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Paediatric treatments do not safeguard against future

21 April 2017

Paediatric treatments do not safeguard against future

Preventive visits to the dentist for children under two may not reduce the need for more care later, a new study suggests.

Early preventive dental care was associated with more frequent subsequent treatment for tooth decay, more visits, and more spending on dental care, compared with no early preventive dental care.

However, preventive care from primary care providers was not significantly associated with tooth decay-related treatment or expenditures.

“We don’t think that going to the dentist is somehow causing these kids to have tooth decay,” says Michael Morrisey, professor and head of the health policy & management department at the Texas A&M School of Public Health. “At the same time, we want parents to know that early checkups probably won’t reduce the need for future dental procedures like filings.”

The American Academy of Pediatrics, American Dental Association, and American Academy of Pediatric Dentistry recommend children receive dental care once baby teeth begin to appear.

For the study, published in JAMA Pediatrics, researchers analyzed Medicaid data from 19,658 children in Alabama, 25.8 percent of whom received preventive dental care from a dentist before age 2. The average follow-up time was almost four years.

Compared with similar children without early preventive dental care, those receiving such care from a dentist had more frequent tooth decay-related treatment (20.6 percent versus 11.3 percent) and a higher rate of visits and higher annual dental expenditures ($168 versus $87) later in childhood.

The researchers stress the study has limitations. Because the study only included children on Alabama’s Medicaid, the publicly funded health care program for low-income Americans, children elsewhere may show different trends. Further, researchers didn’t examine oral health behaviors such as teeth brushing or environmental ones like water fluoridation.

“It’s a bit surprising that we found so few benefits, especially since parents are routinely encouraged to take their children for early dental checkups,” Morrisey says. “Still, it is possible that even though the dentist visits were coded as preventive, the babies and toddlers already had some sign or risk factor of tooth decay. To really answer the question of efficacy of early routine checkups, one should do randomized clinical trials.”

It also wasn’t clear from the data analyzed in the study what each preventive care visit involved. Typically, the main service at these visits is a topical fluoride varnish, but children who already have high levels of tooth decay may continue to get new decay even when the varnish is applied. These visits may also serve as an opportunity for parents to ask questions about how best to teach their children good oral care habits.

“All I can recommend is that parents follow the advice of their child’s dentist or health care provider,” Morrisey says. “We examined the data in the aggregate, but only those seeing the individual child will be able to determine what’s best for him or her.”

Shops agree to limit sugary drinks sales in hospitals

WHSmith, Marks & Spencer, Subway and Greggs have all agreed to cut the proportion of sugary drinks they sell in their hospital shops in England.

NHS England has asked all retailers with hospital outlets to limit the drinks to no more than 10% of the total beverages they sell by next April.

Companies that do not comply will face a total ban on selling sugary drinks in hospital shops.

Campaigners welcomed the move to limit sugar intake in hospitals.

Retailers have been asked to cut sales of drinks such as fruit juices with added sugar and coffees with sugar syrup and NHS England will ask them to provide sales figures to check on progress.

All retailers in hospitals in England are being urged to make the changes to their stock.

The plans are part of a health drive to cut obesity and tooth decay across the country.

NHS England said progress had already been made this year to remove all price promotions on sugary drinks and junk food sold in hospitals and to make sure healthy food options were available at all times for patients and staff.

Over the next 12 months, NHS England now wants hospitals to stock a healthier range of sweets and confectionery and more low-fat and low-calorie pre-packed sandwiches.

Simon Stevens, chief executive of NHS England, said: "A spoonful of sugar may help the medicine go down but spoonfuls of added sugar day in, day out mean serious health problems.

"The NHS is in a great position to take action on the damage being caused by poor diet to the nation's health and the wider healthcare system.

"With more money spent each year on the treatment of obesity and diabetes than on the police, fire service and judicial system combined, urgent action is needed."

Katherine Button, Campaign for Better Hospital Food co-ordinator, said she was delighted by the move.

"NHS hospitals are trusted by patients, families and staff to keep them fit and well and NHS England is helping everyone to take a big healthy step in the right direction."

Chris Askew, chief executive of Diabetes UK, said it was great news that NHS England was "taking this step to make hospitals healthier places for all of us".

He added: "With this plan, people with type 1 diabetes should still have access to products that are commonly used to treat hypos."

The sugar problem

  • There has been growing concern about the damaging impact of sugar on health - from the state of people's teeth to type 2 diabetes and obesity
  • Sugar has been blamed for providing "empty calories" because it has no nutritional benefit
  • Government advisers recommend no more than 5% of daily calories should come from sugar
  • That is about 1oz (25g; six or seven teaspoons) for an adult of normal weight every day. For children, it is slightly less
  • The limits apply to all sugars added to food, as well as sugar naturally present in syrups and honey
  • To put this in context, a typical can of fizzy drink contains about nine teaspoons of sugar

Balloon emergency surgery treatment gets £1.1m Aberdeen study

An emergency treatment using a balloon device to control catastrophic bleeding in accident victims is being trialled as part of a new £1.1m study.

The University of Aberdeen trial - over four years - compares the survival of those who receive the treatment against those who do not.

Reboa (resuscitative endovascular balloon occlusion of the aorta) works by inserting a balloon device into the body's main artery.

London Air Ambulance has used it.

The trial will examine if the technique can prevent deaths and disability from road collisions and falls from height.

The study is being supported by a £1.1m grant from the National Institute of Health Research.

The trial will take place across 10 major trauma centres in England.

The research team estimates about 120 patients may be treated using Reboa during the course of the study.

It was first used in the UK by the Royal London Hospital.

Pedestrians or cyclists involved in serious crashes often have internal bleeding due to injury to blood vessels deep inside the body, but these cannot be compressed from the outside.

Some people will die at the scene or before they can be transferred safely to hospital.

The technique allows doctors to control bleeding from within.

Jan Jansen, a consultant in general surgery and intensive care medicine at the University of Aberdeen and the chief investigator of the study, said: "Reboa is quite a simple concept which many in the medical profession believe will be a tool that helps save more lives.

"This trial will provide evidence that either supports or refutes that conception.

"The technology is not without its complications. Cutting off blood from half the body can only be done for so long and you have to deal with the consequences of that but with injuries this severe it can be a trade-off worth making.

"We want to find out if it is worth taking an extra few minutes to do this procedure and arrive in the theatre in a more controlled state."

He added: "It's important to stress that this procedure is only used in extreme cases where there is a real chance of the patient dying in the emergency department.

"All teams involved will be given bespoke training and, as well as assessing the success of Reboa, we will be evaluating how practical it is to incorporate into the procedures of each individual trauma team.

"Some early adopter teams have already started using this but this trial will provide some thorough research that shows just how effective it is at saving lives."


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