Using Policy Briefs to Communicate Dental Research Findings to Policymakers.

OBJECTIVES: New scientific knowledge is not always available to decision makers. Policy briefs are a way that dental researchers can communicate research findings to policymakers. This study compares usefulness of 2 types of policy briefs about sugar-sweetened beverage (SSB) intake and tooth decay. METHODS: We developed 2 policy brief types (data focused and narrative focused) and emailed a randomly assigned policy brief to 825 policymakers and staff from 3 levels of government (city, county, and state) in Washington State. Participants completed a 22-item online questionnaire. There were 4 study outcomes: whether the brief was understandable, whether the brief was credible, likelihood of use, and likelihood to be shared (each measured on a 5-point Likert-like scale). The t test was used to evaluate whether outcomes differed by policy brief type and government level (α = 0.05). RESULTS: There were 108 respondents (adjusted response rate 14.6%). About 41.6% of participants were in city government, 26.9% were in county government, and 29.6% were in state government. Participants reported that both data- and narrative-focused briefs were understandable (mean rating [MR] and standard deviation [SD]: 4.15 ± 0.68 and 4.09 ± 0.81, respectively; P = 0.65) and credible (MR and SD: 4.13 ± 0.70 and 4.09 ± 0.70, respectively; P = 0.74), but they were not likely to use (MR and SD: 2.71 ± 1.15 and 2.55 ± 1.28, respectively; P = 0.51) or share it (MR and SD: 2.62 ± 1.04 and 2.66 ± 1.30, respectively; P = 0.87). The likelihood of sharing briefs differed significantly by level of government (P = 0.017). Participants at the state level were more likely to share information from the briefs (mean rating and SD: 3.10 ± 0.80) than city- and county-level participants (MR and SD: 2.62 ± 1.27, and 2.24 ± 1.21, respectively). CONCLUSION: Both data- and narrative-focused policy briefs may be a useful way to communicate dental research findings to policymakers, but additional steps are needed to ensure that briefs are used and shared. KNOWLEDGE TRANSFER STATEMENT: Researchers should disseminate their research findings to maximize scientific impact. Our study findings indicate that policy briefs may be a useful way to communicate dental research findings to policymakers, but additional research is needed on the best ways to disseminate findings.

Sleep related rhythmic movement disorder: phenotypic characteristics and treatment response in a paediatric cohort.

OBJECTIVE: To describe phenotypic, polysomnographic characteristics, impact, and treatment response in children with sleep related rhythmic movement disorder (SR-RMD). BACKGROUND: There is limited research on SR-RMD. We have developed a systematic clinical evaluation of children with SR-RMD to improve understanding and treatment. METHODS: A retrospective chart review of 66 children at a UK tertiary hospital. Baseline assessment included validated screening questionnaires to study autism spectrum characteristics, general behaviour and sensory profile. A standardised questionnaire assessed impact on sleep quality and daytime wellbeing of child and family. Polysomnography data were collated. RESULTS: Children were aged 0.9-16.3 years (78.8% male). 51.5% had a neurodevelopmental disorder, most commonly autism spectrum disorder. High rates of behavioural disturbance and sensory processing differences were reported, not confined to children with neurodevelopmental disorders. Parents reported concerns about risk of injury, loss of sleep and persistence into adulthood. Daytime wellbeing was affected in 72% of children and 75% of other family members. Only 31/48 children demonstrated rhythmic movements during video-polysomnography, occupying on average 6.1% of time in bed. Most clusters occurred in the settling period but also arose from N1, N2 and REM sleep and wake after sleep onset. Melatonin was prescribed to 52 children, all but one were extended-release preparations. 24/27 children with available data were reported to improve with melatonin. CONCLUSIONS: SR-RMD places a significant burden on child and family wellbeing. Our novel findings of sensory processing differences in this population and parent reported therapeutic response to extended-release melatonin offer potential avenues for future research.

Oral surgery II: Part 6. Oral and maxillofacial trauma.

Oral and maxillofacial trauma can range from an avulsed tooth as a result of a simple fall, to pan-facial injuries in the context of a polytraumatised patient involved in a road traffic accident. Regardless of aetiology, similar principles apply to all oral and maxillofacial injuries, and this chapter broadly outlines the more common forms of oral and maxillofacial trauma and the options available for their management. Throughout the chapter all references and values are for adult patients unless indicated.

Oral surgery II: Part 4. Common oral lesions.

Lesions of the mouth are surprisingly common and vary from the totally innocuous to highly malignant neoplasms. As required for the management of all patients, a clear and concise history and a thorough clinical examination are essential. In addition, radiographs and other laboratory investigations may be required to formulate a differential diagnosis. A definitive diagnosis, on which treatment planning should always be based, can usually only be confirmed following a histological examination. This may be obtained through a biopsy or following total excision of a lesion.

Oral surgery II: Part 3. Cysts of the mouth and jaws and their management.

A cyst may be defined as a pathological (or abnormal) body cavity, usually lined by epithelium, which contains fluid (gas or liquid) or semi-solid substances other than (primarily) pus. Even this definition is contentious, as some pathologists prefer the term pseudocyst or cavity when there is no epithelial lining. However, the above definition, based on that of Kramer, is as inclusive as possible. Cysts of the mouth and jaws are fairly common and their management is an essential component of oral surgery. This third article in the series deals with the classification, diagnosis and management of the common cysts of the head and neck.

Oral surgery II: Part 2. The maxillary sinus (antrum) and oral surgery.

The maxillary sinus is the largest of the four paranasal sinuses and, being anatomically adjacent to the dentate region of the maxilla, is commonly a source of problems - not simply in terms of conditions affecting the sinus but also in establishing an accurate diagnosis. As anyone who has suffered both sinusitis and a dental abscess in the posterior maxilla will tell you, the symptoms are almost indistinguishable. For this reason, a sound understanding of the maxillary sinus is an essential requisite for all dentists.

Nocturnal haemoglobin oxygen desaturation in urban and rural East African paediatric cohorts with and without sickle cell anaemia: a cross-sectional study.

Low haemoglobin oxygen saturation (SpO2) predicts complications in children with sickle cell anaemia (SCA) in the North but there are few data from Africa, where the majority of the patients reside. We measured daytime and overnight SpO2 in children with SCA in routine follow-up clinic, and controls without symptoms of SCA, comparing rural (Kilifi, Kenya) and urban (Dar-es-Salaam, Tanzania) cohorts. Daytime SpO2 was lower in 65 Tanzanian children with SCA (TS; median 97 (IQR 94-100)%); p<0.0001) than in 113 Kenyan children with SCA (KS; 99 (98-100)%) and 20 Tanzanian controls (TC; 100 (98-100)%). Compared with 95 Kenyan children with SCA, in 54 Tanzanian children with SCA and 19 TC who returned for overnight oximetry, mean (KS 99.0 (96.7-99.8)%; TS 97.9 (95.4-99.3)%; TC 98.4 (97.5-99.1)%; p=0.01) and minimum nocturnal SpO2 (92 (86-95)%; 87 (78.5-91)%; 90 (83.5-93)% p=0.0001) were lower. The difference between children with SCA persisted after adjustment for haemoglobin (p=0.004). Urban Tanzanian children, with and without SCA, experience greater exposure to low daytime and night-time SpO2 compared with rural Kenyan children with SCA. Possible explanations include differences in the prevalence of obstructive sleep apnoea or asthma, alterations in the oxyhaemoglobin desaturation curve or cardiovascular compromise, for example, to shunting at atrial or pulmonary level secondary to increased pulmonary artery pressure. The fact that non-SCA siblings in the urban area are also affected suggests that environmental exposures, for example, air pollution, nutrition or physical exercise, may play a role. Further studies should determine aetiology and clinical relevance for the SCA phenotype in children resident in Africa.

Dexketoprofen/tramadol: randomised double-blind trial and confirmation of empirical theory of combination analgesics in acute pain.

BACKGROUND: Combination analgesics are effective in acute pain, and a theoretical framework predicts efficacy for combinations. The combination of dexketoprofen and tramadol is untested, but predicted to be highly effective. METHODS: This was a randomised, double-blind, double-dummy, parallel-group, placebo-controlled, single-dose trial in patients with moderate or severe pain following third molar extraction. There were ten treatment arms, including dexketoprofen trometamol (12.5 mg and 25 mg) and tramadol hydrochloride (37.5 mg and 75 mg), given as four different fixed combinations and single components, with ibuprofen 400 mg as active control as well as a placebo control. The study objective was to evaluate the superior analgesic efficacy and safety of each combination and each single agent versus placebo. The primary outcome was the proportion of patients with at least 50 % max TOTPAR over six hours. RESULTS: 606 patients were randomised and provided at least one post-dose assessment. All combinations were significantly better than placebo. The highest percentage of responders (72%) was achieved in the dexketoprofen trometamol 25 mg plus tramadol hydrochloride 75 mg group (NNT 1.6, 95% confidence interval 1.3 to 2.1). Addition of tramadol to dexketoprofen resulted in greater peak pain relief and greater pain relief over the longer term, particularly at times longer than six hours (median duration of 8.1 h). Adverse events were unremarkable. CONCLUSIONS: Dexketoprofen trometamol 25 mg combined with tramadol hydrochloride 75 mg provided good analgesia with rapid onset and long duration in a model of moderate to severe pain. The results of the dose finding study are consistent with pre-trial calculations based on empirical formulae. TRIAL REGISTRATION: EudraCT (2010-022798-32); Clinicaltrials.gov (NCT01307020).

Executive function and sleep problems in childhood epilepsy.

Pediatric epilepsy has been reported to be associated with both sleep problems and cognitive deficits. In turn, in healthy children, poorer sleep has been associated with deficits in cognitive functioning. We hypothesized that poor sleep in childhood epilepsy may contribute to cognitive deficits. Using actigraphy, we objectively measured the sleep of children with epilepsy alongside that of healthy controls. In contrast to previous reports, we did not find any differences in objectively measured sleep between children with epilepsy and healthy controls. However, significant deficits in cognitive functioning were demonstrated that were not explained by differences in sleep.

Oral surgery: part 1. Introduction and the management of the medically compromised patient.

This paper is intended to provide an overview of current thinking in the more relevant medical conditions to oral surgery for primary care practitioners, giving the detail necessary to assist the primary dental clinical team in caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of discussion and illustration of uncommon or more complex medical conditions. Clinical tips for planning, execution and post-surgical care are discussed, and a brief overview of pre-operative, peri- and post-operative care is provided to minimise risk.

Poor sleep in PCOS; is melatonin the culprit?

STUDY QUESTION: Are daily cycles in urinary melatonin and oxidative stress marker levels (8-hydroxydeoxyguanosine) altered in PCOS, and is this associated with changes in sleep quality? SUMMARY ANSWER: There is an association between elevated nighttime melatonin and 8-hydroxy-2-deoxyguanosine (8-OHdG) levels, and poor sleep quality in our PCOS study group. WHAT IS KNOWN ALREADY: Women with PCOS are known to have poorer sleep. However, there have been few studies examining the possible association between melatonin levels and sleep quality in women with polycystic ovarian syndrome (PCOS). STUDY DESIGN, SIZE, DURATION: This is a case-control study of PCOS (n = 26) and non-PCOS control (n = 26) subjects recruited from a tertiary gynaecological centre. PARTICIPANTS/MATERIALS, SETTING, METHODS: The participants were requested to complete sleep questionnaires for a month. In a subgroup from these cohorts (PCOS, n = 15; controls, n = 18), urine samples were also collected at various time points over a 24-h period. In addition, their sleep patterns and lighting environment were monitored for 3 consecutive days and nights using a wrist-mounted Actiwatch device. MAIN RESULTS AND THE ROLE OF CHANCE: PCOS women had significantly elevated night-time urinary levels of the melatonin metabolite 6-sulfatoxymelatonin (aMT6s) and of 8-OHdG (both at P < 0.05), as well as significantly reduced sleep quality (P < 0.05), compared with the controls. LIMITATIONS, REASONS FOR CAUTION: Due to the small sample size of the study, further studies will be required to confirm our findings. WIDER IMPLICATIONS OF THE FINDINGS: Our preliminary work provides a possible new insight into the interactions between melatonin, increased oxidative stress and sleep in women with PCOS. STUDY FUNDING/COMPETING INTEREST(S): The study was funded by the Faculty of Medicine, University of Southampton.

An hour less sleep is a risk factor for childhood conduct problems.

BACKGROUND: There is emerging evidence that sleep problems in childhood may have enduring consequences. Studies using parental and objective sleep measurement suggest that sleep difficulties in children may be associated with behavioural problems. However, the findings using objective sleep measures are inconsistent and it is not clear what aspects of sleep quality are associated with daytime behavioural difficulties. The aim of this paper is to identify which behavioural symptoms are best predicted by actigraphic sleep measures in a general population sample of school-aged children aged 6-11 years. METHODS: Actigraphy was used to measure sleep in 91 typically developing children aged 6-11 years for 6 days. Parents completed the Strengths and Difficulties Questionnaire (SDQ). A series of multivariate linear regression models were computed to analyse the effects of sleep on SDQ subscales. RESULTS: Sleep did not predict emotional symptoms or hyperactivity. After controlling for age and gender, sleep accounted for 18% of the variance in conduct problems. Only actual sleep time in minutes made a significant contribution to the model. CONCLUSIONS: A child who sleeps 1 h less than the average child may be at risk of conduct problems. Clinicians should consider routinely screening for sleep difficulties when assessing children with conduct problems.

Nocturnal haemoglobin oxygen saturation variability is associated with vitamin C deficiency in Tanzanian children with sickle cell anaemia.

AIM: To compare pulse oximetry in children with sickle cell anaemia (SCA) and controls and test the hypothesis that vitamin C deficiency (VCD; <11.4 µmol/L) is associated with nocturnal haemoglobin oxygen desaturation in SCA. METHODS: We undertook nocturnal and daytime pulse oximetry in 23 children with SCA (median age 8 years) with known steady-state plasma vitamin C concentrations and 18 siblings (median 7 years). RESULTS: Median nocturnal delta 12 s index (delta12 s), a measure of haemoglobin oxygen saturation (SpO(2)) variability, was 0.38 (interquartile range 0.28-0.51) in SCA and 0.35 (0.23-0.48) in controls, with 9/23 and 6/18, respectively, having a delta12 s >0.4, compatible with obstructive sleep apnoea (OSA). Eleven of twenty-three with SCA had VCD; logged vitamin C concentrations showed a 66% decrease per 0.1 unit increase in delta12 s ([95% CI -86%, -15%]; p=0.023) and delta12 s >0.4 was associated with VCD (odds ratio 8.75 [1.24-61.7], p=0.029). Daytime and mean nocturnal SpO(2) were lower in SCA but there was no association with vitamin C. CONCLUSION: Obstructive sleep apnoea (OSA), detected from nocturnal haemoglobin oxygen saturation variability, is common in Tanzanian children and associated with vitamin C Deficiency in SCA. The direction of causality could be determined by comparing OSA treatment with vitamin C supplementation.

ECG variations in patients pre- and post-local anaesthesia and analgesia.

OBJECTIVES: To determine the incidence of ECG abnormalities in a healthy adults undergoing a surgical extraction of third molar teeth pre-and post-operatively and to study the effect of local anaesthetics, surgical stress and analgesics on cardiac rhythm. METHOD: One hundred and ninety-eight healthy adult patients taking part in a clinical trial of analgesics were randomly selected for this study. All patients required the removal of at least one impacted mandibular wisdom tooth under local anaesthetic. An ECG was taken at a screening visit and repeated post-operatively 30 minutes after analgesia was given. The effects of analgesia were also monitored to ascertain whether any changes were related to pain experience or the analgesic itself. RESULTS: ECG abnormalities were detected in 44 patients at the screening visit. Of these patients, 20 showed rsR complex patterns, seven showed non-specific ST elevation, six patients had an abnormal P wave axis, three patients presented with single atrial premature beats and three patients showed a short PR interval. Other minor abnormalities were occasionally seen. The results recorded were of minimal clinical significance and the numbers are in line with previous research. Post-operative abnormalities were seen in 60 patients. Nineteen patients showed rsR complex patterns, sinus arrhythmias were seen in 11 individuals, seven patients showed non-specific ST elevation and six patients had an abnormal P-wave axis. Other minor abnormalities were occasionally seen. CONCLUSION: Although the results were not statistically significant, some of the patients did show clinically relevant abnormalities which necessitated referral to a cardiologist. These included: marked ST elevation; marked ST depression and one case of Right Bundle Branch Block (RBBB).

Accuracy of clinical assessment of paediatric obstructive sleep apnoea in two English centres.

OBJECTIVES: To ascertain the sensitivity and specificity of clinical diagnosis of obstructive sleep apnoea in children, and to determine if a published clinical algorithm identifies those at high risk of post-adenotonsillectomy complications. METHOD: Sixty-seven children aged three to eight years underwent clinical assessment and overnight polysomnography. RESULTS: Polysomnography detected a significant apnoea-hypopnoea index (i.e. > or =5, indicating significant obstructive sleep apnoea) in 13 (43 per cent) children with a clinical diagnosis of obstructive sleep apnoea and in six (19 per cent) children with no such diagnosis. The sensitivity of clinical assessment was 68.4 per cent and the specificity 59.5 per cent. The post-operative risk algorithm failed to identify any high risk children, although in actuality seven had severe obstructive sleep apnoea confirmed by polysomnography. CONCLUSIONS: This study of two English centres confirms that the clinical diagnostic process for obstructive sleep apnoea is reasonably insensitive and has low specificity. The studied algorithm discriminated poorly between children with and without severe obstructive sleep apnoea. Realistic diagnostic screening guidelines for paediatric sleep apnoea are overdue in the UK, where access to polysomnography is limited.

Sleep problems in a Down syndrome population.

OBJECTIVE: To determine the prevalence of sleep problems in children with Down syndrome. DESIGN AND SETTING: A community prevalence study in a child population of 100 000 in England. PARTICIPANTS: 58 children with Down syndrome aged to 0.65-17.9 years (mean 8.6 years). INTERVENTIONS: Child Sleep Habits Questionnaire. RESULTS: Compared to published data for typically developing populations, children with Down syndrome were reported to have significantly greater bedtime resistance, sleep anxiety, night waking, parasomnias, sleep disordered breathing and day-time sleepiness. Amongst children 4 years and older, 66% rarely fell asleep in their own beds, 55% were always restless during sleep and 40% usually woke at least once during the night. Importantly, 78% seemed tired during the day at least 2 days per week, suggesting inadequate sleep. CONCLUSIONS: Parents report universal sleep problems in school aged children with Down syndrome. Paediatricians should routinely enquire about sleep behaviour in these children.

A study of the association between children's access to drinking water in primary schools and their fluid intake: can water be 'cool' in school?

BACKGROUND: Water is essential for health. The 'Water is Cool in School' campaign promoted improved drinking water access in UK schools. Implementation has been patchy, and impact has not been studied. The aim of this study is to determine whether fluid intake and frequency of toilet visits are associated with children's access to drinking water in the classroom. METHODS: A total of 145 schoolchildren in Year 2 (aged 6-7 years) and 153 in Year 5 (aged 9-10 years) classes were studied in six Southampton schools. Total fluid intake and toilet visits were recorded during one school day. Schools were recruited according to drinking policy: 'prohibited access' = water prohibited in classroom; 'limited access' = water allowed in classroom but not on the desk; and 'free access' = water bottle encouraged on the desk. Data were analysed on an intention-to-treat basis. RESULTS: In total, 120 children in prohibited access, 91 in limited access and 87 in free access settings were recruited. Total fluid intake was significantly higher in Year 2 free access schools (geometric mean 293, range 104-953 mL) compared with prohibited access schools (geometric mean 189, range 0-735 mL, P=0.046), in Year 5 free access schools (geometric mean 489, range 88-1200 mL) compared with prohibited access schools (geometric mean 206, range 0-953 mL, P=0.001), and in free access versus limited access schools (geometric mean 219, range 0-812 mL, P=0.003). A total of 81% and 80% of children in prohibited and limited access schools, respectively, consumed below the minimum recommended amount of total fluid at school, compared with 46.5% in the free access schools. In total, 34.6% of children did not use the toilets at all during the school day. There was no trend observed between water access and frequency of toilet visits (median of 1 trip for each group, P=0.605). CONCLUSION: Most children have an inadequate fluid intake in school. Free access to drinking water in class is associated with improved total fluid intake. Primary schools should promote water drinking in class.