Background: The accuracy of a prediction model for periodontal disease using the community periodontal index (CPI) has been undertaken by using an area under a receiver operating characteristics ...(AUROC) curve. How the uncalibrated CPI, as measured by general dentists trained by periodontists in a large epidemiologic study, and affects the performance in a prediction model, has not been researched yet.
Methods: A two‐stage design was conducted by first proposing a validation study to calibrate CPI between a senior periodontal specialist and trained general dentists who measured CPIs in the main study of a nationwide survey. A Bayesian hierarchical logistic regression model was applied to estimate the non‐updated and updated clinical weights used for building up risk scores. How the calibrated CPI affected performance of the updated prediction model was quantified by comparing AUROC curves between the original and updated models.
Results: Estimates regarding calibration of CPI obtained from the validation study were 66% and 85% for sensitivity and specificity, respectively. After updating, clinical weights of each predictor were inflated, and the risk score for the highest risk category was elevated from 434 to 630. Such an update improved the AUROC performance of the two corresponding prediction models from 62.6% (95% confidence interval CI: 61.7% to 63.6%) for the non‐updated model to 68.9% (95% CI: 68.0% to 69.6%) for the updated one, reaching a statistically significant difference (P <0.05).
Conclusion: An improvement in the updated prediction model was demonstrated for periodontal disease as measured by the calibrated CPI derived from a large epidemiologic survey.
The relationship between hyperglycemia (including diabetes) and periodontal disease (PD) has been noted previously, but its temporal sequence in the same study based on a population-based study has ...been barely addressed. Our study sought to clarify temporal bidirectional relationships between both diseases among Taiwanese aged 35–44 years. A prospective follow-up cohort study was designed by following over time the two normal cohorts (PD-free or hyperglycemia-free) derived from 5,885 subjects aged 35–44 years who were periodically attending a screening program. We ascertained both incident cases of PD (defined by Community Periodontal Index score ≧ 3) and hyperglycemia fasting plasma glucose (FPG) ≧100 mg/dL or type 2 diabetes (FPG ≧ 126 mg/dL) with 5-year follow-up. Cox proportional hazards regression model was used to assess the effect of PD on hyperglycemia and vice versa with adjustment for other confounding factors. Participants with PD presented a 33 % increase in their risk of incident hyperglycemia (including diabetes) adjusted hazard ratio (aHR) = 1.33 (95 % CI 1.09–1.63) after controlling for potential confounding factors. Conversely, prediabetes and type 2 diabetes mellitus led to a significant elevated risk for PD aHR = 1.25 (95 % CI 1.00–1.57) and aHR = 1.95 (95 % CI 1.22–3.13) after adjustment for other confounding factors. In conclusion, a significant bidirectional relationships was found between hyperglycemia and PD, suggesting that both diseases may share common latent traits and pathways that are worthy of being further elucidated by continuing a long-term follow-up of this cohort.
We sought to assess how much of the variation in incidence of colorectal neoplasia is explained by baseline fecal hemoglobin concentration (FHbC) and also to assess the additional predictive value of ...conventional risk factors. We enrolled subjects aged 40 years and over who attended screening for colorectal cancer with the fecal immunochemical test (FIT) in Keelung community‐based integrated screening program. The accelerated failure time model was used to train the clinical weights of covariates in the prediction model. Datasets from two external communities were used for external validation. The area under curve (AUC) for the model containing only FHbC was 83.0% (95% CI: 81.5–84.4%), which was considerably greater than the one containing only conventional risk factors (65.8%, 95% CI: 64.2–67.4%). Adding conventional risk factors did not make significant additional contribution (p = 0.62, AUC = 83.5%, 95% CI: 82.1–84.9%) to the predictive model with FHbC only. Males showed a stronger linear dose‐response relationship than females, yielding gender‐specific FHbC predictive models. External validation confirms these results. The high predictive ability supported by a dose‐dependent relationship between baseline FHbC and the risk of developing colorectal neoplasia suggests that FHbC may be useful for identifying cases requiring closer postdiagnosis clinical surveillance as well as being an early indicator of colorectal neoplasia risk in the general population. Our findings may also make contribution to the development of the FHbC‐guided screening policy but its pros and cons in connection with cost and effectiveness of screening should be evaluated before it can be applied to population‐based screening for colorectal cancer.
What's new?
Currently, the fecal immunochemical test is widely used for population screening for colorectal cancer. Could testing for a different protein improve predictive ability? In this paper, the authors evaluated the usefulness of quantifying fecal hemoglobin. They showed that the higher the concentration of fecal hemoglobin, the higher the risk of developing cancer. Thus, this test may help identify patients who need further interventions, if it proves cost‐effective and practical to administer.
Previous studies have found that polymorphisms of the DNA repair gene X-ray repair cross-complementing group 1(XRCC1) and environmental factors are both associated with an increased risk of stomach ...cancer, but no study has reported on the potential additive effect of these factors among Thai people. The aim of this study was to investigate whether the risk of stomach cancer from XRCC1 gene polymorphisms was modified by environmental factors in the Thai population.
Hospital-based matched case-control study data were collected from 101 new stomach cancer cases and 202 controls, which were recruited from2002 to 2006 and were matched for gender and age. Genotype analysis was performed using real-time PCR-HRM. The data were analysed by the chi-square test and conditional logistic regression.
The Arg/Arg homozygote polymorphism of the XRCC1 gene was associated with an increased risk of stomach cancer in the Thai population (OR
, 3.7; 95%CI, 1.30-10.72) compared with Gln/Gln homozygosity. The effect of the XRCC1gene on the risk of stomach cancer was modified by both a high intake of vegetable oils and salt (p = 0.036 and p = 0.014), particularly for the Arg/Arg homozygous genotype. There were, however, no additive effects on the risk of stomach cancer between variants of the XRCC1gene and smoking,alcohol or pork oil consumption.
The effect of the XRCC1 gene homozygosity, particularly Arg/Arg, on the risk for stomach cancer was elevated by a high intake of vegetable oils and salt.
Objective
To investigate the risk for second primary cancer in the hypopharynx and esophagus (SPC‐HE) among individuals with an initial oral/oropharyngeal cancer.
Materials and Methods
Mass screening ...data from Taiwan (2004–2009) included individuals who were ≥18 years old and smoked cigarettes and/or chewed betel quid. Occurrence of SPC‐HE was monitored until December 31, 2014. Results were expressed as adjusted relative risk (aRR) and 95% confidence interval (CI).
Results
One hundred and fifty‐eight out of 4,494 subjects with oral cancer developed SPC‐HE (incidence rate: 6.47 per 1,000 person‐years). Relative to patients with primary cancers in the lip, the risk of an SPC‐HE was higher in patients with primary cancers in oropharynx (aRR: 19.98, 95% CI: 4.72–84.55), floor of mouth (aRR: 12.13, 95% CI: 2.67–55.15), and hard palate (aRR: 7.31, 95% CI: 1.65–32.37), but not in patients with cancers in tongue (aRR: 3.67, 95% CI: 0.89–15.17) or gum (aRR: 3.99, 95% CI: 0.92–17.35). Regression analyses also showed the risk of an SPC‐HE was greater in alcohol drinkers than those who did not (aRR: 1.65, 95% CI: 1.10–2.48).
Conclusions
Compared with the initial cancer in the lip, patients with a cancer in the oropharynx, floor of mouth, and hard palate had a higher risk for the SPC‐HE.
The spread of the emerging pathogen, named as SARS-CoV-2, has led to an unprecedented COVID-19 pandemic since 1918 influenza pandemic. This review first sheds light on the similarity on global ...transmission, surges of pandemics, and the disparity of prevention between two pandemics. Such a brief comparison also provides an insight into the potential sequelae of COVID-19 based on the inference drawn from the fact that a cascade of successive influenza pandemic occurred after 1918 and also the previous experience on the epidemic of SARS and MERS occurring in 2003 and 2015, respectively. We then propose a systematic framework for elucidating emerging infectious disease (EID) such as COVID-19 with a panorama viewpoint from natural infection and disease process, public health interventions (non-pharmaceutical interventions (NPIs) and vaccine), clinical treatments and therapies (antivirals), until global aspects of health and economic loss, and economic evaluation of interventions with emphasis on mass vaccination. This review not only concisely delves for evidence-based scientific literatures from the origin of outbreak, the spread of SARS-CoV-2 to three surges of pandemic, and NPIs and vaccine uptakes but also provides a new insight into how to apply big data analytics to identify unprecedented discoveries through COVID-19 pandemic scenario embracing from biomedical to economic viewpoints.
Objective
The aim of this study was to evaluate the long‐term effectiveness of a school‐based child oral hygiene program on oral heath after approximately 10 years of follow‐up.
Methods
A prospective ...cohort study was designed to include 120 schoolchildren aged 10–11 years with instructions on how to practice daily flossing and brushing under the supervision of school nurses for one semester (the intervention group) and to recruit a comparison group with no intervention from 120 classmates matched by gender (the nonintervention group). Both groups participated in a questionnaire survey and received dental examinations after long‐term follow‐up.
Results
The mean value of overall plaque score in the intervention group (16.9%) was lower than that of the nonintervention group (32.6%); the adjusted relative risk (aRR) of having a plaque score for the intervention group versus the nonintervention group was 0.4 (95% CI: 0.3, 0.5). The percentage of pocketing (CPI ≧ 2) in the intervention group (75.0%) was lower than that of the nonintervention group (90.8%); the aRR of having calculus or pocketing (CPI ≧ 2) was 0.3 (95% CI: 0.1, 0.6). The intervention group had lower DMFT values and DMFS score than the nonintervention group (4.1 and 6.6 versus 6.2 and 11.0). Moreover, the intervention group had significantly better dental knowledge and habits and dental conditions than the nonintervention group.
Conclusions
This longitudinal follow‐up study demonstrated that a highly targeted oral hygiene program can display positive long‐term effectiveness.
ObjectiveAlthough mass eradication of Helicobacter pylori has been proposed as a means to eliminate gastric cancer, its long-term effects remain unclear.DesignMass eradication of H. pylori infection ...was launched in 2004 and continued until 2018 for a high-risk Taiwanese population aged 30 years or older dwelling on Matsu Islands with prevalent H. pylori infection. Test positives for the 13C-urea breath test underwent eradication therapy. We evaluated the effectiveness of the mass eradication in reducing two main outcomes, incidence and mortality rates of gastric cancer, until the end of 2016 and 2018, respectively.ResultsAfter six rounds of mass screening and eradication, the coverage rate reached 85.5% (6512/7616). The referral rate for treatment was 93.5% (4286/4584). The prevalence rates of H. pylori fell from 64.2% to 15.0% with reinfection rates of less than 1% per person-year. The presence and severity of atrophic gastritis and intestinal metaplasia also decreased with time. Compared with the historical control period from 1995 to 2003, the effectiveness in reducing gastric cancer incidence and mortality during the chemoprevention period was 53% (95% CI 30% to 69%, p<0.001) and 25% (95% CI −14% to 51%, p=0.18), respectively. No significant changes were noted in the incidence rates of other digestive tract cancers or the antibiotic resistance rate of H. pylori.ConclusionPopulation-based eradication of H. pylori has significantly reduced gastric cancer incidence with no increase in the likelihood of adverse consequences. A significant reduction in mortality is likely to be achieved with a longer follow-up period.Trial registration number NCT00155389
Aims
The aim of this study was to predict periodontal disease (PD) with demographical features, oral health behaviour, and clinical correlates based on a national survey of periodontal disease in ...Taiwan.
Materials and Methods
A total of 4061 subjects who were enrolled in a cross‐sectional nationwide survey on periodontal conditions of residents aged 18 years or older in Taiwan between 2007 and 2008 were included. The community periodontal index (CPI) was used to measure the periodontal status at the subject and sextant levels. Information on demographical features and other relevant predictive factors for PD was collected using a questionnaire.
Results
In our study population, 56.2% of subjects had CPI grades ≥3. Periodontitis, as defined by CPI ≥3, was best predicted by a model including age, gender, education, brushing frequency, mobile teeth, gingival bleeding, smoking, and BMI. The area under the curve (AUC) for the final prediction model was 0.712 (0.690–0.734). The AUC was 0.702 (0.665–0.740) according to cross‐validation.
Conclusions
A prediction model for PD using information obtained from questionnaires was developed. The feasibility of its application to risk stratification of PD should be considered with regard to community‐based screening for asymptomatic PD.
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