Pauline Adair

Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia

Objective To report on the prevalence of postoperative morbidity in children undergoing tooth extraction under chair dental general anaesthetic (CDGA) in relation to pre-operative dental anxiety and anaesthetic induction distress.Design A prospective national study.Setting Twenty-five Scottish DGA centres in 2001.Subjects and method Four hundred and seven children (mean age 6.6 years; range: 2.3 to 14.8 years; 52% male). Before CDGA, the Modified Child Dental Anxiety (MCDAS) and Modified Dental Anxiety (MDAS) Scales were completed for children and accompanying adult respectively; the latter also returned a morbidity questionnaire 24 hours and one week post-operatively. Anaesthetic induction distress was scored immediately before CDGA induction using the Childrens Hospital of Eastern Ontario Pain Scale (CHEOPS).Results The mean MCDAS score was 24.2 (population norm 18.2); 21% of adults were anxious. Forty-two per cent of children had induction distress; this related to their MCDAS scores (r= 0.43, p<0.001, Pearson Product Moment Correlation Coefficient). Morbidity at 24 hours and seven days was 63% and 24% respectively; this related to MCDAS scores (r= 0.15, p=0.029 and r= 0.17, p= 0.009, Pearson Product Moment Correlation Coefficient) and to induction distress (chi2= 7.14, p= 0.007 and chi2= 11.70, p= 0.001).Conclusion The majority of children suffered next day morbidity and many still had symptoms a week later. Most children were dentally anxious; this related to induction distress and postoperative morbidity.

Systematic review of post-treatment psychosocial and behaviour change interventions for men with cancer.

Objectives: The psychosocial impacts of a cancer diagnosis include reduced quality of life, poorer inter‐personal relationships, hopelessness and mental illness. Worse outcomes, including mortality rates have been found for single men with cancer compared with women and partnered men. The aim of this systematic review was to examine the effectiveness of post‐treatment psychosocial and behaviour change interventions for adult men with cancer, in order to inform the development of an intervention. A focus on single men was intended.

Analysis of health behaviour change interventions for preventing dental caries delivered in primary schools.

To improve oral health in children, the key behaviours (tooth brushing and sugar control) responsible for development of dental caries need to be better understood, as well as how to promote these behaviours effectively so they become habitual; and, the specific, optimal techniques to use in interventions. The aim of this paper is to describe and analyse the behaviour change techniques that have been used in primary school-based interventions to prevent dental caries (utilizing a Cochrane systematic review that we have undertaken) and to identify opportunities for improving future interventions by incorporating a comprehensive range of behaviour change techniques. Papers of five interventions were reviewed and data were independently extracted. Results indicate that behaviour change techniques were limited to information-behaviour links, information on consequences, instruction and demonstration of behaviours. None of the interventions were based on behaviour change theory. We conclude that behaviour change techniques used in school interventions to reduce dental caries were limited and focused around providing information about how behaviour impacts on health and the consequences of not developing the correct health behaviours as well as providing oral hygiene instruction. Establishing which techniques are effective is difficult due to poor reporting of interventions in studies. Future design of oral health promotion interventions using behaviour change theory for development and evaluation (and reporting results in academic journals) could strengthen the potential for efficacy and provide a framework to use a much wider range of behaviour change techniques. Future studies should include development and publication of intervention manuals which is becoming standard practice in other health promoting programmes.

Identifying the participant characteristics that predict recruitment and retention of participants to randomised controlled trials involving children : a systematic review

BackgroundRandomised controlled trials (RCTs) are recommended as the ‘gold standard’ in evaluating health care interventions. The conduct of RCTs is often impacted by difficulties surrounding recruitment and retention of participants in both adult and child populations. Factors influencing recruitment and retention of children to RCTs can be more complex than in adults. There is little synthesised evidence of what influences participation in research involving parents and children.AimTo identify predictors of recruitment and retention in RCTs involving children.MethodsA systematic review of RCTs was conducted to synthesise the available evidence. An electronic search strategy was applied to four databases and restricted to English language publications. Quantitative studies reporting participant predictors of recruitment and retention in RCTs involving children aged 0–12 were identified. Data was extracted and synthesised narratively. Quality assessment of articles was conducted using a structured tool developed from two existing quality evaluation checklists.ResultsTwenty-eight studies were included in the review. Of the 154 participant factors reported, 66 were found to be significant predictors of recruitment and retention in at least one study. These were classified as parent, child, family and neighbourhood characteristics. Parent characteristics (e.g. ethnicity, age, education, socioeconomic status (SES)) were the most commonly reported predictors of participation for both recruitment and retention. Being young, less educated, of an ethnic minority and having low SES appear to be barriers to participation in RCTs although there was little agreement between studies. When analysed according to setting and severity of the child’s illness there appeared to be little variation between groups. The quality of the studies varied. Articles adhered well to reporting guidelines around provision of a scientific rationale for the study and background information as well as displaying good internal consistency of results. However, few studies discussed the external validity of the results or provided recommendations for future research.ConclusionParent characteristics may predict participation of children and their families to RCTs; however, there was a lack of consensus. Whilst sociodemographic variables may be useful in identifying which groups are least likely to participate they do not provide insight into the processes and barriers to participation for children and families. Further studies that explore variables that can be influenced are warranted. Reporting of studies in this field need greater clarity as well as agreed definitions of what is meant by retention.

Effectiveness of behavioral interventions to reduce the intake of sugar sweetened beverages among children and adolescents: A systematic review and meta-analysis

Abstract Context Consumption of sugar-sweetened beverages (SSBs) among children has been associated with adverse health outcomes. Numerous behavioral interventions aimed at reducing the intake of SSBs among children have been reported, yet evidence of their effectiveness is lacking. Objective This systematic review explored the effectiveness of educational and behavioral interventions to reduce SSB intake and to influence health outcomes among children aged 4 to 16 years. Data Sources Seven databases were searched for randomized controlled trials published prior to September 2016. Studies identified were screened for eligibility. Study Selection Trials were included in the review if they met the PICOS (Population, Intervention, Comparison, Outcome, and Study design) criteria for inclusion of studies. Data Extraction Data were extracted by 2 reviewers following Cochrane guidelines and using Review Manager software. Results Of the 16 trials included, 12 were school based and 4 were community or home based. Only 3 trials provided data that could be pooled into a meta-analysis for evaluating change in SSB intake. Subgroup analyses showed a trend toward a significant reduction in SSB intake in participants in school-based interventions compared with control groups. Change in body mass index z scores was not statistically significant between groups. Conclusions The quality of evidence from included trials was considered moderate, and the effectiveness of educational and behavioral interventions in reducing SSB intake was modest. Systematic Review Registration PROSPERO registration number CRD42014004432.

A randomised controlled feasibility trial of Group Cognitive Behavioural Therapy for people with severe asthma

ABSTRACT Objectives: Evidence for the efficacy of Cognitive Behavioural Therapy (CBT) in asthma is developing but it is not known if this translates to benefits in severe asthma or if a group approach is acceptable to this patient group. This study aimed to assess the feasibility and acceptability of Group-CBT in severe asthma. Method: This was a two-centre, randomised controlled parallel group feasibility study. Eligible participants (patients with severe asthma and a clinically significant diagnosis of anxiety and/or depression – Hospital Anxiety and Depression Scale (HAD) score greater than 8 for the anxiety or depression sub-scale) received Group-CBT in weekly sessions for eight consecutive weeks and usual care or usual care only. Follow-up was for 16 weeks and end points were: Asthma Quality of Life Questionnaire, Asthma Control Questionnaire, HAD, Dyspnoea-12, EuroQual-5D and EuroQuol-VAS. Results: 51 patients were randomised: 36% (51 out of 140) consent rate and attrition at week 16 was 12. Screening logs indicated that study take-up was influenced by patients living long distances from the treatment centre and inability to commit to the weekly demands of the programme. Drop-out was higher in Group-CBT compared due to inability to commit to the weekly programme because of poor health. Participants who contributed to focus group discussions reported that Group-CBT contributed to a better understanding of their illness and related approaches to anxiety management and acceptance of their asthma condition. Although weekly face-to-face sessions were challenging, this was the preferred method of delivery for these participants. Conclusions: This feasibility study shows that Group-CBT warrants further investigation as a potentially promising treatment option for patients with severe asthma. It has been possible but not easy to recruit and retain the sample. Options for a less demanding intervention schedule, such as less frequent face-to-face visits and the use of web-based interventions, require careful consideration.

An evaluation of a storybook targeting parental attitudes, intention and self-efficacy to change their child’s oral health behaviour

Objective: Methods for reducing dental disease have traditionally focused on health education rather than targeting psychosocial determinants of the core behaviors through behavior change strategies. This study tested a novel intervention in the form of a children’s story (Kitten’s First Tooth) embedded with behavior change techniques (Abraham & Michie, 2008) with the aim of investigating how effective the intervention was at improving parents’ efficacy and intention to enact oral health behaviors for their child. Method: A controlled before and after study conducted in a deprived area of England (n = 149; child mean age 4 years) with an intervention and control group. Changes in task specific parental self-efficacy (PSE) and intention were measured using the Oral Health Behaviors Questionnaire (OHBQ; Adair et al., 2004) at baseline and 3 months following intervention. Results: Of the 149 participants, 129 returned both baseline and evaluation questionnaires (retention 86.6%), 125 of these pairs of questionnaires were used in the analysis (83.4%). The OHBQ was analyzed using a general linear model (ANCOVA). A significant difference was found in favor of the intervention group for PSE related to child tooth brushing behaviors, F(1,1) = 12.04, p = .001, however no change was observed for PSE related to control of dietary sugars. Conclusions: A theorized children’s story can be effective as an oral health promotion intervention by supporting parents to improve their child’s oral health-related behavior. Change was observed for child tooth brushing but not sugar control. This may reflect story contents or may be indicative of difficulties of changing dietary behavior.

The development and psychometric properties of instruments measuring religious coping in clinical cancer research: a systematic review

Background: It has been reported that a quarter of people diagnosed with cancer lack social support. Online cancer communities could provide this form of support. Sixty-one per cent of adults in the UK access social media every day and online cancer communities are rising in popularity. However, there is limited evidence about how people use online cancer communities, and how they may, or may not, support people affected by cancer. Aims: This study aims to explore experiences of people affected by cancer visiting online cancer communities. Methods: A qualitative study was conducted using a constructivist grounded theory approach. Data were generated through semi-structured interviews with people who had visited online cancer communities, including people diagnosed with cancer and their family members. Results: A core category was developed and labelled ‘navigating cancer using online communities’. Participants used support in communities to navigate challenges they faced with cancer. This produced three categories of experience in online communities. Firstly, the advice of community members set participants on a ‘journey to become informed’. Secondly, participants were cast into a ‘journey to recreate identity’ as they connected and formed friendships online. Thirdly, participants navigated a ‘journey through different online worlds’ to the most relevant and often hidden communities. Conclusions: Social support is prevalent in online communities, multifaceted and mobilises active self-management in cancer care. This theoretical framework can inform the development of existing online communities to suit the needs of people affected by cancer. Further research should consider online communities in interventions for cancer self-management.

Looked after young people: Reducing health inequalities through an evidence- and theory-informed intervention

Objective: The study aimed to design and evaluate a health behaviour change intervention for looked after young people, targeting sexual health, smoking, exercise, healthy eating and non-dependent alcohol and drug use. Design: A pre–post intervention evaluation was undertaken exploring health behaviours and wellbeing. Methodology: The one-to-one intervention was individually tailored to each person. Young people eligible for the intervention were aged 11 years and over and were ‘looked after’, meaning they were under a supervision order with a local authority in Scotland, or were a care leaver. A total of 144 young people referred to the intervention service between March 2009 and January 2014 were eligible for the evaluation. Evaluation data were analysed using standard statistical tests on SPSS. Results: Behaviour change techniques, including goal setting, action planning, barrier identification/problem solving and motivational interviewing contributed to improvements in all areas. Difficulties with consent and follow-up were highlighted as barriers to effective evaluation. Conclusion: Improving the current health of looked after young people with a view to prevent future ill health using a tailored intervention with behaviour change techniques enables this group to improve health behaviours, despite numerous challenges in working with these vulnerable clients.