scholarly journals Carious lesions in permanent dentitions are reduced in remote Indigenous Australian children taking part in a non-randomised preventive trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244927
Author(s):  
Ratilal Lalloo ◽  
Santosh K. Tadakamadla ◽  
Jeroen Kroon ◽  
Lisa M. Jamieson ◽  
Robert S. Ware ◽  
...  
Keyword(s):  
Dental Caries ◽  
Comparison Group ◽  
Dental Treatment ◽  
Multivariable Analysis ◽  
Intervention Group ◽  
Permanent Dentition ◽  
Standard Diet ◽  
Treatment Standard ◽  
Caries Increment ◽  
Indigenous Children

We tested the effect of an annual caries preventive intervention, delivered by a fly-in/fly-out oral health professional team, with Indigenous children residing in a remote Australian community. Around 600 Indigenous children aged 5 to 17 years were invited to participate at baseline, of who 408 had caregiver consent. One hundred and ninety-six consented to the epidemiological examination and intervention (Intervention group) and 212 consented to the epidemiological examination only (Comparison group). The intervention, which occurred annually, comprised placement of fissure sealants on suitable teeth, and application of povidone-iodine and fluoride varnish to the whole dentition, following completion of any necessary restorative dental treatment. Standard diet and oral hygiene advice were provided. Caries increment (number of tooth surfaces with new dental caries) in both deciduous and permanent dentitions was measured at the 2-year follow-up. Comparison group children had significantly higher number of new surfaces with advanced caries in the permanent dentition than the Intervention group (IRR = 1.61; 95% CI: 1.02–2.54; p = 0.04); with a preventive fraction of 43%. The effect of intervention remained significant with children in the Comparison group developing significantly more advanced caries lesions in the permanent dentition than the Intervention group children in the adjusted multivariable analysis (IRR = 2.21; 95% CI: 1.03–4.71). Indigenous children exposed to the intervention had less increment in advanced dental caries in the permanent dentition than those not exposed to the intervention.

scholarly journals Predicting Dental Caries Increment Using Salivary Biomarkers in a Remote Indigenous Australian Child Population

2021 ◽  
Author(s):  
Surani Fernando ◽  
Santosh Kumar Tadakamadla ◽  
Jeroen Kroon ◽  
Ratilal Lalloo ◽  
Newell W Johnson
Keyword(s):  
Dental Caries ◽  
Comparison Group ◽  
Salivary Flow ◽  
Buffering Capacity ◽  
Mutans Streptococci ◽  
Assessment System ◽  
Flow Rates ◽  
Explanatory Variables ◽  
Salivary Biomarkers ◽  
Caries Increment

Abstract Background The burden of childhood dental caries amongst Indigenous Australians is higher than that of other Australians. Because of differences in lifestyle and the evolutionary history of the oral microbiota associated risk indicators may differ. Our objective was to evaluate associations between caries increment, salivary biomarkers, and baseline caries status among a rural Indigenous community in Far North Queensland, Australia.MethodsThis study was part of a trial assessing effectiveness and cost-effectiveness of an intervention to prevent dental caries among children. A baseline epidemiological survey and application of topical caries preventive measures was conducted in 2015, followed-up in 2016 and 2017. Saliva flow rate, pH, buffering capacity and bacterial loads were measured. Caries was scored by the International Caries Detection and Assessment system. The outcome was caries increment. Explanatory variables were sex, being in experimental or comparison group, baseline caries status, saliva flowrate and buffering capacity, pH, and salivary loads of mutans streptococci (MS), Lactobacilli (LB), and yeast. Descriptive statistics assessed frequencies, means and percentages. Chi Square tests compared caries incidence in relation to explanatory variables and Generalised Linear Models with negative binomial regression and log-link explored associations between explanatory and outcome variables. ResultsOf children caries free at baseline, significantly fewer had incipient (p=0.01) and advanced (p=0.04) caries after two years. From Univariate analysis, children in the experimental group experienced fewer tooth surfaces with advanced caries (p=0.02) than children in the comparison group. Having caries at baseline (p=0.02) and low salivary flow rates (p <0.001) saw a significant increase in advanced caries after two years. Children with high salivary loads of MS (p=0.03) and LB (p=0.004) experienced more advanced carious surfaces. Multivariable analysis revealed 58% reduction (p=0.001) in advanced caries among children with high salivary flow rates. Caries increment was 61% (p=0.03) more for incipient and 121% (p=0.007) more for advanced caries among children who harboured higher loads of MS. ConclusionAs with other ethnicities, children with low salivary flow rates and those with high loads of MS had higher incipient and advanced caries increments after two years. These risk assessments can facilitate targeted preventive interventions for such communities. Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527; date of registration: 3rd July 2015.

scholarly journals Impact of a caries preventive intervention in remote Indigenous Australian children

2019 ◽  
Author(s):  
Ratilal Lalloo ◽  
TADAKAMADLA SANTOSH KUMAR ◽  
Jeroen Kroon ◽  
Lisa M Jamieson ◽  
Newell Johnson
Keyword(s):  
Comparison Group ◽  
Preventive Intervention ◽  
Big Bang ◽  
Carious Lesions ◽  
Caries Increment ◽  
Indigenous Children ◽  
Preventive Fraction ◽  
The Big Bang ◽  
Experimental Group

IMPORTANCE: The burden of dental caries in remote Indigenous communities in Australia is unacceptably high. OBJECTIVES: We tested the impact of an annual caries preventive intervention, delivered by a fly-in/fly-out professional team, on Indigenous children residing in a remote Australian community, involving selective fissure sealants, topical povidone iodine and fluoride varnish application. The outcome was caries increment at 12- and 24-month follow-up. DESIGN, SETTING, PARTICIPANTS: Around 600 Indigenous children aged 5 to 17 years were invited to participate at baseline, of which 408 had caregiver consent provided. Of these, 196 consented to both the study and the treatment arm and comprised the experimental group. Two hundred and twelve consented to the epidemiological examination only, and constituted the comparison group. INTERVENTION: The Big Bang intervention, which occurred annually, comprised placement of fissure sealants, and application of povidone-iodine and fluoride varnish, following completion of each childs dental treatment plan. Standard diet and oral hygiene advice was provided. MAIN OUTCOMES AND MEASURES: Caries increment (number of tooth surfaces with new dental caries) in both primary and permanent dentitions at 12- and 24-month follow-up. RESULTS: At 12-month follow-up, children in the experimental group had, on average, 5.05 (5.47) new carious lesions compared to 7.49 (6.94) in the comparison group (p=0.001). The preventive fraction was 33%. At 24-month follow-up, children in the experimental group had, on average, 6.47 (6.07) new carious lesions compared to 8.43 (5.83) in the comparison group (p=0.002). The preventive fraction was 23%. CONCLUSIONS AND RELEVANCE: Indigenous children exposed to the Big Bang caries intervention had significantly less increment in dental disease than those not exposed to the intervention. Benefits were demonstrated at both 12- and 24-month follow-ups, suggesting that the intervention is likely to be sustained if delivered across a childs life. The cost-effectiveness of this approach is being evaluated.

scholarly journals Predicting dental caries increment using salivary biomarkers in a remote Indigenous Australian child population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Surani Fernando ◽  
Santosh Tadakamadla ◽  
Jeroen Kroon ◽  
Ratilal Lalloo ◽  
Newell W. Johnson
Keyword(s):  
Dental Caries ◽  
Comparison Group ◽  
Salivary Flow ◽  
Mutans Streptococci ◽  
Assessment System ◽  
Flow Rates ◽  
Explanatory Variables ◽  
Salivary Biomarkers ◽  
Caries Increment

Abstract Background The burden of childhood dental caries amongst Indigenous Australians is higher than in other Australians. Because of differences in lifestyle and the evolutionary history of the oral microbiota, associated risk indicators may differ. Here, we evaluate associations between caries increment, salivary biomarkers and baseline caries among children aged 5–17 years residing in a remote rural Indigenous community. Methods This study was part of a trial assessing cost-effectiveness of an intervention to prevent dental caries among children. Baseline epidemiology and application of topical caries-preventive measures was conducted in 2015, followed-up in 2016 and 2017. Children who did not consent or failed to attend the prevention visits but did attend for follow-up epidemiology constituted a natural comparison group for evaluating the intervention. Saliva flow, pH, buffering and bacterial loads were measured at all visits. Caries was scored by the International Caries Detection and Assessment system. Outcome was caries increment. Explanatory variables were sex, being in experimental or comparison group, baseline caries, saliva flowrate and buffering, pH, and salivary loads of mutans streptococci (MS), Lactobacilli (LB), and yeast. Chi Square tests compared caries incidence in relation to explanatory variables and Generalised Linear Models explored associations between explanatory and outcome variables. Results Of 408 participants at baseline, only 208 presented at 2-year follow-up. Of caries-free children at baseline, significantly fewer had incipient (p = 0.01) and advanced (p = 0.04) caries after two years. Children in the experimental group experienced fewer tooth surfaces with advanced caries (p = 0.02) than comparison children. Having caries at baseline (p = 0.02) and low salivary flow-rates (p < 0.001) saw a significant increase in advanced caries after two years. Children with high salivary loads of MS (p = 0.03) and LB (p = 0.004) experienced more advanced carious surfaces. Multivariable analysis revealed 58% reduction (p = 0.001) in advanced caries among children with high salivary flow rates. Caries increment was 61% (p = 0.03) more for incipient and 121% (p = 0.007) more for advanced caries among children who harboured higher loads of MS. Conclusion As with other ethnicities, children with low salivary flow and those with high MS had higher incipient and advanced caries increments after two years. Such risk assessments facilitate targeted preventive interventions for such communities. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527: 3 July 2015.

Effectiveness of a Care Delivery Model for High-Need Older Adults in Communities

2020 ◽  
pp. 104973152098235
Author(s):  
Kuei-Min Chen ◽  
Hui-Fen Hsu ◽  
Li-Yen Yang ◽  
Chiang-Ching Chang ◽  
Yu-Ming Chen ◽  
...  
Keyword(s):  
Older Adults ◽  
Repeated Measures ◽  
Comparison Group ◽  
Care Delivery ◽  
Intervention Group ◽  
Community Dwelling ◽  
Delivery Model ◽  
Positive Effects ◽  
Repeated Measures Design ◽  
Care Delivery Model

Purpose: This study aimed to test the effectiveness of High-Need Community-Dwelling Older Adults Care Delivery Model (HCOACDM) in Taiwan. Methods: A cluster randomized controlled trial with repeated measures design was conducted in eight community care centers, involving 145 high-need older adults who were assigned to the intervention group or comparison group. The HCOACDM was provided over 6 months. Functional ability, quality of life, depressive symptoms, and health care and social service utilizations were measured at baseline, at 3 months, and 6 months into the intervention. The participants’ satisfaction was measured at the end of 6-month intervention. Results: Positive effects were shown on all variables in the intervention group at both the 3-month and 6-month intervals (all p < .05). The intervention group had a higher satisfaction with care delivery than the comparison group ( p < .05). Discussion: The promising findings supported a long-term implementation of the HCOACDM as applicable and beneficial.

The decision-making of treatment and outcome in elderly patients with symptomatic severe aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Q Zhao ◽  
H Xu ◽  
J Lv ◽  
Y Wu
Keyword(s):  
Decision Making ◽  
Aortic Stenosis ◽  
Elderly Patients ◽  
Science And Technology ◽  
Multivariable Analysis ◽  
Intervention Group ◽  
Left Ventricular ◽  
Lower Mortality ◽  
Funding Source ◽  
The Impact

Abstract Background The prevalence of aortic stenosis (AS) steadily increases with age. There is a consensus that intervention should be advised in patients with symptomatic severe AS. However, decision to operate raises complex issues in the elderly due to the increasing operative comorbidity and mortality. There is limited information regarding the characteristics and outcome of elderly patients with symptomatic severe AS who were denied intervention and the reasons leading to the denial. Purpose To analyze the decision-making and the prognosis in elderly patients with symptomatic severe AS. Methods In a cohort of 8929 patients aged ≥60 years with significant valvular heart disease, we divided patients with severe (valve area ≤1 cm2 or peak velocity ≥4.0 m/s or mean gradient ≥40 mmHg), symptomatic (angina or NYHA II-IV or syncope) AS into three groups by final treatment decision: intervention group, doctor-deny group, patient-deny group. The impact of characteristics on decision-making was evaluated and 1-year mortality among three groups were compared. Results Among 546 patients with severe symptomatic AS, the interventional decision was taken in 338 patients (61.9%), 134 patients (24.5%) were denied intervention by doctor after evaluation and 74 patients (13.5%) refused intervention due to personal preference. In multivariable analysis, age [OR=1.104, 95% CI (1.068–1.142)], multi-comorbidities [OR=4.706, 95% CI (2.355–9.403)] and left ventricular end-diastolic diameter (LVEDD) [OR=1.021, 95% CI (1.001–1.042)] were markedly associated with the conservative decision made by doctor, while LVEF &gt;50% [OR=0.260, 95% CI (0.082–0.823)] was significantly linked with the interventional decision. Lower mortality was observed in intervention group during 1-year follow-up compared with either doctor-deny group or patient-deny group (both P&lt;0.001 after adjustment). Further, diabetes [HR=2.513, 95% CI (1.243–5.084)], syncope [HR=2.856, 95% CI (1.338–6.098)], atrial fibrillation (AF) [HR=2.764, 95% CI (1.305–5.855)], stroke [HR=2.921, 95% CI (1.252–6.851)] and multi-comorbidities [HR=3.120, 95% CI (1.363–7.142)] were strong 1-year mortality predictors, whereas interventional treatment [HR=0.195, 95% CI (0.091–0.417)] and LEVF &gt;50% [HR=0.960, 95% CI (0.938–0.984)] were related to lower mortality. Conclusions Intervention was denied in about forty percent of elderly patients with symptomatic severe AS. Patients with advanced age, multi-comorbidities and increased LVEDD tended to be denied intervention by doctors, whereas interventions were more likely to be performed on patients with normal LVEF. Diabetes, syncope, AF, stroke and multi-comorbidities were the predictive factors of 1-year mortality. Elderly patients with symptomatic severe AS could benefit from intervention. Patient education needs to be strengthened, to encourage more patients accept the appropriate intervention. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Twelfth Five-year Science and Technology Support Projects by Ministry of Science and Technology of China

scholarly journals The effect of oat bran consumption on gestational diabetes: a randomized controlled clinical trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zahra Barati ◽  
Mina Iravani ◽  
Majid Karandish ◽  
Mohammad Hosein Haghighizadeh ◽  
Sara Masihi
Keyword(s):  
Clinical Trial ◽  
Blood Glucose ◽  
Gestational Diabetes ◽  
Fasting Blood Glucose ◽  
Intervention Group ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Standard Diet ◽  
Oat Bran ◽  
Significant Difference

Abstract Background Gestational diabetes is the most common medical complication in pregnancy, and it has many side effects for the mother and the fetus. The aim of this study was to evaluate the effect of oat bran consumption on gestational diabetes. Methods This study is a randomized clinical trial that was performed on 112 women with gestational diabetes treated with diet. Participants were randomly divided into two groups of 56. Participants in both groups were given a diet for gestational diabetes. In addition to the diet, the intervention group received 30 g of oat bran daily for 4 weeks at lunch and dinner. Tests of fasting blood glucose and two-hour postprandial (2hpp) glucose were taken from both groups: before the intervention, and 2 and 4 weeks after the start of the intervention. Data analysis was performed using SPSS statistical software (version 22) using independent t-test, as well as Chi-square and Mann-Whitney tests. P values less than 0.05 were considered statistically significant. Results There was no statistically significant difference between the two groups in terms of mean blood glucose before the intervention, while 2 and 4 weeks after the intervention, mean fasting blood glucose and two-hour postprandial (2hpp) glucose decreased significantly in the intervention group compared with the control group (P < 0.001). Conclusion Based on the results of this study, the addition of oat bran to the standard diet for pregnant women with gestational diabetes reduced fasting blood glucose and two-hour postprandial (2hpp) glucose. More detailed studies with higher sample sizes are recommended to prove the effectiveness of this valuable dietary supplement. Trial registration IRCT registration number:IRCT20191220045828N1. Registration date: 2020-04-18. Registered while recruiting.

scholarly journals Effectiveness of a Care Delivery Model for High-Need Community-Dwelling Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 279-279
Author(s):  
Kuei-Min Chen ◽  
Hui-Fen Hsu
Keyword(s):  
Older Adults ◽  
Comparison Group ◽  
Care Delivery ◽  
Care Service ◽  
Intervention Group ◽  
Community Dwelling ◽  
Delivery Model ◽  
Care Services ◽  
Care Delivery Model ◽  
Community Dwelling Older Adults

Abstract The effectiveness of sufficient care coordination for high-need community-dwelling older adults has not been discussed. This study aimed to examine the effectiveness of a newly-developed care delivery model for high-need community-dwelling older adults. A cluster randomized controlled trial with repeated measures design was employed. A total of 145 high-need older adults participated in the study and were randomly assigned to either the intervention group or comparison group. A categorized list of care services based on the types of high-need older adults as the intervention allowed care coordinators to make adequate care service linkages. The intervention period ranged over 6 months with regulated home visits and assesssments. Functional ability, quality of life, depressive symptoms, and healthcare and social service utilizations were measured at baseline, and at 3 and 6 months into the intervention. The participants’ satisfaction with care delivery was measured at the end of 6-month intervention. Results showed that the intervention group had a better functional ability, a higher quality of life, reduced depressive symptoms, and more efficient healthcare and social service utilizations than the comparison group at both the 3-month and 6-month intervals (all p &lt; .05). By the end of the 6-month study, the intervention group were more satisfied with the care service linkages than the comparison group (p &lt; .05). The positive effects of providing a categorized list of care services for care coordinators to make service linkages have been evidenced by the outcomes. The promising findings supported a further longer-term implementation of the care delivery model.

scholarly journals Prevalence of dental caries and associated factors among school-aged children in Tripoli, Libya: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hosam Alraqiq ◽  
Ahmid Eddali ◽  
Reema Boufis
Keyword(s):  
Dental Caries ◽  
Maternal Employment ◽  
Dental Treatment ◽  
First Grade ◽  
Cross Sectional Study ◽  
Arab Countries ◽  
Caries Prevalence ◽  
Seventh Grade ◽  
Cross Sectional ◽  
Factors Associated

Abstract Background In many developing countries, the prevalence of dental caries has increased due to lifestyle changes, lack of preventive services, and inadequate access to dental care. In Arab countries, the increased prevalence of caries has correlated with economic growth over the past decades, resulting in greater access to unhealthy foods and higher consumption of sugar, particularly among children. However, few studies have assessed caries prevalence among pediatric populations in Arab countries. The objective of this study was to assess the prevalence of dental caries and factors associated with caries among children in Tripoli, Libya. Methods This cross-sectional study included a convenience sample of 1934 children in first grade (age 6–7 years, n = 1000) and seventh grade (age 11–12 years, n = 934). Four health centers in Tripoli were selected for screening based on location and participation in school-entry health examinations. Data were collected through self-administered parent surveys and visual dental screenings by trained examiners from September 24 to October 15, 2019. The survey comprised questions about socioeconomic characteristics and oral health behaviors, including toothbrushing, sugar consumption, and dental care history. During screenings, untreated decay, missing teeth, and filled teeth (DMFT or dmft) were recorded. Prevalence of tooth decay was calculated as the proportion of children with high DMFT/dmft scores. Binary logistic and negative binomial regression analyses (with significance at p ≤ 0.05) were used to assess factors associated with caries. Results Among 1000 first-grade children, 78.0% had decay in their primary teeth, with a mean dmft of 3.7. Among 934 seventh-grade children, 48.2% had caries in their permanent teeth, with a mean DMFT of 1.7. The most significant factors associated with caries prevalence were socioeconomic, such as screening site (first grade, p = 0.02; seventh grade, p < 0.001) and maternal employment (seventh grade, p = 0.02), and behavioral, such as toothbrushing duration (seventh grade, p = 0.01), past dental treatment (both grades, p < 0.001), and past emergency visit (both grades, p < 0.001). Conclusions Caries prevalence was associated with several behavioral and socioeconomic factors, including screening site, maternal employment, toothbrushing duration, past dental treatment, and past emergency visit. Efforts should be made to address these factors to minimize barriers and improve oral health behavior and care utilization. These findings can be used to evaluate current public health initiatives and inform future planning.

scholarly journals THE EFFECT OF THE POP-UP BOOK AKU DAN GIGIKU ON PULSE RATE IN CHILDREN AGED 4–6 YEARS

2018 ◽  
Vol 9 ◽  
pp. 135
Author(s):  
Meutia D Citrawuni ◽  
Margaretha Suharsini ◽  
Eva Fauziah ◽  
Kusuma P Adriani
Keyword(s):  
Health Education ◽  
Clinical Research ◽  
Pulse Rate ◽  
Dental Treatment ◽  
Psychological Intervention ◽  
Dental Health ◽  
Physiological Responses ◽  
Intervention Group ◽  
Control Group ◽  
Significant Difference

Objective: Anxiety is regarded as a major problem in children undergoing dental treatment. One of the physiological responses to anxiety is an increased pulse rate. Young children respond aggressively to anxiety and are in need of psychological intervention. Pop-up books can be used as an instrument to improve their interest and to help them understand the substance of dental health education.The objective of this study was to utilize pulse rate measurements to investigate the intervention of a pop-up book in reducing anxiety. A total of 78 children aged 4–6 years were divided into two groups: An intervention group with the pop-up book Aku dan Gigiku and a control group without intervention. The pulse rates of both groups were measured. This study comprised an experimental clinical research design. The independent t-test was used to measure comparisons of decreased pulse rate between the two groups.Result: The result showed that there was a statistically significant difference in decreased pulse rate with and without the intervention of the pop-up book Aku dan Gigiku. Pop-up books are often used as an educational medium for children because they present interesting illustrations and are easy to understand.Conclusion: As a medium of dental health education, pop-up books can contribute significantly to reducing anxiety in children.

scholarly journals Color/race inequalities in oral health among Brazilian adolescents

2009 ◽  
Vol 12 (3) ◽  
pp. 313-324 ◽  
Author(s):  
João Luiz Bastos ◽  
José Leopoldo Ferreira Antunes ◽  
Antonio Carlos Frias ◽  
Maria da Luz Rosário de Souza ◽  
Karen Glazer Peres ◽  
...  
Keyword(s):  
Oral Health ◽  
Dental Caries ◽  
Health Outcomes ◽  
Dental Treatment ◽  
Oral Disease ◽  
World Health ◽  
Treatment Needs ◽  
Gingival Bleeding ◽  
Untreated Dental Caries ◽  
Oral Health Outcomes

This study assessed oral health outcomes (perceived dental treatment need, untreated dental caries, gingival bleeding, periodontal pockets, and pain in teeth and gums), in relation to color/race inequalities among adolescents in each Brazilian region. The database included dental examination and interview of 16,833 15-19-year-old adolescents, surveyed by the Brazilian health authority, from May 2002 to October 2003, in accordance with international diagnostic criteria standardized by the World Health Organization. Prevalence ratios estimated by Poisson regression, and controlled by socioeconomic status and access to fluoridated piped water, assessed oral health differentials among color/race groups and country's regions. Except for periodontal pockets, prevalence figures were higher in the North and Northeast: perceived dental treatment needs, untreated dental caries, gingival bleeding at probing and pain in teeth and gums varied between 80-83%, 75-76%, 38-43%, and 17-18%, respectively, in these regions. Adolescents living in the Southeast - the richest Brazilian region - presented a better general profile of oral health than their counterparts living in the remaining regions; they had a lower prevalence of untreated dental caries (54%) and unfavorable gingival status (29%). However, the Southeast presented color/race inequalities in all oral health outcomes, with a poorer profile systematically affecting browns or blacks, depending on the oral health condition under consideration. These results reinforce the need for expanding the amplitude of health initiatives aimed at adolescent oral health. Socially appropriate health programs should concurrently aim at the reduction of levels of oral disease and its inequalities.

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