Abstract
Objectives
Child oral health is a result of interactions between multilevel influences within a complex system. Understanding those interactions informs conceptualizing a socioecological ...framework of important influences on oral health. This paper aimed to present a scoping review on the determinants of dental caries and their interactions in childhood and adolescence.
Methods
The two review questions were as follows:
Which factors are determinants of child dental caries
? and,
How do determinants interact within and across socioecological levels
? The three main electronic databases for biomedical records, PubMed, Web of Science and Scopus were searched, followed by reference check. The search and screening/selection procedures followed an a priori strategy and inclusion/exclusion criteria were specified in advance. The main components of the strategy were participants, concept and context. Following the final selection, eligible studies were assessed with quality appraisal tools for the risk of methodologic biases. Determinants reported in the included studies were then assigned to the micro‐, meso‐, exo‐ or macro‐systems levels in a socioecological framework. Interactions between determinants were also identified and reported.
Results
A total of 100 studies were included after removal of duplicates, screening on the title/abstracts and full‐text assessment among 3313 records initially identified. A higher number of studies included were cross‐sectional studies published in recent years. The majority of determinants found to influence child dental health were assigned to microsystem level within the framework. However, determinants were found at all levels and interactions were reported within and between socioecological levels. Determinants identified in the scoping review represent factors at different socioecological levels that influence child oral health.
Conclusion
Application of a socioecological model through a complex systems approach should lead to valid and robust progress towards practical solutions for better child oral health globally.
Dental fear and adult oral health in Australia Armfield, Jason M.; Slade, Gary D.; Spencer, A. John
Community dentistry and oral epidemiology,
June 2009, Letnik:
37, Številka:
3
Journal Article
Recenzirano
– Objective: This study aimed to investigate the association between dental fear and both dental caries and periodontal indicators.
Methods: A three‐stage stratified clustered sample of the ...Australian adult population completed a computer‐assisted telephone interview followed by a clinical examination. Oral health measures were the DMFT index and its components, periodontitis and gingivitis. A total of 5364 adults aged 18–91 years were dentally examined.
Results: Higher dental fear was significantly associated with more decayed teeth (DT), missing teeth (MT) and DMFT. There was an inverted ‘U’ association between dental fear and the number of filled teeth (FT). Periodontitis and gingivitis were not associated with dental fear. The association between dental fear and DMFT was significant for adults aged 18–29 and 30–44 years, but not in older ages. Dental fear was significantly associated with more DT, MT, and DMFT but with fewer FT after controlling for age, sex, income, employment status, tertiary education, dental insurance status and oral hygiene.
Conclusion: This study helps reconcile some of the conflicting results of previous studies and establishes that dental fear is associated with more decayed and missing teeth but fewer FT. That people with higher dental fear have significantly more caries experience underlines the importance of identifying and then reducing dental fear as important steps in improving adult oral health.
CONTEXT Whether epidural analgesia is a better method than parenteral opioids
for postoperative pain control remains controversial. OBJECTIVE To systematically review the efficacy of postoperative ...epidural analgesia
vs parenteral opioids, the primary alternative technique. DATA SOURCES Studies were identified primarily by searching the National Library
of Medicine's PubMed database (1966 to April 25, 2002) and other sources for
studies related to postoperative epidural analgesia. STUDY SELECTION Inclusion criteria were a comparison of epidural therapy vs parenteral
opioids for postoperative analgesia, measurement of pain using a visual analog
scale (VAS) or numeric rating scale, randomization of patients to either therapy,
and adult patients (≥18 years). A total of 1404 abstracts were identified,
100 of which met all inclusion criteria. DATA EXTRACTION Each article was reviewed and data extracted from tables, text, or extrapolated
from figures as needed. Weighted mean pain scores, weighted mean differences
in pain score, and weighted incidences of complications were determined by
using a fixed-effect model. DATA SYNTHESIS Epidural analgesia provided better postoperative analgesia compared
with parenteral opioids (mean SE, 19.40 mm 0.17 vs 29.40 mm 0.20 on
the VAS; P<.001). When analyzed by postoperative
day, epidural analgesia was better than parenteral opioids on each postoperative
day (P<.001 for each day after surgery). For all
types of surgery and pain assessments, all forms of epidural analgesia provided
significantly better postoperative analgesia compared with parenteral opioid
analgesia (P<.001 for all), with the exception
of thoracic epidural analgesia vs opioids for rest pain after thoracic surgery
(weighted mean difference, 0.6 mm; 95% confidence interval, –0.3 to
1.5 mm; P = .12). The complication rates were lower
than expected for nausea or vomiting and pruritus but comparable with existing
data for lower extremity motor block. CONCLUSION Epidural analgesia, regardless of analgesic agent, location of catheter
placement, and type and time of pain assessment, provided better postoperative
analgesia compared with parenteral opioids.
The cost-effectiveness of screening the U.S. population for Centers for Disease Control and Prevention (CDC) Tier 1 genomic conditions is unknown.
To estimate the cost-effectiveness of simultaneous ...genomic screening for Lynch syndrome (LS), hereditary breast and ovarian cancer syndrome (HBOC), and familial hypercholesterolemia (FH).
Decision analytic Markov model.
Published literature.
Separate age-based cohorts (ages 20 to 60 years at time of screening) of racially and ethnically representative U.S. adults.
Lifetime.
U.S. health care payer.
Population genomic screening using clinical sequencing with a restricted panel of high-evidence genes, cascade testing of first-degree relatives, and recommended preventive interventions for identified probands.
Incident breast, ovarian, and colorectal cancer cases; incident cardiovascular events; quality-adjusted survival; and costs.
Screening 100 000 unselected 30-year-olds resulted in 101 (95% uncertainty interval UI, 77 to 127) fewer overall cancer cases and 15 (95% UI, 4 to 28) fewer cardiovascular events and an increase of 495 quality-adjusted life-years (QALYs) (95% UI, 401 to 757) at an incremental cost of $33.9 million (95% UI, $27.0 million to $41.1 million). The incremental cost-effectiveness ratio was $68 600 per QALY gained (95% UI, $41 800 to $88 900).
Screening 30-, 40-, and 50-year-old cohorts was cost-effective in 99%, 88%, and 19% of probabilistic simulations, respectively, at a $100 000-per-QALY threshold. The test costs at which screening 30-, 40-, and 50-year-olds reached the $100 000-per-QALY threshold were $413, $290, and $166, respectively. Variant prevalence and adherence to preventive interventions were also highly influential parameters.
Population averages for model inputs, which were derived predominantly from European populations, vary across ancestries and health care environments.
Population genomic screening with a restricted panel of high-evidence genes associated with 3 CDC Tier 1 conditions is likely to be cost-effective in U.S. adults younger than 40 years if the testing cost is relatively low and probands have access to preventive interventions.
National Human Genome Research Institute.
Occult hemorrhages after trauma can be present insidiously, and if not detected early enough can result in patient death. This study evaluated a hemorrhage model on 18 human subjects, comparing the ...performance of traditional vital signs to multiple off-the-shelf non-invasive biomarkers. A validated lower body negative pressure (LBNP) model was used to induce progression towards hypovolemic cardiovascular instability. Traditional vital signs included mean arterial pressure (MAP), electrocardiography (ECG), plethysmography (Pleth), and the test systems utilized electrical impedance via commercial electrical impedance tomography (EIT) and multifrequency electrical impedance spectroscopy (EIS) devices. Absolute and relative metrics were used to evaluate the performance in addition to machine learning-based modeling. Relative EIT-based metrics measured on the thorax outperformed vital sign metrics (MAP, ECG, and Pleth) achieving an area-under-the-curve (AUC) of 0.99 (CI 0.95-1.00, 100% sensitivity, 87.5% specificity) at the smallest LBNP change (0-15 mmHg). The best vital sign metric (MAP) at this LBNP change yielded an AUC of 0.6 (CI 0.38-0.79, 100% sensitivity, 25% specificity). Out-of-sample predictive performance from machine learning models were strong, especially when combining signals from multiple technologies simultaneously. EIT, alone or in machine learning-based combination, appears promising as a technology for early detection of progression toward hemodynamic instability.
Background
Water fluoridation's effectiveness has been reaffirmed by systematic reviews. However, most of the included nonrandomised controlled before and after studies were conducted pre‐1975. ...Opportunity for such studies is limited in a steady state of community fluoridation programmes. As an alternative for evidence to support or refute the effectiveness of water fluoridation, this study used data from a recent national child oral health study to examine associations between lifetime exposure to fluoridated water (%LEFW) and childhood caries.
Methods
A population‐based study of child oral health in Australia was conducted in 2012‐2014, using complex sampling and weighting procedures. Parents provided detailed household information and children underwent oral epidemiological examination by trained examiners. Residential history from birth was used to calculate %LEFW. Caries prevalence (dmfs/DMFS>0) and experience (dmfs/DMFS) in both primary (age 5‐8) and permanent dentitions (age 9‐14) were estimated. Socioeconomic factors that were significantly different by %LEFW were then used as covariates in multivariable log‐Poisson regression models for each caries outcome by %LEFW.
Results
A total of 24 664 children had complete data. Caries prevalence and experience were higher among 5‐8‐year‐old children with lower %LEFW (46.9%; 4.27 surfaces) than those with 100%LEFW (31.5%; 1.98 surfaces) and for the 9‐14‐year‐old children with lower %LEFW (37.0%; 1.34 surfaces) than those with 100%LEFW (25.0%; 0.67 surfaces). In the multivariable models, the prevalence ratios for primary and permanent caries were significant for the two lower exposure groups against the 100%LEFW group. Similarly, the mean ratios for primary dmfs were significant for all three lower exposure groups and for permanent DMFS were significant for the two lower exposure groups against the 100%LEFW group. Mean ratios for the 0%LEFW compared to the 100%LEFW group were 2.10 (1.83‐2.40) for dmfs and 1.82 (1.57‐2.10) for DMFS.
Conclusion
Analysis of contemporary data representative of the Australian child population found consistent associations between %LEFW and childhood caries, which persisted when socioeconomic differences were adjusted across exposure groups, supporting the continued effectiveness of water fluoridation.
Objectives Middle-aged and older adults are retaining teeth and avoiding dentures, which should impact quality of life. The aims of our study were to investigate tooth loss and chewing ability and ...their association with oral- and general-health-related quality of life and life satisfaction. Methods A random sample of 45- to 54-year-olds from Adelaide, South Australia, was surveyed by self-complete questionnaire in 2004-2005 (n = 879, response rate = 43.8%). Health-related quality of life was measured with the Oral Health Impact Profile 14-item version and EuroQol Visual Analogue Scale instruments and life satisfaction by the Satisfaction with Life Scale. Functional tooth units were recorded at oral examinations performed by calibrated dentists on 709 persons (completion rate = 80.7%). Results Number of functional teeth was positively associated with chewing ability (β = 0.31, P < 0.01). In multivariate analyses, controlling for number of functional teeth and other explanatory variables spanning dental visit pattern, dental behaviour, socio-demographics and socio-economic status, chewing ability was negatively associated with oral-health-related impacts (β = -0.37, P < 0.01) and positively associated with general health (β = 0.10, P < 0.05) and well- being (β = 0.16, P < 0.01). Conclusions Chewing ability was related to oral-health-related quality of life and general health, possibly reflecting the impact of chewing on food choice and enjoyment of meals and diet, and also indicated the importance of oral health to general well-being.
PurposeThe long-term goal of the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE) birth cohort study is to identify and evaluate the relative importance and timing of critical ...factors that shape the oral health of young children. It will then evaluate those factors in their inter-relationship with socioeconomic influences.ParticipantsSMILE is a single-centre study conducted in Adelaide, Australia. All newborns at the main three public hospitals between July 2013 and August 2014 were eligible for inclusion. The final recruited sample at birth was 2181 mother/infant dyads. Participants were followed up with questionnaires when the child was 3 and 6 months of age, and 1, 2 and 5 years of age. Oral epidemiological examinations and anthropometric assessments were conducted at age 2 and 5 years.Findings to dateSMILE has contributed comprehensive data on dietary patterns of young children. Intakes of free sugars, core and discretionary foods and drinks have been detailed. There was a sharp increase in free sugars intake with age. Determinants of dietary patterns, oral health status and body weight during the first 5 years of life have been evaluated. Socioeconomic characteristics such as maternal education and household income and area-level socioeconomic profile influenced dietary patterns and oral health behaviours and status.Future planFunding has been obtained to conduct oral epidemiological examinations and anthropometric assessments at age 7–8 years. Plans are being developed to follow the cohort into adolescent years.
We examined associations between dietary patterns at 12 months, characterised using multiple methodologies, and risk of obesity and early childhood caries (ECC) at 24-36 months. Participants were ...Australian toddlers (n = 1170) from the Study of Mothers' and Infants' Life Events affecting oral health (SMILE) birth cohort. Principal Components Analysis (PCA) and the Dietary Guideline Index for Children and Adolescents (DGI-CA) were applied to dietary intake data (1, 2 or 3-days) at 12 months, and regression analysis used to examine associations of dietary patterns with body mass index
-score and presence of ECC at 24-36 months. Two dietary patterns were extracted using PCA:
and
. The mean DGI-CA score was 56 ± 13 (out of a possible 100). No statistically significant or clinically meaningful associations were found between dietary pattern or DGI-CA scores, and BMI
-scores or ECC (n = 680). Higher
pattern scores were associated with higher energy and free sugars intakes, and higher
pattern scores and DGI-CA scores with lower free sugars intakes. The association between dietary patterns and intermediate outcomes of free sugars and energy intakes suggests that obesity and/or ECC may not yet have manifested, and thus longitudinal investigation beyond two years of age is warranted.
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