%). One study quantified outcomes in Quality Adjusted Life Years (QALYs), and one study utilised a child-reported outcome measure. The mean percentage of applicable Drummond checklist criteria met by the studies in this review was 48% (median = 50%, range = 0-100%) with key methodological weaknesses noted in relation to discounting of costs and outcomes. The mean percentage of applicable CHEERS criteria met by each study was 77% (median = 83%, range = 33-100%), with limited reporting of conflicts of interest. Children's engagement was largely overlooked. CONCLUSIONS: There is a paucity of high-quality economic evaluations in the field of child oral health. This deficiency could be addressed through the endorsement of standardised economic evaluation guidelines by dental journals. The development of a child-centred utility measure for use in paediatric oral health would enable researchers to quantify outcomes in terms of quality adjusted life years (QALYs) whilst promoting child-centred research.

Down-regulation of CD28, TCR-zeta (zeta) and up-regulation of FAS in peripheral cytotoxic T-cells of primary breast cancer patients.

BACKGROUND: Several studies have supported the hypothesis that the concept of immuno-surveillance would not be effective in cancer patients. One reason for suppression of antitumor immunity may be attributed to immune impairment of T-lymphocytes, which extends beyond the tumor-microenvironment and might effect the peripheral blood. Therefore the aim of this study was to investigate the expression of immunoregulatory antigens in peripheral blood lymphocytes of primary breast cancer patients in comparison with healthy donors. MATERIALS AND METHODS: The peripheral blood immune status of 61 patients with primary breast cancer was analysed by FACS-analysis. The different lymphocytic subpopulations were identified by intracellular/extracellular monoclonal antibodies in three-color flow cytometry. The distribution was compared to age-matched healthy female donors (n = 29). RESULTS: The expression of TCR zeta-chain, an important signal complex for T-cell activation and functional integrity of specific immune response, was significantly reduced in the cytotoxic specific T-cell population. Cytotoxic T-cells (CD3+/CD8+) also showed a down-regulation of CD28, the important ligand to the co-stimulatory molecule CD80 (B7.1) on antigen-presenting cells. Moreover, breast cancer patients had significantly more CD95 (FAS) expressing cytotoxic T-cells than their healthy counterparts (p < 0.05). CONCLUSION: The significant up-regulation of CD95 and down-regulation of TCR zeta and CD28 in peripheral cytotoxic T-cells of breast cancer patients leads to the hypothesis of systemic immunosuppression, which could open the door for tumor cell dissemination via the blood stream and which is the subject of ongoing studies.