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Barriers and facilitators in utilisation of dental health services across low- and middle-income countries: a scoping review.
Get PDFOBJECTIVES: This scoping review aims to systematically identify and theoretically categorise barriers and facilitators affecting access to dental care in LMICs. METHODS: This scoping review employed the Theoretical Domains Framework (TDF) to synthesise the findings thematically. A comprehensive search of literature published up to May 2025 in MEDLINE (PubMed), Embase, Scopus, and Web of Science, as well as grey literature sources, was conducted to identify relevant articles. Screening was performed using Rayyan, and data were extracted and categorised into the TDF domains. RESULTS: From the 15,140 initial hits, 214 articles were found eligible for final analysis. The maximum number of studies was published in India, Brazil, Nigeria and Iran. Eleven TDF domains were identified, and 'environmental context and resources' (n = 452, 41.5%) emerged as the most frequent domain, followed by 'beliefs about consequences' (n = 251, 23.1%) and 'knowledge' (n = 144, 13.2%). Barriers were more frequently reported than facilitators across all domains. Distinct domain patterns were observed across population subgroups and income categories, with structural barriers dominating in all contexts. CONCLUSION: Findings from this review underscore the need for integrated, context-sensitive interventions that combine system-level reforms with behaviour change strategies to improve dental care utilisation and reduce inequalities in oral health access across LMICs. There is also a need for more research on this health issue in low-income countries
Remote unsupervised tests of isolated REM sleep behaviour disorder in the community: results from the Tasmanian ISLAND Sleep Study
No full textTargeted Prostate Cancer Screening in Carriers of BRCA1 or BRCA2 Pathogenic Germline Variants Detects Clinically Relevant Disease: 5-year Results from the IMPACT Study.
No full textBACKGROUND AND OBJECTIVE: BRCA1 and BRCA2 pathogenic germline variants (PGVs) are associated with higher risk of prostate cancer (PC). The IMPACT study evaluated the utility of targeted prostate-specific antigen (PSA) screening in BRCA1/BRCA2 PGV carriers. Here we report outcomes after five rounds of PSA screening in IMPACT. METHODS: Between 2005 and 2015, 3063 participants aged 40-69 yr (median 54 yr) were recruited from 65 centres in 20 countries in two cohorts: (1) BRCA1/BRCA2 PGV carriers (915 BRCA1, 901 BRCA2); and (2) age-matched noncarriers for a familial PGV (727 BRCA1 and 520 BRCA2 noncarriers). Annual PSA screening was performed, with PSA >3.0 ng/ml used as the indication for prostate biopsy. Our aim was to identify differences by PGV status in (1) the incidence of PC and of clinically significant PC (csPC; grade group ≥2) and (2) tumour stage and characteristics after five screening rounds. KEY FINDINGS AND LIMITATIONS: There was no statistically significant difference in PC incidence between BRCA1/BRCA2 PGV carriers and noncarriers. csPC incidence was significantly higher for BRCA2 PGV carriers than for noncarriers (3.1% vs 1.3%; p = 0.04). Among men with PC, the proportion of tumours with National Comprehensive Cancer Network intermediate unfavourable/high risk was higher in the BRCA1/BRCA2 PGV groups versus the corresponding group without PGVs (BRCA2: 65% vs 32%, p = 0.029; BRCA1: 56% vs 18%, p = 0.0017). There were no T4 or metastatic PC cases. Pathology after radical prostatectomy revealed tumour upgrading for 7/23 (26%) BRCA1 PGV carriers and 10/34 (26%) BRCA2 PGV carriers, with no tumour upgrading for men without PGVs. Study limitations include the biopsy compliance rate and changes in PC diagnostic pathways since 2005. CONCLUSIONS AND CLINICAL IMPLICATIONS: Annual PSA screening in BRCA2 PGV carriers confirmed a higher incidence of csPC and detection of clinically relevant tumours in comparison to noncarriers. For the first time, we confirm that PSA screening in BRCA1 PGV carriers results in early detection of NCCN IR-U/HR PC. Systematic PSA screening is recommended for BRCA2 PGV carriers and should be considered for BRCA1 PGV carriers
Nonlinear sufficient dimension reduction for Conditional quantiles in scalar-on-function single-index models
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Prediction of asphaltene deposition risk in CO2-EOR using Hansen solubility parameters by molecular dynamics simulation
No full textThis study aims to evaluate asphaltene precipitation risk during the CO2-EOR process. First, a digital oil model of stock tank oil (STO) was established, including gas chromatography for light fraction and quantitative molecular representation for heavy fraction and asphaltenes. The heavy fraction was further optimized by adding resin molecules obtained from Fourier Transform Ion Cyclotron Resonance Mass Spectrometry (FT-ICR MS). The digital oil model can reproduce the experimental density of the STO with an error within 2–3 % and HSPs of the STO measured in solvents. The live crude oil was then constructed by combining the STO and gas fractions. The HSPs of asphaltenes, crude oil, and CO2 mixtures across a broad pressure spectrum (1 − 60 MPa) at reservoir temperature (422 K) were computed utilizing the “in-solvent” methodology. The solubility of asphaltenes was then obtained using the classic Flory-Huggins solubility model. It is demonstrated that the addition of CO2 enhances the solubility of asphaltenes in the liquid phase under both low and high pressures. In contrast, the upper asphaltene onset pressure increased by about 9.8 MPa with increasing CO2 concentration to 50 mol%, indicating an increased asphaltenes precipitation risk at moderate pressure. We demonstrate that CO2 contributes to the dissolution of asphaltenes at high pressures, and the improvement in solvency power is attributed to the increased stabilizing effect of resins on asphaltene molecules at low pressures. This study provides a new protocol for assessing the risk of asphaltene deposition, a problem that may well be confronted during CO2-EOR
Trump’s 2025 National Security Strategy: Goodbye, Liberal International Order; Hello, Radical Right
No full textTHE ROLE OF OSTEOCYT E MECHANICAL LOADING ON BONE RESORPTION
No full textBone remodelling is an important process in skeletal development and diseases such as, osteoporosis and metastatic cancers. Bone resorption and formation are mediated by osteoclasts and osteoblasts respectively and coordinated by osteocytes. Osteocyte regulation of bone remodelling is modulated by mechanical loading. Primary cilia are slender microtubule organelles thought to play a role in osteocyte mechanotransuction potentially providing a therapeutic target to modulate bone remodelling in disease. The overall aim of this work was to examine the effects of lithium chloride and fenoldopam on primary cilia expression in osteocytes and how fluid shear stress applied to osteocytes regulates bone resorption by osteoclasts. The studies utilised confocal microscopy to characterise primary cilia expression in the osteocyte cell line, MLO-Y4, and to quantify the temporal dose response of compounds shown to regulate cilia expression in other cell types. When exposed to a concentration of 20 mM LiCl, there was an increase in cilia length from 2.41 ± 0.6 to 3.13 ± 0.9 μm (mean ± st. dev) and the administration of LiCl did not affect cilia prevalence. Besides, the findings indicate that there was no significant increase in cilia length following treatment with fenoldopam. Differentiation of RAW264.7 (a macrophage cell line) cells into osteoclasts was successful achieved through treatment with RANKL and M-CSF, as confirmed by tartrate-resistant acid phosphatase (TRAP) staining after 7 days of differentiation. A mechanical simulation model was developed to replicate physiological oscillatory fluid shear stress as experienced by osteocytes in vivo. This enabled the collection of conditioned medium (CM) which was then added 50:50 with fresh media and applied to RAW cells during osteoclast differentiation. CM from static osteocytes and oscillatory fluid flow both inhibited osteoclast formation by 84%. This suggests that osteocytes release soluble mediators which suppress differentiation independently of mechanical stimulation. Further studies were conducted to develop a more sophisticated model that would allow future studies to analyse the effect of CM on osteoclast function. This was achieved by examining differentiated osteoclast behaviour on bone slices and on specially prepared hydroxyapatite substrates. Bone resorptive capacity was assessed by observing the reabsorption pits made by osteoclasts and by measuring the concentrations of Ca and PO4 released in the medium. Multinucleated osteoclasts, positive for TRAP staining, were observed along with clearly visible resorption pits and statistically significant increases in Ca levels. In conclusion, this project shows the development and testing of simple in vitro models of osteoclast mediated bone resorption using conditioned media 6 from osteocytes subjected to physiological fluid shear. Mechanical stimulation of MLO-Y4 osteocytes had no effect on osteoclast formation compared to conditioned media from static controls. Future work will examine whether conditioned media from mechanically stimulated osteocytes influences osteoclast activity and bone resorption. The compound LiCl was shown to result in significant elongation of the primary cilia axoneme with no change in prevalence. On going work will examine whether this change in cilia expression is associated with alterations in osteocyte mechanosensitivity and downstream paracrine regulation of osteoclast bone resorption. These findings provide a framework for further investigation of the potential for therapeutic manipulation of cilia-mediated osteocyte mechanotransduction as a means of controlling bone resorption in disease
‘Until You Get the Diagnosis You're Forever in Limbo’—Parents' Experiences of Waiting for an Attention‐Deficit/Hyperactivity Disorder Assessment With Child and Adolescent Mental Health Services
Get PDFABSTRACT Background Parents in the United Kingdom seeking an assessment for attention‐deficit/hyperactivity disorder (ADHD) for their child experience a significant wait before receiving an appointment with Child and Adolescent Mental Health Services (CAMHS), yet little has been written on how parents experience this period. Through qualitative interviews, we sought to understand how the period of waiting from being accepted onto a service waitlist and receiving a diagnostic assessment impacts parents and their children. Method The study was nested within a large randomised controlled trial. We conducted semi‐structured interviews with 41 parents of children aged 5–11 years. 30% of parents had waited between 18 and 24 months on a CAMHS waitlist, with 10% waiting more than 2 years. Reflexive thematic analysis was used to analyse data. Results At the point of the interview, around 50% of children were still waiting for an initial assessment. Six themes reflecting parents' uncertainty around the assessment process, lack of communication from services, the importance of receiving a diagnosis, difficulty accessing support and the negative impact of waiting on mental health and education, as well as recommendations to improve communication between services and families, emerged. Conclusion Parents recognised the pressures on services to offer timely support; however, their well‐being could be substantially improved by more clarity around wait times, as well as more effective signposting and support from services concerning the assessment process. This may help alleviate some of the stressors associated with their child's assessment journey, such as feeling responsible for their child's difficulties and the burden of supporting their educational needs. Patient and Public Contribution This study was nested within the OPTIMA trial, where PPI panel members provided ongoing support in various aspects of the study, including advising on participant communication, study design and data analysis. All PPI members have lived experience of having a neurodivergent child. For this study, the PPI co‐produced the interview schedule and took part in transcript analysis using a thematic framework approach. To acknowledge their contributions, members of the PPI panel are included as co‐authors. </jats:sec
