Inequalities in dental caries among Indigenous and non-Indigenous children in Australia: A literature review

Dental caries constitutes one of the most ubiquitous diseases in Australia, with Indigenous children presenting a notably higher prevalence than their non-Indigenous peers. This literature review aims to update the knowledge base developed by Christian and Blinkhorn in 2012, with a particular focus on the contemporary disparities in dental caries between Indigenous and non-Indigenous children. Our research strategy involved a thorough exploration of the Medline, PubMed, and Scopus databases to identify pertinent studies published between 2009 and 2022. Supplementary resources included various government websites and citation searches. We prioritised studies that focused on children aged 5-6 or 12 years-reflecting the World Health Organization's index ages for oral health-and that reported dental caries prevalence and experience indicators. Our review methodology was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The updated search, spanning 2009 to 2023, retrieved studies that reported caries estimates exclusively from 2009 to 2014. Within this period, the prevalence of dental caries in Indigenous children's primary teeth ranged between 52% and 77%, while the prevalence in permanent teeth varied from 36% to 60%. This updated review indicated that Indigenous children continue to experience caries at an approximately twice higher rate than non-Indigenous children, sustaining the persisting disparity in caries estimates. The findings from this review show that no discernible improvement in dental caries rates among Australian Indigenous children has been observed in comparison to the previous review; and that Indigenous children continue to experience both higher prevalence and severity of dental caries compared to non-Indigenous children.

Measurement of synaptic density in Down syndrome using PET imaging: a pilot study

Down syndrome (DS) is the most prevalent genetic cause of intellectual disability, resulting from trisomy 21. Recently, positron emission tomography (PET) imaging has been used to image synapses in vivo. The motivation for this pilot study was to investigate whether synaptic density in low functioning adults with DS can be evaluated using the PET radiotracer [11C]UCB-J. Data were acquired from low functioning adults with DS (n = 4) and older neurotypical (NT) adults (n = 37). Motion during the scans required the use of a 10-minute acquisition window for the calculation of synaptic density using SUVR50-60,CS which was determined to be a suitable approximation for specific binding in this analysis using dynamic data from the NT group. Of the regions analyzed a large effect was observed when comparing DS and NT hippocampus and cerebral cortex synaptic density as well as hippocampus and cerebellum volumes. In this pilot study, PET imaging of [11C]UCB-J was successfully completed and synaptic density measured in low functioning DS adults. This work provides the basis for studies where synaptic density may be compared between larger groups of NT adults and adults with DS who have varying degrees of baseline cognitive status.

'DANMM that's good!': evaluating the feasibility and acceptability of the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Programme across rural, regional and metropolitan NSW-a collaborative study protocol

INTRODUCTION

This paper will describe the research protocol for the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Project, which will determine the feasibility and acceptability of a cultural mentoring programme designed for Aboriginal and Torres Strait Islander nurses and midwives across five diverse local health districts in New South Wales, Australia. Government and health agencies highlight the importance of culturally appropriate and safe environments for Aboriginal people. Specifically, New South Wales Health prioritises workforce strategies that support Aboriginal people to enter and stay in the health workforce. However, retaining Aboriginal nurses and midwives remains challenging. The DANMM Project aligns with these local and state-wide health plans and strategies, addressing critical issues of workforce cultural safety and retention.

METHODS AND ANALYSIS

A mixed-methods study design will be employed to assess feasibility, acceptability and preliminary efficacy of the DANMM Programme across five publicly funded local health districts in New South Wales, Australia. Adhering to cultural safety, a project cultural governance group will be formed. Quantitative outcome measures include the use of questionnaires (Nursing Workplace Satisfaction Questionnaire, Ganngaleh nga Yagaleh Cultural Safety assessment tool). Resource implications will be measured using the Organisational Commitment and Health Professional Program Readiness Assessment Compass. These will be triangulated with individual and group yarning circles to provide a holistic evaluation of the programme.

ETHICS AND DISSEMINATION

The study has ethics approval: Aboriginal Health and Medical Research Council (#2054/23); New South Wales Health Human Research Committees (Greater Western Human Research Committee #2022/ETH01971, Murrumbidgee-site-specific approval, Sydney Local Health District-site-specific approval, Western Sydney Local Health District-site-specific approval and Mid North Coast-site-specific approval); and Charles Sturt University Human Research Committee (#2054/23). Findings will be disseminated through peer-reviewed articles, conferences and through roundtable discussions with key stakeholders.

Strategies to integrate oral health into primary care: a systematic review

OBJECTIVES

Integration of oral health into primary care has been proposed as a primary healthcare approach for efficient and sustainable delivery of oral health services, and the effective management of oral diseases. This paper aimed to synthesise evidence on the effectiveness of strategies to integrate oral health into primary care.

DESIGN

Systematic review.

DATA SOURCES

MEDLINE, CINAHL, Embase, Scopus, ProQuest, Cochrane and Google Scholar were searched without date limits until the third week of June 2022. Reference lists of eligible studies were also searched. Experts in the field and existing professional networks were consulted.

ELIGIBILITY CRITERIA

Only studies that evaluated integration strategies were included in the review. Eligibility was restricted to English language studies published in academic peer-reviewed journals.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data and performed the risk of bias assessments. A narrative synthesis approach was used to report review findings. Heterogeneity among included studies precluded a meta-analysis.

RESULTS

The search identified 8731 unique articles, of which 49 were included in the review. Majority of the studies explored provision of oral healthcare by primary care professionals in primary care settings, where integration was primarily via training/education and/or policy changes. Most studies reported results favouring the integration strategy, such as improvements in referral pathways, documentation processes, operating efficiencies, number of available health staff, number of visits to non-dental primary care professionals for oral health issues, proportion of children receiving fluoride varnish applications/other preventive treatment, proportion of visits to an oral health professional and dental caries estimates.

CONCLUSION

The findings from this review demonstrate that the majority of identified strategies were associated with improved outcomes and can be used to inform decision-making on strategy selection. However, more research and evaluation are required to identify best practice models of service integration.

PROSPERO REGISTRATION NUMBER

CRD42020203111.

Timing of Alzheimer's Disease by Intellectual Disability Level in Down Syndrome

BACKGROUND

Trisomy 21 causes Down syndrome (DS) and is a recognized cause of early-onset Alzheimer's disease (AD).

OBJECTIVE

The current study sought to determine if premorbid intellectual disability level (ID) was associated with variability in age-trajectories of AD biomarkers and cognitive impairments. General linear mixed models compared the age-trajectory of the AD biomarkers PET Aβ and tau and cognitive decline across premorbid ID levels (mild, moderate, and severe/profound), in models controlling trisomy type, APOE status, biological sex, and site.

METHODS

Analyses involved adults with DS from the Alzheimer's Biomarkers Consortium-Down Syndrome. Participants completed measures of memory, mental status, and visuospatial ability. Premorbid ID level was based on IQ or mental age scores prior to dementia concerns. PET was acquired using [11C] PiB for Aβ, and [18F] AV-1451 for tau.

RESULTS

Cognitive data was available for 361 participants with a mean age of 45.22 (SD = 9.92) and PET biomarker data was available for 154 participants. There was not a significant effect of premorbid ID level by age on cognitive outcomes. There was not a significant effect of premorbid ID by age on PET Aβ or on tau PET. There was not a significant difference in age at time of study visit of those with mild cognitive impairment-DS or dementia by premorbid ID level.

CONCLUSION

Findings provide robust evidence of a similar time course in AD trajectory across premorbid ID levels, laying the groundwork for the inclusion of individuals with DS with a variety of IQ levels in clinical AD trials.

The Indigenous Adolescent Oral Health Partnership Study: A Co-Design Study Protocol

Background: in this protocol we outline a method of working alongside Aboriginal communities to learn about and facilitate improvement in the oral health habits in Aboriginal adolescents. By facilitating positive oral health in Aboriginal adolescents, we hope to achieve lifelong improvement in oral health and general wellbeing. Methods: this paper outlines a co-design methodology through which researchers and Aboriginal communities will work together to create a custom oral healthcare program aimed at Aboriginal adolescents. Researchers, a youth advisory group, Aboriginal community-controlled health services and three regional NSW communities will together devise an oral health strategy focused on five components: application of topical fluoride, increasing water consumption, improving nutrition, daily toothbrushing, and enhancing social and emotional wellbeing. Capacity building is a key outcome of this program. Discussion: as the gap in health status between Aboriginal and non-Aboriginal people remains wide, it is clear that new approaches and attitudes are needed in Aboriginal public health research. This protocol is representative of this shifting approach; giving power to Aboriginal communities who seek to have sovereignty and self-determination over their healthcare. Trial registration: TRN: ISRCTN15496753 Date of registration: 20 October 2021.

Item-Level Story Recall Predictors of Amyloid-Beta in Late Middle-Aged Adults at Increased Risk for Alzheimer's Disease

Background

Story recall (SR) tests have shown variable sensitivity to rate of cognitive decline in individuals with Alzheimer's disease (AD) biomarkers. Although SR tasks are typically scored by obtaining a sum of items recalled, item-level analyses may provide additional sensitivity to change and AD processes. Here, we examined the difficulty and discrimination indices of each item from the Logical Memory (LM) SR task, and determined if these metrics differed by recall conditions, story version (A vs. B), lexical categories, serial position, and amyloid status.

Methods

n = 1,141 participants from the Wisconsin Registry for Alzheimer's Prevention longitudinal study who had item-level data were included in these analyses, as well as a subset of n = 338 who also had amyloid positron emission tomography (PET) imaging. LM data were categorized into four lexical categories (proper names, verbs, numbers, and "other"), and by serial position (primacy, middle, and recency). We calculated difficulty and discriminability/memorability by item, category, and serial position and ran separate repeated measures ANOVAs for each recall condition, lexical category, and serial position. For the subset with amyloid imaging, we used a two-sample t-test to examine whether amyloid positive (Aβ+) and amyloid negative (Aβ-) groups differed in difficulty or discrimination for the same summary metrics.

Results

In the larger sample, items were more difficult (less memorable) in the delayed recall condition across both story A and story B. Item discrimination was higher at delayed than immediate recall, and proper names had better discrimination than any of the other lexical categories or serial position groups. In the subsample with amyloid PET imaging, proper names were more difficult for Aβ+ than Aβ-; items in the verb and "other" lexical categories and all serial positions from delayed recall were more discriminate for the Aβ+ group compared to the Aβ- group.

Conclusion

This study provides empirical evidence that both LM stories are effective at discriminating ability levels and amyloid status, and that individual items vary in difficulty and discrimination by amyloid status, while total scores do not. These results can be informative for the future development of sensitive tasks or composite scores for early detection of cognitive decline.

Oral health surveillance in Australia: the need for ongoing data to inform public health decision-making

Surveillance of people's health takes on an important meaning in the practice of public health because it allows monitoring of diseases and prompt response to change in proportions and rates at which diseases occur in populations. Improving health of populations requires establishment of an effective public health system. Population level data and analysis is critically important in government policy and program development and monitoring. Lack of or inadequate information about the health of populations leads to ineffective policies that may often attenuate health problems instead of solving them. Australia's current oral health surveillance is mostly through ad hoc sentinel surveys, which lack recency in time. This position paper is to present the need for real-time oral health surveillance in Australia, which can be used to inform health decision-making in a timely manner.

Serial position effects in the Logical Memory Test: Loss of primacy predicts amyloid positivity

BACKGROUND

Story recall is a frequently used neuropsychological test of episodic memory with clinical populations and for screening participants in drug trials for Alzheimer's disease. However, it is unclear at this stage which underlying mechanisms confer the test its sensitivity. In this paper, we examined serial position effects, that is, better recall for items learned early and late on a list, in story recall, and their usefulness to predict early changes associated with neurodegenerative markers.

METHODS

We analysed data from the Wisconsin Registry for Alzheimer's Prevention. First, we tested whether serial position effects were present in story recall (measured with the Wechsler Memory Scale Logical Memory Task; LMT) across individuals who were classified as cognitively unimpaired - stable, cognitively unimpaired - declining, or as having mild cognitive impairment (MCI).

RESULTS

Our results showed clear serial position effects for all groups, except for delayed recall among individuals with MCI, where no primacy effect was observed. Second, we tested whether loss of primacy from immediate to delayed recall was associated with amyloid burden (as measured with PiB PET) in individuals who were cognitively unimpaired at baseline. We found that more primacy loss predicted amyloid positivity, above and beyond the LMT total score.

CONCLUSIONS

This report is the first to show that loss of primacy between immediate and delayed story recall is associated with amyloid burden.

Building the Future Therapies for Down Syndrome: The Third International Conference of the T21 Research Society

Research focused on Down syndrome has increased in the last several years to advance understanding of the consequences of trisomy 21 (T21) on molecular and cellular processes and, ultimately, on individuals with Down syndrome. The Trisomy 21 Research Society (T21RS) is the premier scientific organization for researchers and clinicians studying Down syndrome. The Third International Conference of T21RS, held June 6-9, 2019, in Barcelona, Spain, brought together 429 scientists, families, and industry representatives to share the latest discoveries on underlying cellular and molecular mechanisms of T21, define cognitive and behavioral challenges and better understand comorbidities associated with Down syndrome, including Alzheimer's disease and leukemia. Presentation of cutting-edge results in neuroscience, neurology, model systems, psychology, cancer, biomarkers and molecular and phar-ma-cological therapeutic approaches demonstrate the compelling interest and continuing advancement in all aspects of understanding and ameliorating conditions associated with T21.

Acute Regression in Down Syndrome

BACKGROUND

Acute regression has been reported in some individuals with Down syndrome (DS), typically occurring between the teenage years and mid to late 20s. Characterized by sudden, and often unexplained, reductions in language skills, functional living skills and reduced psychomotor activity, some individuals have been incorrectly diagnosed with Alzheimer's disease (AD).

METHODS

This paper compares five individuals with DS who previously experienced acute regression with a matched group of 15 unaffected individuals with DS using a set of AD biomarkers.

RESULTS

While the sample was too small to conduct statistical analyses, findings suggest there are possible meaningful differences between the groups on proteomics biomarkers (e.g., NfL, total tau). Hippocampal, caudate and putamen volumes were slightly larger in the regression group, the opposite of what was hypothesized. A slightly lower amyloid load was found on the PET scans for the regression group, but no differences were noted on tau PET.

CONCLUSIONS

Some proteomics biomarker findings suggest that individuals with DS who experience acute regression may be at increased risk for AD at an earlier age in comparison to unaffected adults with DS. However, due to the age of the group (mean 38 years), it may be too early to observe meaningful group differences on image-based biomarkers.

The Health & Aging Brain among Latino Elders (HABLE) study methods and participant characteristics

INTRODUCTION

Mexican Americans remain severely underrepresented in Alzheimer's disease (AD) research. The Health & Aging Brain among Latino Elders (HABLE) study was created to fill important gaps in the existing literature.

METHODS

Community-dwelling Mexican Americans and non-Hispanic White adults and elders (age 50 and above) were recruited. All participants underwent comprehensive assessments including an interview, functional exam, clinical labs, informant interview, neuropsychological testing, and 3T magnetic resonance imaging (MRI) of the brain. Amyloid and tau positron emission tomography (PET) scans were added at visit 2. Blood samples were stored in the Biorepository.

RESULTS

Data was examined from n = 1705 participants. Significant group differences were found in medical, demographic, and sociocultural factors. Cerebral amyloid and neurodegeneration imaging markers were significantly different between Mexican Americans and non-Hispanic Whites.

DISCUSSION

The current data provide strong support for continued investigations that examine the risk factors for and biomarkers of AD among diverse populations.

Amyloid beta associations with connected speech in cognitively unimpaired adults

INTRODUCTION

Connected speech and language (CSL) decline has been associated with early cognitive decline, but associations between CSL and Alzheimer's disease (AD) biomarkers remain a gap in the literature. Our goal was to examine associations with amyloid beta (Aβ) and longitudinal CSL trajectories in cognitively unimpaired adults at increased AD risk.

METHODS

Using data from the Wisconsin Registry for Alzheimer's Prevention, CSL measures were automatically extracted from digitally recorded picture descriptions. Positron emission tomography determined Aβ status. Linear mixed effects models assessed the interaction between age and Aβ on CSL trajectories.

RESULTS

Participants who were Aβ positive experienced more rapid decline on specific word content, when controlling for age, sex, and literacy. There were no differences between groups in lexical diversity measures over time.

DISCUSSION

These results indicate that declines in connected speech may be related to preclinical AD. CSL may be a promising, inexpensive, and easy-to-collect digital cognitive marker for AD studies.

Oral health interventions for older people in residential aged care facilities: a protocol for a realist systematic review

INTRODUCTION

Poor oral health among older people is a global problem impacting on health and well-being. The economic cost to the health system is significant. An ageing population is intensifying the urgency for action. However, poor oral health, particularly for those in residential aged care facilities, continues to be highly resistant to resolution. The overall aims of this realist review are to: (A) explore and synthesise evidence on oral health interventions for older people in residential aged care facilities, (B) produce a causal theory on how contextual factors and mechanisms interact to produce outcomes, and (C) produce guidelines/policies to inform high-quality oral health interventions to improve older people's oral health in residential aged care facilities.

METHODS AND ANALYSIS

The review is guided by the RAMESES publication standards for realist synthesis. Participants include older people in residential aged care facilities, the aged care workforce, carers and families. Interventions include oral healthcare, oral health education, policy interventions and oral health promotion. The five-step realist review process of Pawson et al will guide the review: clarification of scope and development of initial framework, systematic searches, study appraisal and data extraction, synthesising evidence, drawing conclusions, and dissemination, implementation and evaluation. Expert input with key stakeholders will occur through a blog. Stakeholders will examine consistencies across studies and an explanatory causal theory will be developed to guide policy and practice.

ETHICS AND DISSEMINATION

Formal ethical approval was granted by the La Trobe University Ethics Committee HREC 20144. The developed theory will guide education, practice and policy decisions about interventions and the factors that impact on implementation. Using an integrated knowledge translation approach, traditional research outputs such as international conference presentations and publications will be supplemented with stakeholder forums, infographics, blogs, social media postings, webinars, podcasts and writing for web-based independent outlets.

PROSPERO REGISTRATION NUMBER

CRD42021155658.

White matter microstructure associations with episodic memory in adults with Down syndrome: a tract-based spatial statistics study

BACKGROUND

Nearly all persons with Down syndrome will show pathology of Alzheimer's disease in their 40s. There is a critical need for studies to identify early biomarkers of these various pathological changes of Alzheimer's disease in the Down syndrome population and understand the relationship of these biomarkers to cognitive symptoms in order to inform clinical trials. Although Alzheimer's disease is often considered a disease of gray matter, white matter degeneration has been documented during the preclinical stage of Alzheimer's disease. The current study examined the association between diffusion tensor imaging (DTI) measures of white matter microstructure and episodic memory performance in 52 adults with Down syndrome.

METHODS

Seventy (N = 70) participants (M = 40.13, SD = 7.77 years) received baseline scans as part of the Neurodegeneration in Aging Down Syndrome (NiAD) study at two imaging facilities (36 at the University of Wisconsin-Madison [UW-Madison] and 34 at the University of Pittsburgh Medical Center [UPMC]). All participants had genetically confirmed trisomy 21. Fifty-two (N = 52) participants remained after QC. The DTI measures, fractional anisotropy (FA) and mean diffusivity (MD), were calculated for each participant. A combined measure of episodic memory was generated by summing the z-scores of (1) Free and Cued Recall test and (2) Rivermead Behavioural Memory Test for Children Picture Recognition. The DTI data were projected onto a population-derived FA skeleton and tract-based spatial statistics analysis was conducted using the FSL tool PALM to calculate Pearson's r values between FA and MD with episodic memory.

RESULTS

A positive correlation of episodic memory with FA and a negative correlation of episodic memory and MD in the major association white matter tracts were observed. Results were significant (p < 0.05) after correction for chronological age, imaging site, and premorbid cognitive ability.

CONCLUSION

These findings suggest that white matter degeneration may be implicated in early episodic memory declines prior to the onset of dementia in adults with Down syndrome. Further, our findings suggest a coupling of episodic memory and white matter microstructure independent of chronological age.

A Validation and Cost-Analysis Study of a Targeted School-Based Dental Check-Up Intervention: Children's Dental Program

Background: Limited evidence exists to inform best practice approaches to implement school-based dental screening to address child retention via referral for dental services. This research tested the null hypothesis that a targeted school-based dental check-up program (intervention) has a 75% child retention rate for public dental care (H₀ = 0.75). Methods: A prospective non-randomised controlled trial was conducted with a convenience sampling approach in metropolitan Melbourne, Australia. Children in the intervention group were recruited from two preschools and two primary schools from a low socioeconomic area. Children in the standard care group were recruited from the local public dental service. Statistical analysis was performed using Stata IC Version 12. Results: Children in the intervention (45%) were significantly less likely to have never had a dental check-up compared to standard care (20%) (p < 0.001). There was no significant difference for the child retention rate for the intervention group when compared against the null hypothesis (p = 0.954). The total society costs were AU$754.7 and AU$612.2 for the intervention and standard care groups, respectively (p = 0.049). Conclusions: This validation study provides evidence that a targeted school-based dental check-up program can achieve a 75% child retention rate and should be considered for program expansion.

Natural history of dental caries: Baseline characteristics of the VicGen birth cohort study

BACKGROUND

Early-life dental caries is a major global health problem. Children's first dental visit is recommended at 2 years age. The VicGeneration (VicGen) oral health birth cohort study aims to understand the multifactorial nature of early childhood caries. This report describes the baseline characteristics of children in the VicGen study.

METHODS

We merged data between the first (at birth) and fourth waves (18 month age) to assess dental caries among children (primary outcome) and other oral diseases (secondary outcomes) employing t tests, chi-square tests, Fisher's exact tests, and Cochran-Mantel-Haenszel tests using IBM-SPSS(v25).

RESULTS

Most children lived in metros with two-parent families. Most guardians were women graduated from high school. Twenty-seven of 389 (6.94%) 18-month-old children experienced dental caries. More children living in rural areas (vs. urban) experienced caries. Females were more likely to experience caries (OR: 2.16). Several children had other oral health problems. In early life, children's oral examination was conducted by midwives, breastfeeding/lactation consultants, hospital nurses, speech pathologists, and breastfeeding clinic staff.

CONCLUSION

VicGen baseline characteristics show that almost 7% of the 18-month-old children experienced caries. There is a need to advance children's recommended first dental visit date and to train early-life healthcare professionals about oral diseases.

Oral health interventions for people living with mental disorders: protocol for a realist systematic review

BACKGROUND

The increasing number of people who experience mental disorders is a global problem. People with mental disorders have high rates of co-morbidity and significantly poorer oral health outcomes than the general public. However, their oral health remains largely a hidden and neglected issue. A complex range of factors impact the oral health of this group. These include anxiety and dental phobia, dietary habits, including the heavy consumption of sugary drinks, substance misuse of tobacco, alcohol, and/or psychostimulants, the adverse orofacial side effects of anti-psychotic and anti-depression medications, and financial, geographic, and social barriers to accessing oral health care.

METHODS

The aim of this realist systematic review is to (a) identify and synthesise evidence that explores oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal, contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level. Using a five-step process, that incorporates primary data collection from key stakeholders, a beginning theoretical framework will be developed to describe contextual and mechanistic factors and how they might impact on the success or failure of oral health interventions for people with mental disorders. Key database searches will be conducted, with data extraction focused on the factors that might have impacted on intervention implementation and outcomes. Quality appraisal of studies will occur, and the theoretical framework will be populated with extracted data. Stakeholder input will support the development and refinement of a theory on oral health interventions for people with mental disorders.

DISCUSSION

This will be the first review to take a realist approach to explore the broad scope of causal factors that impact on the success or failure of oral health interventions for people with mental disorders. The approach includes extensive stakeholder engagement and will advance realist systematic review methodology. Review outcomes will be important in guiding policy and practice to ensure oral health interventions better meet the needs of people with mental disorders.Systematic review registration This review protocol is registered with PROSPERO (Number) 155969.

An epidemiological study of dental caries and associated risk factors among primary school children in the Aileu Municipality, Timor-Leste

INTRODUCTION

Recent evidence indicates that the oral health for children in Timor-Leste is deteriorating, with 40% of school children experiencing toothache during 2014. Timorese have easy access to sugar, poor food security and lack of water fluoridation, all of which exacerbate the risk of dental caries. A lack of quality epidemiological data is available to confirm anecdotal information of high caries rates in rural and remote Timor-Leste. Such data are required to inform oral health issues and health policy at both the local and national levels. This study investigated the caries status and potential risk factors among primary school children in the rural Aileu municipality of Timor-Leste. The objectives of this study were to determine caries prevalence and experience, the status (active/arrested) of existing caries lesions and associations between dental caries and potential risk factors, among primary school children in the Aileu municipality, Timor-Leste.

METHODS

This study analysed secondary data. De-identified data for this analysis were obtained from North Richmond Community Health (NRCH), Melbourne, Australia. North Richmond Community Health (NRCH) has been working with the Friends of Aileu (a government-to-government partnership between an Australian local government area and the municipality of Aileu) to improve the oral health of school children in the municipality of Aileu. NRCH conducts an outreach school-based oral health promotion program, called Kose Nehan, at six primary schools in the Aileu municipality. Caries was diagnosed using the International Caries Detection and Assessment System &#40;ICDAS&#41; and reported using the decayed, missing and filled teeth (DMFT/dmft) index. Examiners were trained and calibrated. A brief interviewer-administered questionnaire was used to capture information on child oral hygiene and diet behaviours. For the analysis, dental caries was defined as 'any caries lesions' (ICDAS caries codes 1-6). Descriptive and inferential analyses were conducted using STATA 14. Multivariable logistic regression analysis predicting the odds of dental caries (yes/no) was used to determine independent associations between the exposures and the outcome.

RESULTS

Data were analysed for 685 children. In the primary dentition, the overall prevalence of caries was 64% and the mean dmft score was 2.74 (standard deviation (SD) 3.08). In the permanent dentition, the overall prevalence was 53% and the mean DMFT score was 1.74 (SD 2.46). Overall, approximately 84% of caries lesions were identified as being active. The multivariable regression analysis did not identify independent predictors of caries.

CONCLUSION

Dental caries was highly prevalent among this population and urgent action is required to reduce the population burden of this disease. Malnutrition, which was not measured for this study, is highly prevalent among children in Timor-Leste and could explain the high caries rates in this population. The effect of malnutrition on dental caries and vice-versa needs further investigation. Programs and policies are urgently needed for oral health promotion and also the prevention and management of dental caries in Timorese children. These strategies should also address the urgent need for emergency dental services aimed at pain relief, first aid for oral infections and restorations, given the high prevalence of advanced disease in this child population.

A systematic review to assess the methodological quality of studies on measurement properties for caries risk assessment tools for young children

BACKGROUND

At present, there are numerous caries risk assessment tools (CRATs) being promoted for disease management. However, the evidence to inform CRAT selection is unclear.

AIM

This review aimed to assess the strength of evidence to inform the selection of CRATs for children ages 6 years and less.

DESIGN

MEDLINE was the principal search database for this review. Other key databases, the reference lists of included articles, known cariology literature and experts were also consulted. Peer-reviewed papers describing CRATs and their development methodology were included. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist guided the quality assessment. The reporting of the key measurement properties (reliability, validity and responsiveness) informed the quality assessment.

RESULTS

The search resulted in ten papers, reporting on eight different CRATs. The identified CRATs were: Caries Management By Risk Assessment (CAMBRA), Cariogram, National University of Singapore CRAT (NUS-CRAT), MySmileBuddy, Dundee Caries Risk Assessment Model, University of North Carolina Risk Assessment Models, University of Michigan pediatric dental clinic caries risk assessment sheet and American Academy of Pediatric Dentistry (AAPD) CRAT. Common across all CRATs was the lack of information to determine the levels of evidence for the measurement properties of reliability and construct validity. Studies on tools that were assessed as having strong evidence for content validity, identified the relevant risk factors for caries in the population being studied, before developing and testing their respective CRATs.

CONCLUSIONS

The evidence to inform the selection of current CRATs for children is mostly yet to be established. Overall, the NUS-CRAT studies reported the most information to inform the assessment of its measurement properties and as a result this tool attained a higher quality rating than other CRATs studied. This article is protected by copyright. All rights reserved.

An epidemiological study of dental caries and associated factors among children residing in orphanages in Kerala, India: Health in Orphanages Project (HOPe)

BACKGROUND

It is estimated that, as of 2010, there were 32 million orphaned children in India. There is little published information on the oral health of children in orphanages in India.

AIM

To determine caries status and associated risk factors among children in orphanages in Kerala, India.

METHODS

This cross-sectional study assessed caries using World Health Organization (WHO) criteria, and caries experience was reported as decayed, missing and filled primary or secondary teeth (dmft or DMFT, respectively). A brief questionnaire captured information on child oral health behaviours. Mean [standard deviation (SD)] and median [interquartile range (IQR)] scores were used to describe caries rates. Multivariable logistic regression analysis was conducted to identify independent disease predictors. Study design complexities, such as clustering by orphanage and stratification by district, were accounted for in the multivariable regression analysis. This was carried out using the survey commands in STATA 13. A value of P<0.05 was considered as statistically significant.

RESULTS

Overall, 1,137 children residing in 31 orphanages across the State of Kerala were recruited to the study. Female children made up 82% of the sample. In 6-year-old children the prevalence of caries was 77% and the mean dmft score was 3.60 (SD= 3.50); in 12-year-old children the prevalence of caries was 44% and the mean DMFT score was 1.35 (SD = 1.96). Among 12-year-old children, those who reported being shown how to clean their teeth were less likely to have caries (odds ratio = 0.62; 95% confidence interval: 0.38-0.95).

CONCLUSION

Caries rates among children in orphanages were much higher than among children in the general population in Kerala. There is an urgent need for evidence-based and sustainable primary prevention strategies to reduce the burden of caries in this highly vulnerable population.

Examiner calibration in caries detection for populations and settings where in vivo calibration is not practical

AIM

to compare two methods of in vitro examiner calibration in populations and settings where clinical (in vivo) calibration is not practical.

METHODS

Study design was cross-sectional and fully-crossed. The units of analysis were 880 tooth surfaces, from ten children ages 3 to 4 years. The study had three data components: (1) Examiner training and calibration using the International Caries Detection and Assessment System (ICDAS) e-Learning programme (2) In vivo community-based visual examination and (3) Intra-oral digital photographs of the same tooth surfaces from the in vivo visual examination. Kappa and weighted kappa scores were used to study reliability estimates. Systematic differences in caries assessments were determined using the Stuart Maxwell test. Data were analysed using STATA 13.1 and SAS 9.2.

RESULTS

Weighted kappa scores for the in vivo component ranged from 0.50 to 0.66 and from 0.64-0.74, for inter- and intraexaminer reliability, respectively. Caries lesions detected in vivo were also detected on photographs, albeit with more false positives when using photographs. For example, of 46 tooth surfaces assessed as being sound in the in vivo examination, 22 (48%) of these were assessed as having caries when photographs were used as the diagnostic method.

CONCLUSIONS

From this research it appears that good quality photographs alone may be used for training and calibration among challenging populations or settings without adversely affecting data quality.

A health-promoting community dental service in Melbourne, Victoria, Australia: protocol for the North Richmond model of oral health care

Despite the best efforts and commitment of oral health programs, there is no evidence that the current surgical output-based model of oral health care is delivering better oral health outcomes to the community. In fact, Australian evidence indicates the oral health of the community could be getting worse. It is now well-understood that this traditional surgical model of oral health care will never successfully manage the disease itself. It is proposed that a health-promoting, minimally invasive oral disease management model of care may lead to a sustainable benefit to the oral health status of the individual and community groups. The aim of this paper is to describe such a model of oral health care (MoC) currently being implemented by the North Richmond Community Health Oral Health (NRCH-OH) program in Melbourne, Victoria, Australia; this model may serve as a template for other services to re-orient their healthcare delivery towards health promotion and prevention. The paper describes the guiding principles and theories for the model and also its operational components, which are: pre-engagement while on the waitlist; client engagement at the reception area; the assessment phase; oral health education (high-risk clients only); disease management; and reviews and recall.

Child oral health in migrant families: A cross-sectional study of caries in 1-4 year old children from migrant backgrounds residing in Melbourne, Australia

Early Childhood Caries (ECC) is the most common, preventable disease of childhood. It can affect children's health and wellbeing and children from migrant families may be at greater risk of developing ECC.

OBJECTIVE

To describe ECC in children from migrant families, and explore possible influences.

BASIC RESEARCH DESIGN

Cross-sectional analysis of caries data collected as baseline data for an oral health promotion study.

PARTICIPANTS

The analysis sample included 630 1-4 year-old children clustered within 481 Iraqi, Lebanese and Pakistani families in Melbourne, Australia.

METHOD

Child participants received a community-based visual dental examination. Parents completed a self-administered questionnaire on demographics, ethnicity, and oral health knowledge, behaviour and attitudes.

MAIN OUTCOME MEASURE

Child caries experience. Bivariate associations between oral health behaviours and ethnicity were tested for significance using chi-square. Multivariate logistic regression analyses were performed to identify associations with ECC, adjusting for demographic variables and accounting for clustering by family.

RESULTS

Overall, 34% of children in the sample experienced caries (both non-cavitated and cavitated). For all caries lesions, parent' length of residence in Australia, consumption of sweet drinks and parental education remained as independent predictors of child caries experience. Adding sugar to drinks was an additional risk factor for cavitation. Ethnicity was associated with some individual oral health behaviours suggesting cultural influences on health, however the relationship was not independent of other predictors.

CONCLUSION

Culturally competent oral health promotion interventions should aim to support migrant families with young children, and focus on reducing sweet drink consumption.

Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia

OBJECTIVES

The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally diverse communities in Australia.

DESIGN

An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from migrant backgrounds. Mixed method, longitudinal evaluation.

SETTING

The intervention was based in Moreland, a culturally diverse locality in Melbourne, Australia.

PARTICIPANTS

Families with 1-4-year-old children, self-identified as being from Iraqi, Lebanese or Pakistani backgrounds residing in Melbourne. Participants residing close to the intervention site were allocated to intervention.

INTERVENTION

The intervention was conducted over 5 months and comprised community oral health education sessions led by peer educators and follow-up health messages.

OUTCOME MEASURES

This paper reports on the intervention impacts, process evaluation and descriptive analysis of health, knowledge and behavioural changes 18 months after baseline data collection.

RESULTS

Significant differences in the Debris Index (OR=0.44 (0.22 to 0.88)) and the Modified Gingival Index (OR=0.34 (0.19 to 0.61)) indicated increased tooth brushing and/or improved toothbrushing technique in the intervention group. An increased proportion of intervention parents, compared to those in the comparison group reported that they had been shown how to brush their child's teeth (OR=2.65 (1.49 to 4.69)). Process evaluation results highlighted the problems with recruitment and retention of the study sample (275 complete case families). The child dental screening encouraged involvement in the study, as did linking attendance with other community/cultural activities.

CONCLUSIONS

The Teeth Tales intervention was promising in terms of improving oral hygiene and parent knowledge of tooth brushing technique. Adaptations to delivery of the intervention are required to increase uptake and likely impact. A future cluster randomised controlled trial would provide strongest evidence of effectiveness if appropriate to the community, cultural and economic context.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

Exploring child dental service use among migrant families in metropolitan Melbourne, Australia

BACKGROUND

This study describes and explores factors related to dental service use among migrant children.

METHODS

A cross-sectional analysis of baseline data from Teeth Tales, an exploratory trial implementing a community based child oral health promotion intervention. The sample size and target population was 600 families with 1-4 year old children from Iraqi, Lebanese and Pakistani backgrounds residing in metropolitan Melbourne. Participants were recruited into the study using purposive and snowball sampling techniques.

RESULTS

Most (88%; 550/625) children had never visited the dentist (mean (SD) age 3.06 years (1.11)). In the fully adjusted model the variable most significantly associated with child dental visiting was parent reported 'no reason for child to visit the dentist' (OR = 0.07, p < 0.001). Of those children whose parents reported their child had no reason to visit the dentist, 22% (37/165) experienced dental caries with 8% (13/165) at the level of cavitation.

CONCLUSIONS

Dental service use by migrant preschool children was very low. The relationship between perceived dental need and dental service use is currently not aligned. One in 10 children of select migrant background had visited a dentist, which is in the context of 1 in 3 with dental caries. To improve utilization, health services should consider organizational cultural competence, outreach and increased engagement with the migrant community.

Insulin resistance predicts brain amyloid deposition in late middle-aged adults

BACKGROUND

Insulin resistance (IR) increases Alzheimer's disease (AD) risk. IR is related to greater amyloid burden post-mortem and increased deposition within areas affected by early AD. No studies have examined if IR is associated with an in vivo index of amyloid in the human brain in late middle-aged participants at risk for AD.

METHODS

Asymptomatic, late middle-aged adults (N = 186) from the Wisconsin Registry for Alzheimer's Prevention underwent [C-11]Pittsburgh compound B (PiB) positron emission tomography. The cross-sectional design tested the interaction between insulin resistance and glycemic status on PiB distribution volume ratio in three regions of interest (frontal, parietal, and temporal).

RESULTS

In participants with normoglycemia but not hyperglycemia, higher insulin resistance corresponded to higher PiB uptake in frontal and temporal areas, reflecting increased amyloid deposition.

CONCLUSIONS

This is the first human study to demonstrate that insulin resistance may contribute to amyloid deposition in brain regions affected by AD.

Determinants and trends in dental expenditures in the adult US population: Medical Expenditure Panel Survey 1996-2006

OBJECTIVES

To estimate dental expenditures in 2006, to analyse dental expenditures by potential explanatory factors for 2006 and to explore trends in dental expenditures from 1996-2006.

METHODS

Medical Expenditure Panel Survey (MEPS) data were used. T-tests and analysis of variance were used to test for significance. Multivariable linear regression analysis was conducted to identify independent predictors of dental expenditures. The trend analysis was conducted for the 11-year period, 1996-2006, on adults aged 25 years and older. Expenditures were inflation adjusted to 2006 dollars using the annual average Consumer Price Index. Data were analysed using the MEPS query tool and SASv9.2.

RESULTS

In the 2006 MEPS sample, 8,001 adults had dental expenditures and when weighted represented about 93 million non-institutionalised adult US civilians. The mean dental expenditures for this weighted sample were $611 (sd 1,309), median $233 (inter-quartile range 466). As expected, in 2006, dental expenditures increased with age. Those adults who reported their self-perceived health status as 'excellent' were observed to have lowest dental expenditures in this category. After adjusting for other variables in the multivariable linear regression analysis of dental expenditures, age, race/ethnicity, income, geographic location, perceived health status and dental insurance coverage remained significant.

CONCLUSION

Dental expenditures for 2006 were $611 (mean) and $233 (median). The time-trend showed substantial but non-uniform annual changes in real dental expenditures between 1996 and 2006.

An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds: a protocol paper for Teeth Tales

INTRODUCTION

Inequalities are evident in early childhood caries rates with the socially disadvantaged experiencing greater burden of disease. This study builds on formative qualitative research, conducted in the Moreland/Hume local government areas of Melbourne, Victoria 2006-2009, in response to community concerns for oral health of children from refugee and migrant backgrounds. Development of the community-based intervention described here extends the partnership approach to cogeneration of contemporary evidence with continued and meaningful involvement of investigators, community, cultural and government partners. This trial aims to establish a model for child oral health promotion for culturally diverse communities in Australia.

METHODS AND ANALYSIS

This is an exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds. Families from an Iraqi, Lebanese or Pakistani background with children aged 1-4 years, residing in metropolitan Melbourne, were invited to participate in the trial by peer educators from their respective communities using snowball and purposive sampling techniques. Target sample size was 600. Moreland, a culturally diverse, inner-urban metropolitan area of Melbourne, was chosen as the intervention site. The intervention comprised peer educator led community oral health education sessions and reorienting of dental health and family services through cultural Competency Organisational Review (CORe).

ETHICS AND DISSEMINATION

Ethics approval for this trial was granted by the University of Melbourne Human Research Ethics Committee and the Department of Education and Early Childhood Development Research Committee. Study progress and output will be disseminated via periodic newsletters, peer-reviewed research papers, reports, community seminars and at National and International conferences.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

Oral health care services utilisation in the adult US population: Medical Expenditure Panel Survey 2006

OBJECTIVES

To estimate the proportion of dental visits and to explore determinants of oral health care service (OHCS) utilisation among US civilian non-institutionalised adults.

METHODS

Cross-sectional data from the 2006 Medical Expenditure Panel Survey (MEPS) were used to analyse adults' self-reported dental visits across potential risk factors (n = 22,721). MEPS uses a complex sample design including stratification, clustering, multiple stages of selection, and disproportionate sampling. These survey design complexities were taken into account for analysis in this study. The analysis was performed in SAS 9.2 and used chi-square tests and binary logistic regression.

RESULTS

MEPS (2006) represented approximately 222 million non-institutionalised US adults. 42% (weighted) of this population reported a dental visit in the past 12 months. Dental visit numbers were observed to increase with age, with the 55-64-year-olds approximately 44% more likely than the 18-24-year olds to have visited the dentist in the past year. Hispanics were 48% less likely to report a dental visit compared to Non-Hispanic Whites. Respondents with public- or no- dental insurance were less likely to report a dental visit than persons with private dental coverage.

CONCLUSIONS

Under half the US adult civilian non-institutionalised population reported a dental visit during 2006. To help address utilisation disparities, creative initiatives and systemic approaches aimed at groups currently utilising OHCS less often could be an important step towards oral health equity.

Phase III study of ACVBP versus ACVBP plus rituximab for patients with localized low-risk diffuse large B-cell lymphoma (LNH03-1B)

BACKGROUND

The superiority of a chemotherapy with doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisone (ACVBP) in comparison with cyclophosphamide, doxorubicin, vincristin and prednisone plus radiotherapy for young patients with localized diffuse large B-cell lymphoma (DLBCL) was previously demonstrated. We report the results of a trial which evaluates the role of rituximab combined with ACVBP (R-ACVBP) in these patients.

PATIENTS AND METHODS

Untreated patients younger than 66 years with stage I or II DLBCL and no adverse prognostic factors of the age-adjusted International Prognostic Index were randomly assigned to receive three cycles of ACVBP plus sequential consolidation with or without the addition of four infusions of rituximab.

RESULTS

A total of 223 patients were randomly allocated to the study, 110 in the R-ACVBP group and 113 in the ACVBP group. After a median follow-up of 43 months, our 3-year estimate of event-free survival was 93% in the R-ACVBP group and 82% in the ACVBP group (P = 0.0487). Three-year estimate of progression-free survival was increased in the R-ACVBP group (95% versus 83%, P = 0.0205). Overall survival did not differ between the two groups with a 3-year estimates of 98% and 97%, respectively (P = 0.686).

CONCLUSION

In young patients with low-risk localized DLBCL, rituximab combined with three cycles of ACVBP plus consolidation is significantly superior to ACVBP plus consolidation alone.

Nicotinic α4β2 receptor imaging agents. Part IV. Synthesis and biological evaluation of 3-(2-(S)-3,4-dehydropyrrolinyl methoxy)-5-(3'-¹⁸F-fluoropropyl)pyridine (¹⁸F-Nifrolene) using PET

Imaging agents for nicotinic α4β2 receptors in the brain have been under way for studying various CNS disorders. Previous studies from our laboratories have reported the successful development of agonist, ¹⁸F-nifene. In attempts to develop potential antagonists, ¹⁸F-nifrolidine and ¹⁸F-nifzetidine were previously reported. Further optimization of these fluoropropyl derivatives has now been carried out resulting in 3-(2-(S)-3,4-dehydropyrrolinylmethoxy)-5-(3'-Fluoropropyl)pyridine (nifrolene) as a new high affinity agent for nicotinic α4β2 receptors. Nifrolene in rat brain homogenate assays--labeled with ³H-cytisine--exhibited a binding affinity of 0.36 nM. The fluorine-18 analog, ¹⁸F-nifrolene, was synthesized in approximately 10%-20% yield and specific activity was estimated to be >2000 Ci/mmol. Rat brain slices indicated selective binding to anterior thalamic nuclei, thalamus, subiculum, striata, cortex and other regions consistent with α4β2 receptor distribution. This selective binding was displaced >90% by 300 μM nicotine. Thalamus to cerebellum ratio (>10) was the highest for ¹⁸F-nifrolene with several other regions showing selective binding. In vivo rat PET studies exhibited rapid uptake of ¹⁸F-nifrolene in the brain with specific retention in the thalamus and other brain regions while clearing out from the cerebellum. Thalamus to cerebellum ratio value in the rat was >4. Administration of nicotine caused a rapid decline in the thalamic ¹⁸F-nifrolene suggesting reversible binding to nicotinic receptors. PET imaging studies of ¹⁸F-nifrolene in anesthetized rhesus monkey revealed highest binding in the thalamus followed by regions of the lateral cingulated and temporal cortex. Cerebellum showed the least binding. Thalamus to cerebellum ratio in the monkey brain was >3 at 120 min. These ratios of ¹⁸F-nifrolene are higher than measured for ¹⁸F-nifrolidine and ¹⁸F-nifzetidine. ¹⁸F-Nifrolene thus shows promise as a new PET imaging agent for α4β2 nAChR.