scholarly journals Development of dental caries and risk factors between 1 and 7 years of age in areas of high risk for dental caries in Stockholm, Sweden

2021 ◽  
Author(s):  
M. Anderson ◽  
G. Dahllöf ◽  
A. Warnqvist ◽  
M. Grindefjord
Keyword(s):  
High Risk ◽  
Dental Caries ◽  
Family Income ◽  
Fluoride Varnish ◽  
Secondary Outcome ◽  
Free Sugar ◽  
Secondary Outcome Measure ◽  
Structured Interviews ◽  
Fluoride Toothpaste ◽  
Immigrant Background

Abstract Purpose To explore caries predictors at age 1 year and caries development at ages 5 and 7 years in two groups of children following different fluoride-based preventive programs. Methods We conducted a prospective cluster-randomized controlled intervention trial with two parallel arms comparing two prevention programs: one program included fluoride varnish applications every 6 months, the other did not; otherwise, the programs were the same. Participants were 1- and 3-year-old children enrolled at 23 dental clinics in high-risk areas in Stockholm, Sweden. The baseline examination included structured interviews. Caries data were extracted from dental records. The primary outcome measures were ICDAS 1–6 > 0 at baseline (age 1 year) and defs > 0 at ages 2, 3, 5, and 7 years. The secondary outcome measure at age 7 was DFS > 0. Results Continuous caries development occurred: defs > 0 in 23% at 5 years and in 42% at 7 years. We found no difference in caries development between children who had or had not received fluoride varnish as toddlers. At age 1-year, significant predictors for dental caries in later preschool years were immigrant background, family income, and sweets consumption. Fluoride toothpaste > once a day at 1 year had an OR < 1 for defs > 0 at 5- and 7 years. Conclusions For toddlers, fluoride varnish does not seem to be an adequate prevention tool. Brushing with fluoride toothpaste from 1 year of age could not arrest caries development. Immigrant background was the strongest predictor. A new toolbox as well as collaborative upstream actions for reducing free-sugar intake are needed.

Survival in the gap: experiences of health management among people at high risk of stroke in China: A qualitative study (Preprint)

2019 ◽  
Author(s):  
Lina Guo ◽  
Lin Wang ◽  
Jo Booth ◽  
Yanjin Liu ◽  
Yiru Zhu ◽  
...  
Keyword(s):  
Social Support ◽  
High Risk ◽  
Family Income ◽  
Health Management ◽  
Healthcare Providers ◽  
Service Development ◽  
System Reform ◽  
Management Service ◽  
Structured Interviews ◽  
Step Method

BACKGROUND Effective health management of people at high risk of stroke is challenging. OBJECTIVE To identify and explore the experiences of health management among people at high risk of stroke in order to inform ideas for health management service development for this population. METHODS Semi-structured interviews were conducted with 31stroke people at high risk of stroke. The interviews were collated and analyzed using Colaizzi’s 7-step method. RESULTS The experiences of health management in people at high risk of stroke were described as ‘Survival in the gap’. Themes identified limited knowledge of health management, lack of confidence in health management and poor adherence with health management. The value of health management experience was highlighted and included: becoming active learners, promoting social interaction and enhancing self-health management. Health management was seen to be sensitive to multiple influencing factors including: The severity and complexity of diseases, family income and social support. CONCLUSIONS Health management of people at high risk of stroke is challenging and they ‘survive in the gap’. They learn to manage their ongoing health based mainly on their own experiences. Government and healthcare providers should pay attention to the situation for this special population and be devoted to health system reform, financial support and social support to manage the condition in the longer term.

scholarly journals Child Fluoride Varnish Programs Implementation: A Consensus Workshop and Actions to Increase Scale-Up in Australia

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 1029
Author(s):  
John Skinner ◽  
Yvonne Dimitropoulos ◽  
Woosung Sohn ◽  
Alexander Holden ◽  
Boe Rambaldini ◽  
...  
Keyword(s):  
Oral Health ◽  
High Risk ◽  
Dental Caries ◽  
Scale Up ◽  
Strong Support ◽  
Fluoride Varnish ◽  
Australian State ◽  
High Risk Child ◽  
Dental Professionals

This paper presents the findings of the National Fluoride Varnish Workshop in 2018 along with subsequent actions to scale-up the use of fluoride varnish nationally in Australia. The use of fluoride varnish programs to prevent dental caries in high-risk child populations is an evidence-based population health approach used internationally. Such programs have not been implemented at scale nationally in Australia. A National Fluoride Varnish Consensus Workshop was held in Sydney in November 2018 with an aim of sharing the current work in this area being undertaken by various Australian jurisdictions and seeking consensus on key actions to improve the scale-up nationally. Forty-four people attended the Workshop with oral health representatives from all Australian state and territory health departments, as well as the Australian Dental Association (ADA) at both NSW branch and Federal levels. There was strong support for further scale-up of fluoride varnish programs nationally and to see the wider use of having non-dental professionals apply the varnish. This case study identifies key actions required to ensure scale-up of systematic fluoride varnish programs as part of a strategic population oral health approach to preventing dental caries among high-risk children who may not routinely access dental care.

scholarly journals Fluoride Varnishes for Preventing Occlusal Dental Caries: A Review

2021 ◽  
Vol 9 (6) ◽  
pp. 64
Author(s):  
Alaa Baik ◽  
Najlaa Alamoudi ◽  
Azza El-Housseiny ◽  
Amani Altuwirqi
Keyword(s):  
High Risk ◽  
Dental Caries ◽  
Caries Prevention ◽  
Fluoride Varnish ◽  
Fissure Sealants ◽  
Occlusal Caries ◽  
Vast Number ◽  
Occlusal Surfaces ◽  
Permanent Molars ◽  
First Permanent Molars

Dental caries are most likely to occur on occlusal surfaces from the early eruptive stages of the tooth. In children, about 80% to 90% of dental caries are occlusal caries. Different preventive modalities are used to prevent occlusal caries. One of the methods used for occlusal caries prevention is fluoride varnish. A vast number of clinical trials have evaluated several types of sealant material and fluoride varnish to assess their ability to prevent occlusal caries in both primary and permanent dentition. The purpose of the current study was to provide an updated overview of the development, composition, mechanism of action, application, and safety of fluoride varnish, as well as its effect on occlusal caries prevention. This review of recently published studies on fluoride varnish and its effect on occlusal caries prevention shows that in children at moderate to high risk of caries, fluoride varnishes prevent occlusal caries. Both resin-based fissure sealants and fluoride varnish are effective for occlusal caries prevention for first-permanent molars. However, it was not possible to identify which one has the best effect. It is recommend that fluoride varnish is applied for children at high risk of caries two to four times per year.

EFFECT OF FLUORIDE VARNISH APPLICATION ON PRIMARY DENTITION AMONG PRESCHOOL CHILDREN IN DHARAN: A RANDOMIZED CONTROLLED TRIAL

2019 ◽  
Author(s):  
Santosh Kumari Agrawal ◽  
Ashish Shrestha ◽  
Tarakant Bhagat
Keyword(s):  
Randomized Controlled Trial ◽  
Preschool Children ◽  
High Risk ◽  
Dental Caries ◽  
System Analysis ◽  
Controlled Trial ◽  
Primary Dentition ◽  
Fluoride Varnish ◽  
Tooth Surface ◽  
Randomized Controlled

Abstract Background: Dental caries is a multifactorial disease which starts with microbiological shift within the complex biofilm and is affected by salivary flow and its composition, exposure to fluoride, consumption of dietary sugars, and by preventive behaviors (cleaning teeth). Topical application of fluoride varnish on the tooth surface prevent the dissolution rates of tooth materials and increase the re-precipitation of lost minerals. The objective of the present study was to assess the effectiveness of fluoride varnish application in primary dentition among preschool children at high risk of dental caries. Methods: A randomized controlled trial was conducted with two parallel group, comprising 3-5 year old children, 100 in each group (Fluoride varnish/FV or Placebo varnish/PV). Oral examination of children was performed using mouth mirror and WHO probe. Dental caries was recorded at baseline, three and six months using Caries Assessment and Treatment Instrument (CAST) scoring system. Analysis was done using chi-square test for categorical data, Mann-Whitney U test, independent t test and Wilcoxon Signed Ranks test for quantitative data. The level of significance was set at p<0.05. Results: Overall, dental caries progression from baseline to 3 month and 6 month was more in PV group children than FV (38.98% and 31.3% respectively). At the end of the study, the overall caries incidence was 28.24%. The proportion of children with new caries lesions was more in PV group than that in the FV group at every three months interval. The difference between the groups were statistically significant (p<0.05). FV treatment once in six months had better treatment effect with preventive fraction of 62.1% in comparison to three months (59.0%). Conclusion: Dental caries can be prevented effectively by use of 5% sodium fluoride varnish. It is efficacious when applied twice a year in children at high risk of dental caries. Trial Registration: CTRI/2016/02/006659 (Reg. date: 18/02/2016) Trial Registered Retrospectively Key Words: Dental caries, Fluoride varnish, Primary dentition, Randomized controlled trial

scholarly journals COpenhagen Neuroplastic TRaining Against Contractures in Toddlers (CONTRACT): protocol of an open-label randomised clinical trial with blinded assessment for prevention of contractures in infants with high risk of cerebral palsy

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044674
Author(s):  
Maria Willerslev-Olsen ◽  
Jakob Lorentzen ◽  
Katrine Røhder ◽  
Anina Ritterband-Rosenbaum ◽  
Mikkel Justiniano ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cerebral Palsy ◽  
High Risk ◽  
Standard Care ◽  
Muscle Growth ◽  
Randomised Clinical Trial ◽  
Triceps Surae ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Open Label

IntroductionContractures are frequent causes of reduced mobility in children with cerebral palsy (CP) already at the age of 2–3 years. Reduced muscle use and muscle growth have been suggested as key factors in the development of contractures, suggesting that effective early prevention may have to involve stimuli that can facilitate muscle growth before the age of 1 year. The present study protocol was developed to assess the effectiveness of an early multicomponent intervention, CONTRACT, involving family-oriented and supervised home-based training, diet and electrical muscle stimulation directed at facilitating muscle growth and thus reduce the risk of contractures in children at high risk of CP compared with standard care.Methods and analysisA two-group, parallel, open-label randomised clinical trial with blinded assessment (n=50) will be conducted. Infants diagnosed with CP or designated at high risk of CP based on abnormal neuroimaging or absent fidgety movement determined as part of General Movement Assessment, age 9–17 weeks corrected age (CA) will be recruited. A balanced 1:1 randomisation will be made by a computer. The intervention will last for 6 months aiming to support parents in providing daily individualised, goal-directed activities and primarily in lower legs that may stimulate their child to move more and increase muscle growth. Guidance and education of the parents regarding the nutritional benefits of docosahexaenic acid (DHA) and vitamin D for the developing brain and muscle growth will be provided. Infants will receive DHA drops as nutritional supplements and neuromuscular stimulation to facilitate muscle growth. The control group will receive standard care as offered by their local hospital or community. Outcome measures will be taken at 9, 12, 18, 24, 36 and 48 months CA. Primary and secondary outcome measure will be lower leg muscle volume and stiffness of the triceps surae musculotendinous unit together with infant motor profile, respectively.Ethics and disseminationFull approval from the local ethics committee, Danish Committee System on Health Research Ethics, Region H (H-19041562). Experimental procedures conform with the Declaration of Helsinki.Trial registration numberNCT04250454.Expected recruitment period1 January 2021–1 January 2025.

scholarly journals A Resident-Led QI Project to Improve Dental Health at a Primary Care Pediatric Practice

2020 ◽  
Vol 12 (5) ◽  
pp. 571-577
Author(s):  
Lauren T. Roth ◽  
Laura Robbins-Milne ◽  
Dana Sirota ◽  
Mariellen Lane
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Outcome Measure ◽  
Dental Health ◽  
Primary Care Providers ◽  
Fluoride Varnish ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Care Providers ◽  
The Past

ABSTRACT Background Dental caries are the most common chronic condition of childhood and have significant medical, psychological, and financial consequences. The American Academy of Pediatrics (AAP) recommends primary care physicians apply fluoride varnish (FV) every 3 to 6 months from tooth emergence through age 5. Objective Through a resident-led quality improvement (QI) project, we aimed to provide FV to 50% of patients ages 1 through 5 who did not have a dental visit in the preceding 6 months or receive FV elsewhere in the past month. Methods From May 2017 through April 2018, we conducted 7 monthly plan-do-study-act cycles to improve our primary outcome measure (FV application), secondary outcome measure (percentage of patients who had routine dental care), and process measure (percentage of dental referrals). Balancing measures included time taken away from other clinical priorities and reimbursement rates. Results Fluoride varnish application improved from 3.6% to 44% with a 54% peak. The percentage of patients under 6 who had seen a dentist in the past 6 months increased from 30% to 47%. The percentage of dental referrals increased from 17% to 33%. Conclusions Application of FV is a quick, cost-effective way for primary care providers to improve dental health. This resident-led QI project increased rates of FV application, dental referrals, and dental visits while meeting ACGME guidelines for experiential learning in QI. By adapting to state-specific guidelines and workflows of each clinic, this QI project could be nationally reproduced to improve adherence to AAP and United States Preventive Services Task Force guidelines.

scholarly journals Understanding low chemoprevention uptake by women at high risk of breast cancer: findings from a qualitative inductive study of women’s risk-reduction experiences

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tasleem J. Padamsee ◽  
Megan Hils ◽  
Anna Muraveva
Keyword(s):  
Breast Cancer ◽  
African American ◽  
High Risk ◽  
Risk Reduction ◽  
White Women ◽  
Future Research ◽  
Structured Interviews ◽  
Critical Gap ◽  
High Risk Women ◽  
Parent Project

Abstract Background Chemoprevention is one of several methods that have been developed to help high-risk women reduce their risk of breast cancer. Reasons for the low uptake of chemoprevention are poorly understood. This paper seeks a deeper understanding of this phenomenon by drawing on women’s own narratives about their awareness of chemoprevention and their risk-related experiences. Methods This research is based on a parent project that included fifty in-depth, semi-structured interviews with a purposive sample of African American and White women at elevated risk of breast cancer. This specific study draws on the forty-seven interviews conducted with women at high or severe risk of breast cancer, all of whom are eligible to use chemoprevention for breast cancer risk-reduction. Interviews were analyzed using grounded theory methods. Results Forty-five percent of participants, and only 21% of African American participants, were aware of chemoprevention options. Women who had seen specialists were more likely to be aware, particularly if they had ongoing specialist access. Aware and unaware women relied on different types of sources for prevention-related information. Those whose main source of information was a healthcare provider were more likely to know about chemoprevention. Aware women used more nuanced information gathering strategies and worried more about cancer. Women simultaneously considered all risk-reduction options they knew about. Those who knew about chemoprevention but were reluctant to use it felt this way for multiple reasons, having to do with potential side effects, perceived extreme-ness of the intervention, similarity to chemotherapy, unknown information about chemoprevention, and reluctance to take medications in general. Conclusions Lack of chemoprevention awareness is a critical gap in women’s ability to make health-protective choices. Future research in this field must consider complexities in both women’s perspectives on chemoprevention and the reasons they are reluctant to use it.

scholarly journals Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis

2021 ◽  
Vol 10 (10) ◽  
pp. 2161
Author(s):  
Jae Yun Sung ◽  
Ju Mi Kim ◽  
Jae Yul Hwang ◽  
Kyoung Nam Kim ◽  
Jae Young Kim ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Surgical Outcomes ◽  
Timing Of Surgery ◽  
Secondary Outcome ◽  
Control Group ◽  
Optimal Timing ◽  
Secondary Outcome Measure ◽  
Success Rates ◽  
Endoscopic Dacryocystorhinostomy ◽  
And Gender

Purpose: To evaluate the surgical outcomes of primary early endoscopic dacryocystorhinostomy (EnDCR) in acute dacryocystitis (AD) and to determine the optimal timing for surgery. Methods: A retrospective review of medical records was performed on consecutive patients who underwent primary early EnDCR (within 1 week) for AD between May 2010 and June 2020 (AD group) and an age- and gender-matched control group of NLDO patients who underwent EnDCR (non-AD group). The primary outcome measures were the surgical outcomes at the final follow-up examination. The secondary outcome measure was the clinical course of AD patients. Subgroup analysis was performed to determine the optimal timing of surgery by comparing the outcomes of very early EnDCR (within 3 days) and those of early EnDCR (between 4 and 7 days). Results: Forty-one patients were included in the AD group and 82 patients in the non-AD group. The anatomical and functional success rates were 87.8% and 82.9% in the AD group, and 91.5% and 84.1% in the non-AD group, which were not significantly different between the two groups (p = 0.532 and p = 0.863). In the AD group, the mean times for pain relief and resolution of swelling after surgery were 2.4 and 6.5 days after surgery, respectively. In the subgroup analysis according to the timing of surgery, the time for symptom resolution after diagnosis, the length of hospital stays, and the duration of antibiotic treatments were significantly shorter after very early EnDCR (all ps < 0.05), whereas the surgical outcomes were not different between the two groups (p = 1.000). Conclusions: Primary early EnDCR is a safe and effective procedure for the treatment of AD. In particular, very early EnDCR performed within 3 days leads to faster recovery and shortens the course of antibiotic treatment.

scholarly journals Couples’ experiences with expanded carrier screening: evaluation of a university hospital screening offer

2021 ◽  
Author(s):  
Ivy van Dijke ◽  
Phillis Lakeman ◽  
Naoual Sabiri ◽  
Hanna Rusticus ◽  
Cecile P. E. Ottenheim ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Center ◽  
Informed Choice ◽  
Carrier Screening ◽  
University Hospital ◽  
Structured Interviews ◽  
Expanded Carrier Screening ◽  
Post Test ◽  
Future Child ◽  
Clinically Significant

AbstractPreconception carrier screening offers couples the possibility to receive information about the risk of having a child with a recessive disorder. Since 2016, an expanded carrier screening (ECS) test for 50 severe autosomal recessive disorders has been available at Amsterdam Medical Center, a Dutch university hospital. This mixed-methods study evaluated the experiences of couples that participated in the carrier screening offer, including high-risk participants, as well as participants with a general population risk. All participants received genetic counselling, and pre- (n = 132) and post-test (n = 86) questionnaires and semi-structured interviews (n = 16) were administered. The most important reason to have ECS was to spare a future child a life with a severe disorder (47%). The majority of survey respondents made an informed decision (86%), as assessed by the Multidimensional Measure of Informed Choice. Among the 86 respondents, 27 individual carriers and no new carrier couples were identified. Turn-around time of the test results was considered too long and costs were perceived as too high. Overall, mean levels of anxiety were not clinically elevated. High-risk respondents (n = 89) and pregnant respondents (n = 13) experienced higher levels of anxiety before testing, which decreased after receiving the test result. Although not clinically significant, distress was on average higher for carriers compared to non-carriers (p < 0.0001). All respondents would opt for the test again, and 80.2% would recommend it to others. The results suggest that ECS should ideally be offered before pregnancy, to minimise anxiety. This study could inform current and future implementation initiatives of preconception ECS.

Sign in / Sign up

Export Citation Format

Share Document