1
|
Lin PY, Hsu LY, Ko HLA, Wang PH, Lin PY, Chi LY. Real-world effectiveness of national pit and fissure sealants program in Taiwan. J Dent 2023; 135:104587. [PMID: 37321335 DOI: 10.1016/j.jdent.2023.104587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES This study investigated the effectiveness of a national population-based pit and fissure sealants (PFS) program in Taiwan. METHODS Part 1 (effectiveness of national PFS program) involved children who had participated in the PFS program from 2015 to 2019. After propensity score matching, 670,840 children were selected for analysis until the end of 2019. During follow-up, the permanent first molars of the participants were assessed for caries-related treatments by employing multilevel Cox proportional hazards models. In Part 2 (effectiveness of retained sealants), which involved 1,561 children, sealant retention was evaluated 3 years after placement. A structured questionnaire was employed to collect information on family and individual factors. The endpoints were the same as in Part 1. RESULTS In Part 1, the adjusted hazard ratios (HRs) for caries-related treatments among participants in the PFS program were 0.90 (95% confidence interval [CI] = 0.89, 0.91) for dental restoration, 0.42 (95% CI = 0.38, 0.46) for initiation of endodontic treatment, 0.46 (95% CI = 0.41, 0.52) for completion of endodontic treatment, and 0.25 (95% CI = 0.18, 0.34, all Ps < 0.0001) for extraction. In Part 2, the adjusted HR for dental restoration of teeth with retained sealants was 0.70 (95% CI = 0.58, 0.85), significantly lower than that for teeth without retained sealants (P = 0.0002). CONCLUSIONS Participation in the national PFS program was associated with a significant reduction of at least 10% in the risk of caries-related treatments, and an additional 30% risk reduction may have been attributed to sealant retention. CLINICAL SIGNIFICANCE In a real-world setting, schoolchildren in the national PFS program were associated with a significant reduction of at least 10% in the likelihood of caries-related treatments. The program provided moderate protection against caries for the study population and could be improved by increasing the sealant retention rate.
Collapse
Affiliation(s)
- Po-Yen Lin
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Le-Yin Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Graduate Program of Data Science, National Taiwan University and Academia Sinica, Taipei, Taiwan
| | | | - Perng-Haur Wang
- Department of Oral Health, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ping-Yi Lin
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Lin-Yang Chi
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| |
Collapse
|
2
|
Li KH, Leong PY, Tseng CF, Wang YH, Wei JCC. Influenza Vaccination Is Associated With Lower Incidental Asthma Risk in Patients With Atopic Dermatitis: A Nationwide Cohort Study. Front Immunol 2021; 12:729501. [PMID: 34721391 PMCID: PMC8548273 DOI: 10.3389/fimmu.2021.729501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/24/2021] [Indexed: 12/30/2022] Open
Abstract
Background Atopic march refers to the natural history of atopic dermatitis (AD) in infancy followed by subsequent allergic rhinitis and asthma in later life. Respiratory viruses interact with allergic sensitization to promote recurrent wheezing and the development of asthma. We aimed to evaluate whether influenza vaccination reduces asthma risk in people with AD. Methods This cohort study was conducted retrospectively from 2000 to 2013 by the National Health Insurance Research Database (NHIRD). Patients with newly diagnosed AD (International Classification of Diseases, Ninth Revision, Clinical Modification code 691) were enrolled as the AD cohort. We matched each vaccinated patient with one non-vaccinated patient according to age and sex. We observed each participant until their first asthma event, or the end of the study on December 31, 2013, whichever came first. Results Our analyses included 4,414 people with a mean age of 53 years. Of these, 43.8 were male. The incidence density of asthma was 12.6 per 1,000 person-years for vaccinated patients, and 15.1 per 1000 person-years for non-vaccinated patients. The adjusted hazard ratio (aHR) of asthma in the vaccinated cohort relative to the non-vaccinated cohort was 0.69 (95% CI = 0.55–0.87). Vaccinated patients had a lower cumulative incidence of asthma than unvaccinated patients. Vaccinated participants in all age and sex groups trended toward a lower risk of asthma. People will reduce more asthma risk when taking shots every year. Conclusion Influenza vaccination was associated with lower asthma risk in patients with AD.
Collapse
Affiliation(s)
- Kun Hong Li
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Pui-Ying Leong
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Fang Tseng
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
3
|
Lin PY, Wang J, Chuang TY, Chang YM, Chang HJ, Chi LY. Association between population-based fluoride varnish application services and dental caries experience among schoolchildren in Taiwan. J Formos Med Assoc 2021; 121:986-994. [PMID: 34353718 DOI: 10.1016/j.jfma.2021.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND/PURPOSE Taiwan government has provided population-based fluoride varnish application services for all preschool children since July 2004. This study investigated the association providing such services on dental caries experiences among schoolchildren. METHODS A cross-sectional study was conducted on schoolchildren aged 8-9 years. A questionnaire collected information on sociodemographic background, parents' oral health status, children's oral health-related behavior, and dietary habits. Dental caries was recorded through standardized oral examinations. The number of services was retrieved from the Taiwan National Health Insurance Research Database. Univariate, multivariable linear, and logistic regression analyses were performed. RESULTS The study involved 1246 children. The mean dental caries indices were 3.97 for decayed, extracted, and filled teeth (deft) and 0.94 for decayed, missing and filled teeth (DMFT). After adjustments for confounding factors, it was revealed that children receiving services were not associated with significantly lower deft and DMFT indices (P > 0.05). The adjusted odds ratio (OR) for untreated primary teeth of children receiving 3 or more services was 0.64 (95% CI = 0.44-0.95) compared with those who received no services (P = 0.025). However, subgroup analyses demonstrated that children in the low-risk group were mainly affected (adjusted OR = 0.36-0.89, P = 0.013). CONCLUSION This study revealed that children receiving 3 or more services were associated with a 36% decreased risk of having untreated caries in primary dentition, but these children were mainly in the low-risk group. These results illustrate real data that provides dentists and policymakers with valuable information.
Collapse
Affiliation(s)
- Po-Yen Lin
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tsai-Yi Chuang
- Department of Dentistry, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yung-Ming Chang
- Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; Ministry of Health and Welfare, Taipei, Taiwan
| | - Hong-Ji Chang
- Department of Dentistry, Cheng Hsin General Hospital, Taipei, Taiwan.
| | - Lin-Yang Chi
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
| |
Collapse
|
4
|
Abstract
BACKGROUND Systemic sclerosis (SSc), a life-threatening autoimmune disease characterized by vasculopathy. Numerous SSc patients demonstrate gastrointestinal (GI) involvement but the delicate GI bleeding risk remains sparse. We aimed to explore the role of SSc in determining the long-term risk of GI bleeding, including bleedings of upper (peptic and non-peptic ulcers) and lower GI tracts. METHODS Patients with SSc diagnosis were identified from the Catastrophic Illness Patient Database and the National Health Insurance Research Database from 1998 to 2007. Each SSc patient was matched with five SSc-free individuals by age, sex, and index date. All individuals (case = 3665, control = 18,325) were followed until the appearance of a GI bleeding event, death, or end of 2008. A subdistribution hazards model was assessed to evaluate the GI bleeding risk with adjustments for age, sex, and time-dependent covariates, comorbidity, and medications. RESULTS The incidence rate ratios of GI bleeding were 2.38 (95% confidence interval [CI], 2.02-2.79), 2.06 (95% CI, 1.68-2.53), and 3.16 (95% CI, 2.53-3.96) for over-all, upper, and lower GI bleeding events in SSc patients. In the competing death risk in the subdistribution hazards model with time-covariate adjustment, SSc was an independent risk factor for over-all GI bleeding events (subdistribution hazard ratio [sHR] 2.98, 95% CI, 2.21-4.02), upper GI bleeding events (sHR 2.80, 95% CI, 1.92-4.08), and lower GI bleeding events (sHR 3.93, 95% CI, 2.52-6.13). CONCLUSION SSc patients exhibited a significantly higher risk of over-all and different subtype GI bleeding events compared with the SSc-free population. The prevention strategy is needed for these high GI bleeding risk groups.
Collapse
Affiliation(s)
- Yi-Ting Lin
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Shiuan Chuang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jiunn-Wei Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ping-Hsun Wu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung, 807, Taiwan.
| |
Collapse
|
5
|
Lin PY, Wang J, Chiang YC, Lai CY, Chang HJ, Chi LY. Risk of subsequent attention-deficit/hyperactivity disorder among children and adolescents with amalgam restorations: A nationwide longitudinal study. Community Dent Oral Epidemiol 2017; 46:47-53. [PMID: 28782290 DOI: 10.1111/cdoe.12327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/06/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Dental amalgam has been used as a common restorative material since the 1800s, but concerns have been raised regarding its purported neuropsychological effects due to the neurotoxicity of mercury. In this study, a nationwide population-based database was employed to investigate the association of dental amalgam restoration with the risk of attention-deficit/hyperactivity disorder (ADHD). METHODS After matching, 88 068 young people with at least one tooth restoration during 2002-2010 and no ADHD history before 2001 were selected and then collected the further information until the end of 2011. Cox proportional hazard models were employed to estimate the possible effect of amalgam restorations on the risk of ADHD during the period of 2002-2011. Subgroup analyses were performed according to age, sex and number of amalgam restorations. RESULTS In total, 2073 people (2.4%) received an ADHD diagnosis during the study period, yielding an incidence rate of 32.4 per 100 000 person-years. Those who had 6 or more amalgam restorations had a higher risk of future ADHD in the unadjusted Cox proportional hazard regression model (hazard ratio=1.20, 95% confidence interval [CI]=1.04-1.38, P=.015) than those who had received composite resin or glass ionomer restorations. However, after adjustment for potential confounding factors, the result was found to be confounded by age. CONCLUSIONS The univariate analysis results showed that those who had 6 or more amalgam restorations had a 20% higher risk of future ADHD; however, the association disappeared after the model was adjusted for age. Despite this study analysing a larger sample than those analysed in previous studies, no association was observed between young patients' having received amalgam restorations and a future ADHD diagnosis. Further research aimed at evaluating the association between dental amalgam and other subsequent neuropsychological effects is warranted, especially for people who are vulnerable to mercury exposure.
Collapse
Affiliation(s)
- Po-Yen Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Department of Dentistry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Chih Chiang
- Department of Restorative and Aesthetic Dentistry, School of Dentistry, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | | | - Hong-Ji Chang
- Department of Dentistry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Lin-Yang Chi
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| |
Collapse
|