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Zhao Y, Raymond K, Chondur R, Sharp W, Gadd E, Bailie R, Skinner J, Burgess P. Costs and benefits of community water fluoridation in remote Aboriginal communities of the Northern Territory. Aust J Rural Health 2023; 31:1017-1026. [PMID: 37706591 DOI: 10.1111/ajr.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE To undertake an economic evaluation of community water fluoridation (CWF) in remote communities of the Northern Territory (NT). DESIGN Dental caries experiences were compared between CWF and non-CWF communities before and after intervention. Costs and benefits of CWF are ascertained from the health sector perspective using water quality, accounting, oral health, dental care and hospitalisation datasets. SETTING AND PARTICIPANTS Remote Aboriginal population in the NT between 1 January 2008 and 31 December 2020. INTERVENTION CWF. MAIN OUTCOME MEASURES Potential economic benefits were estimated by changes in caries scores valued at the NT average dental service costs. RESULTS Given the total 20-year life span of a fluoridation plant ($1.77 million), the net present benefit of introducing CWF in a typical community of 300-499 population was $3.79 million. For each $1 invested in CWF by government, the estimated long-term economic value of savings to health services ranged from $1.1 (population ≤300) to $16 (population ≥2000) due to reductions in treating dental caries and associated hospitalisations. The payback period ranged from 15 years (population ≤300) to 2.2 years (population ≥2000). CONCLUSIONS The economic benefits of expanding CWF in remote Aboriginal communities of NT outweigh the costs of installation, operation and maintenance of fluoridation plants over the lifespan of CWF infrastructure for population of 300 or more.
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Affiliation(s)
- Yuejen Zhao
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
| | - Kate Raymond
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
| | - Ramakrishna Chondur
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
| | - Wayne Sharp
- Power and Water Corporation, Northern Territory, Darwin, Northern Territory, Australia
| | - Elizabeth Gadd
- Power and Water Corporation, Northern Territory, Darwin, Northern Territory, Australia
| | - Ross Bailie
- The University of Sydney, Sydney, New South Wales, Australia
| | - John Skinner
- Macquarie University, Sydney, New South Wales, Australia
| | - Paul Burgess
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
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Replacement of refined sugar by natural sweeteners: focus on potential health benefits. Heliyon 2022; 8:e10711. [PMID: 36185143 PMCID: PMC9519493 DOI: 10.1016/j.heliyon.2022.e10711] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/06/2022] [Accepted: 09/15/2022] [Indexed: 11/24/2022] Open
Abstract
Refined sugar is a processed product containing 99% sucrose, which is obtained from sugarcane (70%) or sugar beet (30%). In modern societies, sugar continues to play a significant role in the diet, recognised not only for its flavour and special sweetening properties but also for its role in food preservation. On the other hand, a high consumption of refined sugar is associated with non-communicable diseases and many health issues such as a high risk of dental caries, overweight and neurodevelopmental disorders in children. Alternatives like unrefined sugars have generated a lot of interest as a healthy substitute due to their nutraceutical properties. This paper is aimed to review the beneficial effects of sugar derived from natural sources and highlight health problems that could be caused by refined processed sugar. Refined sugar is frequently used in variety of items including processed foods, soft drinks or ice creams although it is considered unhealthy due to its high salt and sugar content as well as added fats and artificial coloring. Natural sugars are preferred because they have a high nutritional value and a high concentration of healthy compounds, which offset the negative effects of refined sugar. Therefore, removing refined sugar or at least reducing its consumption should be promoted as a healthier option in food choices.
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MacDonald B, Patel J, Tarca A, Yim D. Factors Influencing Oral Health Admissions in Dental Patients With Acute Rheumatic Fever and Rheumatic Heart Disease in a Paediatric Tertiary Hospital. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Machluf Y, Chaiter Y, Farkash R, Sebbag A, Fink DL. Rheumatic Fever in Large Cohort of Adolescents in Israel. Front Med (Lausanne) 2020; 6:328. [PMID: 32039216 PMCID: PMC6992586 DOI: 10.3389/fmed.2019.00328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Acute rheumatic fever (ARF) remains a major worldwide healthcare problem, despite its progressive decline in developed countries. The aims of our study were to estimate the prevalence of ARF among adolescents in Israel and to investigate risk factors. Methods: The study population consisted of 113,671 consecutive conscripts 16–19 years old, born during 1971–1993, who completed the medical profiling as part of the recruitment process to the IDF. ARF was diagnosed according to Jones criteria at time of illness, with confirmation relying on medical documentation and cardiologist evaluation including echocardiography. Results: The general prevalence rate of ARF was 0.12%. A downward trend was observed, from 0.19% among those born during 1971–1980 to 0.07% among those born during 1981–1993. Differences in prevalence of ARF were noted in sub-populations based on country of birth and origin—Israel, Ethiopia and the former soviet union (FUSSR). The prevalence rates of valvar disease among ARF+ and ARF– recruits were 15.7% and 0.95%, respectively. In multivariable logistic regression analyses, 4 variables were negatively associated with ARF: later birth year group, female gender, rural residence, youngest child; and 3 were positively associated with ARF: young parents, above normal BMI and valvar disease. Conclusion: Our study provides support for the documented decline in ARF prevalence and describes socio-demographic and anthropometric risk factors including the association with valvar disease and novel risk factors including above normal BMI and young parents, both warranting further investigation which might help in developing societal level prevention strategies.
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Affiliation(s)
- Yossy Machluf
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel.,Shamir Research Institute, University of Haifa, Haifa, Israel
| | - Yoram Chaiter
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel
| | | | - Anat Sebbag
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel
| | - Daniel Lyon Fink
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel.,Shaare Zedek Medical Center, Jerusalem, Israel.,HaEmek Medical Center, Afula, Israel
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Baker MG, Gurney J, Oliver J, Moreland NJ, Williamson DA, Pierse N, Wilson N, Merriman TR, Percival T, Murray C, Jackson C, Edwards R, Foster Page L, Chan Mow F, Chong A, Gribben B, Lennon D. Risk Factors for Acute Rheumatic Fever: Literature Review and Protocol for a Case-Control Study in New Zealand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4515. [PMID: 31731673 PMCID: PMC6888501 DOI: 10.3390/ijerph16224515] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
Abstract
Acute rheumatic fever (ARF) and its sequela, rheumatic heart disease (RHD), have largely disappeared from high-income countries. However, in New Zealand (NZ), rates remain unacceptably high in indigenous Māori and Pacific populations. The goal of this study is to identify potentially modifiable risk factors for ARF to support effective disease prevention policies and programmes. A case-control design is used. Cases are those meeting the standard NZ case-definition for ARF, recruited within four weeks of hospitalisation for a first episode of ARF, aged less than 20 years, and residing in the North Island of NZ. This study aims to recruit at least 120 cases and 360 controls matched by age, ethnicity, gender, deprivation, district, and time period. For data collection, a comprehensive pre-tested questionnaire focussed on exposures during the four weeks prior to illness or interview will be used. Linked data include previous hospitalisations, dental records, and school characteristics. Specimen collection includes a throat swab (Group A Streptococcus), a nasal swab (Staphylococcus aureus), blood (vitamin D, ferritin, DNA for genetic testing, immune-profiling), and head hair (nicotine). A major strength of this study is its comprehensive focus covering organism, host and environmental factors. Having closely matched controls enables the examination of a wide range of specific environmental risk factors.
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Affiliation(s)
- Michael G Baker
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Jane Oliver
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Nicole J Moreland
- School of Medical Sciences, University of Auckland, Auckland 1010, New Zealand;
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne 3010, Australia;
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland District Health Board, Auckland 1023; New Zealand;
- Department of Paediatrics, University of Auckland, Auckland 1142, New Zealand;
| | - Tony R Merriman
- Biochemistry Department, University of Otago, Dunedin 9054, New Zealand;
| | - Teuila Percival
- School of Population Health, University of Auckland, Auckland 1142, New Zealand;
- KidzFirst Children’s Hospital, Auckland 1640, New Zealand;
| | - Colleen Murray
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand (L.F.P.)
| | - Catherine Jackson
- Auckland Regional Public Health Service, Auckland District Health Board, Auckland 0622, New Zealand;
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Lyndie Foster Page
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand (L.F.P.)
| | | | - Angela Chong
- CBG Health Research Ltd, Auckland 0651, New Zealand; (A.C.); (B.G.)
| | - Barry Gribben
- CBG Health Research Ltd, Auckland 0651, New Zealand; (A.C.); (B.G.)
| | - Diana Lennon
- Department of Paediatrics, University of Auckland, Auckland 1142, New Zealand;
- KidzFirst Children’s Hospital, Auckland 1640, New Zealand;
- Starship Children’s Hospital, Auckland District Health Board, Auckland 1023, New Zealand
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Secular trends 2013-2017 in overweight and visible dental decay in New Zealand preschool children: influence of ethnicity, deprivation and the Under-5-Energize nutrition and physical activity programme. J Dev Orig Health Dis 2018; 10:345-352. [PMID: 30378530 DOI: 10.1017/s2040174418000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Early-life intervention to reduce obesity and poor dental health through early-life nutrition will improve health outcomes in later life. This study examined the prevalence of overweight and obesity and visual dental decay in 4-year old children in New Zealand between 2013 and 2017, and the impact of a nutrition and physical activity intervention programme, Under-5-Energize (U5E), on prevalence of these conditions within ethnic groups and by deprivation. The data set included 277,963 4-year-old children, including 25,140 from the Waikato region children of whom 8067 attended one of the 121 early childhood centres (ECC) receiving the U5E programme from 2014. Purposively the U5E-ECC selected were attended by higher proportions of indigenous Māori children and children living in higher deprivation areas than non-U5E-ECC. From 2013 to 2017, the overall prevalence of obesity, as defined by World Health Organisation criteria, declined slightly but rates of dental decay did not change. In the Waikato region, the prevalence of obesity declined in non-Māori children from 2015 to 2017 and children attending U5E-ECC had lower rates of dental decay than non-U5E children. Binary logistic regression showed that between 2015 and 2017 visible dental decay was more likely in children who were Māori (3.06×3.17), living in high deprivation (1.54×1.66) and male (1.10) but less likely if attending an U5E-ECC (0.83×0.79). Early-life intervention had efficacy at reducing dental decay, and demonstrated that the origins of disparities in health such as ethnicity and deprivation need to be addressed further to break the intergenerational cycles of poor health.
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Merriman TR, Wilcox PL. Cardio-metabolic disease genetic risk factors among Māori and Pacific Island people in Aotearoa New Zealand: current state of knowledge and future directions. Ann Hum Biol 2018; 45:202-214. [PMID: 29877153 DOI: 10.1080/03014460.2018.1461929] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Cardio-metabolic conditions in Aotearoa New Zealand (NZ) Māori and non-indigenous Polynesian (Pacific) populations have been increasing in prevalence and severity, especially over the last two decades. OBJECTIVES To assess knowledge on genetic and non-genetic risk factors for cardio-metabolic disease in the Māori and Pacific populations residing in Aotearoa NZ by a semi-systematic review of the PubMed database. To outline possible future directions in genetic epidemiological research with Māori and Pacific communities. RESULTS There have been few studies to confirm that risk factors in other populations also associate with cardio-metabolic conditions in Māori and Pacific populations. Such data are important when interventions are considered. Genetic studies have been sporadic, with no genome-wide association studies done. CONCLUSIONS Biomedical research with Māori and Pacific communities is important to reduce the prevalence and impact of the cardio-metabolic diseases, as precision medicine is implemented in other Aotearoa NZ populations using overseas findings. Genuine engagement with Māori and Pacific communities is needed to ensure positive outcomes for genetic studies, from data collection through to analysis and dissemination. Important is building trust, understanding by researchers of fundamental cultural concepts and implementing protocols that minimise risks and maximise benefits. Approaches that utilise information such as genealogical information and whole genome sequencing technologies will provide new insights into cardio-metabolic conditions-and new interventions for affected individuals and families.
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Affiliation(s)
- Tony R Merriman
- a Biochemistry Department , University of Otago , Dunedin , Aotearoa , New Zealand
| | - Phillip L Wilcox
- b Department of Mathematics and Statistics , University of Otago , Dunedin , Aotearoa , New Zealand
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Thornley S, Marshall R, Jarrett P, Sundborn G, Reynolds E, Schofield G. Scabies is strongly associated with acute rheumatic fever in a cohort study of Auckland children. J Paediatr Child Health 2018; 54:625-632. [PMID: 29442387 DOI: 10.1111/jpc.13851] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/01/2017] [Accepted: 12/14/2017] [Indexed: 11/30/2022]
Abstract
AIM This study sought to determine whether scabies infection is associated with acute rheumatic fever (ARF) or chronic rheumatic heart disease (CRHD). METHODS A cohort study was undertaken using health records of children aged 3-12 years attending an oral health service for the first time. Subjects were then linked to hospital diagnoses of scabies and ARF or CRHD. RESULTS A total of 213 957 children free of rheumatic heart disease at baseline were available for analysis. During a mean follow-up time of 5.1 years, 440 children were diagnosed with ARF or CRHD in hospital records. Children diagnosed with scabies during follow-up were 23 times more likely to develop ARF or CRHD, compared with children who had no scabies diagnosis. After adjustment for confounders in a Cox model, the association reduced but remained strong (adjusted hazard ratio: 8.98; 95% confidence interval: 6.33-20.2). In an analysis restricted to children hospitalised at least once during follow-up, the adjusted hazard ratio for the same comparison was 3.43 (95% confidence interval: 1.85-6.37). CONCLUSIONS A recent diagnosis of scabies from hospital records is strongly associated with a subsequent diagnosis of ARF. Further investigation of the role that scabies infestation may play in the aetiology of ARF is warranted.
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Affiliation(s)
- Simon Thornley
- Communicable Diseases and Disease Investigation, Auckland Regional Public Health Service, Auckland, New Zealand.,Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Roger Marshall
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Paul Jarrett
- Department of Medicine, Counties Manukau District Health Board, Middlemore Hospital, Auckland, New Zealand.,Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Edwin Reynolds
- Communicable Diseases and Disease Investigation, Auckland Regional Public Health Service, Auckland, New Zealand
| | - Grant Schofield
- Human Potential Centre, Millennium Institute, Auckland University of Technology, Auckland, New Zealand
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