Embedding patient and public involvement into a doctoral study: developing a point-of-care HIV testing intervention for dental settings.

Introduction: Patient and Public Involvement (PPI) can have a positive impact on research. PPI can make research more meaningful and appropriate as well as preventing research waste. For decades, patient advocates with HIV have played a key part in public health and research. This article presents the PPI activity undertaken during a doctoral study. The aim of this article is to demonstrate how PPI was embedded into a doctoral study that explored the feasibility of HIV testing in dental settings. Methods: Patients and the public were invited to be involved with the feasibility study through various organisations and charities. A comprehensive PPI activity strategy was devised, and appropriate funding was obtained. Patients and the public were predominantly consulted or collaboratively involved with several aspects of the study. Findings: Patients and the public positively contributed to the intervention development and the resources supporting its implementation. As a result, the study resources (i.e., questionnaire and information leaflets) were easier to read, and the intervention was more appropriate to the needs of patients. Furthermore, the training and focus groups conducted with dental patients and people with HIV benefitted from input of people with lived experience. Conclusions: PPI can be embedded within doctoral studies provided there is sufficient funding, flexibility, and supervisory support. However, PPI activity may be impacted by limited resource and a priori research protocol and funding agreements.

Effect of treating carious teeth on children's and adolescents' anthropometric outcomes: A systematic review of randomised controlled trials.

OBJECTIVE: To examine the impact of treating carious teeth on children's and adolescents' anthropometric outcomes. BASIC RESEARCH DESIGN: Four electronic databases and four electronic clinical trials registries were searched. Two reviewers independently conducted the screening, data extraction and critical appraisal. The Cochrane Risk of Bias Tool for Randomised Controlled Trials was used to assess the risk of bias in the included studies. RESULTS: The searches yielded 399 potential studies. Following deduplication and screening of the papers, four were considered eligible for inclusion of which two referred to the same study. None of the included studies was found to have a high risk of bias in any of the domains. However, performance bias was deemed of unclear risk in all studies. One of the studies found that following extraction of pulpally involved teeth, underweight children exhibited a statistically significant improvement in their weight-for-age (change in mean=0.26; p⟨0.001) and BMI-for-age z scores (change in mean=0.52, p⟨0.001) and had a significant weight gain (change in mean=1.2; p⟨0.001). Two studies showed that dental intervention did not have a significant effect on anthropometric outcomes. Treatment of caries significantly improved children's oral health-related quality of life in two studies. CONCLUSIONS: The evidence into the impact of treating carious teeth on children's growth is mixed and inconclusive. However, there is consistent evidence that treatment of severely carious teeth can significantly improve children's oral health-related quality of life. Oral health promotion and strategies to screen for oral health problems and widen dental access should be considered as part of integrated public health programs targeting children.

Obesity and Dental Caries in Young Children in Plymouth, United Kingdom: A Spatial Analysis.

OBJECTIVE: To examine the spatial clustering of obesity and dental caries in young children in Plymouth, United Kingdom, to evaluate the association between these conditions and deprivation, and explore the impact of neighbourhood-level characteristics on their distribution. BASIC RESEARCH DESIGN: Cross-sectional study analysing data from the National Child Measurement Programme (N=2427) and the Local Dental Health Survey (N=1425). The association of deprivation with weight status and caries was determined at individual and area level, using ANOVA and Poisson models. The overall spatial clustering was assessed using a modified version of the Global Moran's I, while clusters were located through Local Indicators of Spatial Association. Spatial autocorrelation was assessed using the variograms of the raw values. Log-linear Poisson models were fitted to assess the significance of neighbourhood characteristics on overweight/obesity and caries distribution. RESULTS: At an individual level, deprivation was not associated with BMI z-scores but was a significant predictor of caries (p⟨0.05). However, at area level, deprivation related to the rates of both conditions. A significant positive autocorrelation was observed across neighbourhoods for caries. The variograms suggested spatial autocorrelations up to 2.5 km and 3 km for overweight/obesity and caries, respectively. Among several neighbourhood characteristics, the proportion of people on benefits was found to be a significant predictor of caries rates. CONCLUSIONS: Our results underline the importance of considering geographic location and characteristics of the broader environment when developing strategies to target obesity and caries.

Downstream effects on human low density lipoprotein of homocysteine exported from endothelial cells in an in vitro system.

A model system is presented using human umbilical vein endothelial cells (HUVECs) to investigate the role of homocysteine (Hcy) in atherosclerosis. HUVECs are shown to export Hcy at a rate determined by the flux through the methionine/Hcy pathway. Additional methionine increases intracellular methionine, decreases intracellular folate, and increases Hcy export, whereas additional folate inhibits export. An inverse relationship exists between intracellular folate and Hcy export. Hcy export may be regulated by intracellular S-adenosyl methionine rather than by Hcy. Human LDLs exposed to HUVECs exporting Hcy undergo time-related lipid oxidation, a process inhibited by the thiol trap dithionitrobenzoate. This is likely to be related to the generation of hydroxyl radicals, which we show are associated with Hcy export. Although Hcy is the major oxidant, cysteine also contributes, as shown by the effect of glutamate. Finally, the LDL oxidized in this system showed a time-dependent increase in uptake by human macrophages, implying an upregulation of the scavenger receptor. These results suggest that continuous export of Hcy from endothelial cells contributes to the generation of extracellular hydroxyl radicals, with associated oxidative modification of LDL and incorporation into macrophages, a key step in atherosclerosis. Factors that regulate intracellular Hcy metabolism modulate these effects.