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Mirza A, Watt RG, Heilmann A, Stennett M, Singh A. Social Disadvantage and Multimorbidity Including Oral Conditions in the United States. J Dent Res 2024; 103:477-483. [PMID: 38504091 DOI: 10.1177/00220345241228834] [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] [Indexed: 03/21/2024] Open
Abstract
Existing studies on multimorbidity have largely excluded oral diseases in multimorbidity prevalence estimates. The reason behind this is somewhat unclear, as chronic oral conditions are highly prevalent, affecting over half the global population. To address this gap, we examined the relationship between social disadvantage and multimorbidity, stratifying by the inclusion and exclusion of oral conditions. For participants aged 30 y and over (n = 3,693), cross-sectional analysis was carried out using the US National Health and Nutrition Survey (2013-2014). Multimorbidity was defined as having 2 or more chronic conditions. Five medical conditions were examined: diabetes, asthma, arthritis, cardiovascular disease, and depression, as well as 4 oral health conditions: caries, periodontal disease, number of teeth, and edentulousness. Education and income poverty ratio were selected as measures of social disadvantage. Multimorbidity prevalence estimates according to social disadvantage were analyzed on an absolute and relative scale using inverse probability treatment weighting (IPTW), adjusting for age, sex, and ethnicity. The inclusion of oral health conditions in the assessment of multimorbidity increased the overall prevalence of multimorbidity from 20.8% to 53.4%. Findings from IPTW analysis demonstrated clear social gradients for multimorbidity estimates stratified by the exclusion of oral conditions. Upon inclusion of oral conditions, the prevalence of multimorbidity was higher across all social groups for both education and income. Stratifying by the inclusion of oral conditions, the mean probability of multimorbidity was 27% (95% confidence interval [CI], 23%-30%) higher in the low-education group compared to the high-education group. Similarly, the mean probability of multimorbidity was 44% (95% CI, 40%-48%) higher in the low-income group. On a relative scale, low education was associated with a 1.52 times (95% CI, 1.44-1.61) higher prevalence of multimorbidity compared to high education. Low income was associated with a 2.18 (95% CI, 1.99-2.39) higher prevalence of multimorbidity. This novel study strongly supports the impact of chronic oral conditions on multimorbidity prevalence estimates.
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Affiliation(s)
- A Mirza
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - M Stennett
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A Singh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
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Watt RG, Heilmann A, Conway DI. Oral cancers are rising in the UK. BMJ 2023; 383:2907. [PMID: 38086551 DOI: 10.1136/bmj.p2907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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Borrell LN, Guarnizo-Herreño CC, Heilmann A. Oral health inequalities/inequities: Looking back and looking forward. Community Dent Oral Epidemiol 2023; 51:587-589. [PMID: 37482943 DOI: 10.1111/cdoe.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, New York, USA
| | | | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
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Cooray U, Tsakos G, Heilmann A, Watt RG, Takeuchi K, Kondo K, Osaka K, Aida J. Impact of Teeth on Social Participation: Modified Treatment Policy Approach. J Dent Res 2023:220345231164106. [PMID: 37085984 DOI: 10.1177/00220345231164106] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
Social participation prevents social isolation and loneliness among older adults while having numerous positive effects on their health and well-being in rapidly aging societies. We aimed to estimate the effect of retaining more natural teeth on social participation among older adults in Japan. The analysis used longitudinal data from 24,872 participants in the Japan Gerontological Evaluation Study (2010, 2013, and 2016). We employed a longitudinal modified treatment policy approach to determine the effect of several hypothetical scenarios (preventive scenarios and tooth loss scenarios) on frequent social participation (1 = at least once a week/0 = less than once a week) after a 6-y follow-up. The corresponding statistical parameters were estimated using targeted minimum loss-based estimation (TMLE) method. Number of teeth category (edentate/1-9/10-19/≥20) was treated as a time-varying exposure, and the outcome estimates were adjusted for time-varying (income, self-rated health, marital status, instrumental activities of daily living, vision loss, hearing loss, major comorbidities, and number of household members) and time-invariant covariates (age, sex, education, baseline social participation). Less frequent social participation was associated with older age, male sex, lower income, low educational attainment, and poor self-rated health at the baseline. Social participation improved when tooth loss prevention scenarios were emulated. The best preventive scenario (i.e., maintaining ≥20 teeth among each participant) improved social participation by 8% (risk ratio [RR] = 1.08; 95% confidence interval [CI], 1.05-1.11). Emulated tooth loss scenarios gradually decreased social participation. A hypothetical scenario in which all the participants were edentate throughout the follow-up period resulted in a 11% (RR = 0.89; 95% CI, 0.84-0.94) reduction in social participation. Subsequent tooth loss scenarios showed 8% (RR = 0.92; 95% CI, 0.88-0.95), 6% (RR = 0.94; 95% CI, 0.91-0.97), and 4% (RR = 0.96; 95% CI, 0.93-0.98) reductions, respectively. Thus, among Japanese older adults, retaining a higher number of teeth positively affects their social participation, whereas being edentate or having a relatively lower number of teeth negatively affects their social participation.
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Affiliation(s)
- U Cooray
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - G Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - K Takeuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - K Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - K Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - J Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Mishu MP, Tsakos G, Heilmann A, Watt RG. The role of oral health-related quality of life in the association between dental caries and height, weight and BMI among children in Bangladesh. Community Dent Oral Epidemiol 2022; 50:529-538. [PMID: 34837423 DOI: 10.1111/cdoe.12707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/08/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To examine whether oral health-related quality of life (OHRQoL) explained the negative associations between dental caries and anthropometric measures of child growth among a sample of 5- to 9-year-old children in Dhaka, Bangladesh, while taking potential confounding factors (maternal education, family income, study setting, child's birth weight and childhood diseases) into account. In addition, to test whether specific oral impacts had a role in explaining these associations. METHODS Data collection was conducted via a cross-sectional survey among children and their parents from both hospital and school settings in Dhaka. Dental caries and severe consequences of dental caries (defined here as dental sepsis) were the exposure variables, and age- and sex-adjusted height-z-scores (HAZ), weight-z-scores (WAZ) and BMI-z-scores (BAZ) were the outcome variables. OHRQoL was measured using the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). First, associations between oral impacts (prevalence of overall impacts and specific items of the SOHO-5) and outcome measures were assessed. Multiple linear regression was used to assess associations between caries and anthropometric measures, adjusted for potential confounders. Oral impacts were then added to test whether their inclusion attenuated the associations between exposures and outcomes. To further investigate potential mediating role of oral impacts, structural equation modelling (SEM) was used to test the hypothesis that dental caries and sepsis were associated with the outcomes directly and also indirectly via oral impacts in general. A similar approach was used to investigate mediation by specific SOHO-5 items. RESULTS The sample consisted of 715 children, 73.1% of whom had dental caries, 37.5% presented with sepsis, and 57.3% reported at least one oral impact (SOHO-5 score ≥1). Prevalence of overall oral impacts and also the impact on 'eating difficulty' (a specific item of SOHO-5) were negatively associated with all three outcomes. Dental caries and sepsis was associated with lower HAZ, WAZ and BAZ, and adjustment for overall oral impacts considerably attenuated the associations between 'severe dental caries' and outcomes, and dental sepsis and outcomes. Using SEM, we found significant indirect associations between caries and sepsis and anthropometric measures via oral impacts (except for dental caries and HAZ). Considering specific oral impacts, eating difficulties explained about 44% and 65% of the associations between caries and anthropometric outcomes, and dental sepsis and anthropometric outcomes, respectively. CONCLUSIONS Oral impacts, in particular eating difficulties, appear to mediate associations between caries and markers of child growth among this population.
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Affiliation(s)
- Masuma Pervin Mishu
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, UK
| | - Georgios Tsakos
- Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Anja Heilmann
- Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Richard G Watt
- Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
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Khaliq N, McMunn A, Machuca-Vargas C, Heilmann A. Do social relationships mediate or moderate social inequalities in health? A systematic review protocol. Syst Rev 2022; 11:91. [PMID: 35562839 PMCID: PMC9107128 DOI: 10.1186/s13643-022-01973-w] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Explanations for health inequalities include material, behavioural and psychosocial pathways. Social relationships are an important determinant of health, and research has consistently found that a lack of support networks may diminish favourable health outcomes. There is some evidence that social network structures, partly shaped by socioeconomic factors, contribute to health inequalities. This protocol will summarise the systematic review process. METHODS AND ANALYSES The Systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic database search of MEDLINE, Embase Classic + Embase and PsychINFO using the OvidSP platform will be undertaken. Databases will be searched from the earliest date of entry until 10 June 2022. Articles that have quantitatively assessed the role of social relationships in mediating or moderating health inequalities will be included and any health outcome (mental/physical) will be considered. The database search will be supplemented by reference list screening of all relevant full-text articles identified through the search. Two independent reviewers will be responsible for screening of articles, data extraction and assessment of bias. Observational studies will be risk assessed for bias using a modified version of the Newcastle-Ottawa Quality Assessment Scale, and intervention studies will be assessed using the revised Cochrane risk-of-bias tool. It is anticipated that the eligible studies will be highly variable; therefore, a meta-analysis will only be considered if the available data of the selected studies are similar. If the studies are too heterogeneous, a narrative synthesis of the extracted data will be presented. CONCLUSION The results of the systematic review will examine the link between social relationships and health inequalities. The findings of the review will identify gaps in knowledge where further research is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020181706.
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Affiliation(s)
- Nadia Khaliq
- Department of Epidemiology and Public Health, UCL, London, UK.
| | - Anne McMunn
- Department of Epidemiology and Public Health, UCL, London, UK
| | | | - Anja Heilmann
- Department of Epidemiology and Public Health, UCL, London, UK
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Letelier A, Watt RG, Heilmann A. Head injuries in early childhood in the UK; is there a social gradient? J Epidemiol Community Health 2022; 76:600-605. [PMID: 35318278 DOI: 10.1136/jech-2021-217184] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine if there is a social gradient in early childhood head injuries among UK children. METHODS Cross-sectional study, using data from the UK Millennium Cohort Study (MCS). The second, third and fourth sweeps of the MCS were analysed separately, when children were 3, 5 and 7 years old. Logistic regression models were used to explore the associations between head injuries and family socioeconomic position (social class, household income, maternal education and area deprivation). RESULTS The unadjusted analyses showed different associations with socioeconomic indicators at different ages. At age 3 and 5 years, head injuries were associated with higher area deprivation, lower household income and parents not being in work or in the routine social class. At age 5 years head injuries were also associated with lower maternal education. At age 7 years only associations with area deprivation and maternal education were found. In adjusted analyses (mutually adjusted for all four socioeconomic indicators, maternal age, child age and child sex), the following associations were observed: at ages 3 and 5 years, higher levels of area deprivation were related to higher odds of head injuries. At age 3 years only, lower levels of maternal education were related to lower odds of head injuries. No social gradients were observed. At age 7 years, there were no significant associations between head injuries and any of the SEP measures. CONCLUSION We observed no social gradients in early childhood head injuries. However, at ages 3 and 5 years, head injuries were more frequently reported for children living in more deprived areas.
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Affiliation(s)
- Alejandra Letelier
- Instituto de Odontoestomatología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Región de Los Ríos, Chile .,Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
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Letelier A, Jivraj S, Heilmann A, Watt RG, Tsakos G. Life course socioeconomic position and general and oral health in later life: Assessing the role of social causation and health selection pathways. SSM Popul Health 2022; 17:101026. [PMID: 35242990 PMCID: PMC8881487 DOI: 10.1016/j.ssmph.2022.101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To examine the pathways between life course socioeconomic position (SEP) and general and oral health, assessing the role of two competing theories, social causation and health selection, on a representative sample of individuals aged 50 years and over in England. Methods Secondary analysis from the English Longitudinal Study of Ageing Wave 3 data (n = 8659). Structural equation models estimated the social causation pathways from childhood SEP to adult self-rated general health and total tooth loss, and the health selection pathways from childhood health to adult SEP. Results There were direct and indirect (primarily via education, but also adult SEP, and behavior) pathways from childhood SEP to both health outcomes in older adulthood. There was a direct pathway from childhood health to adult SEP, but no indirect pathway via education. The social causation path total effect estimate was three times larger for self-rated general health and four times larger for total tooth loss than the health selection path respective estimates. Conclusions The relationship between SEP and health is bidirectional, but with a clearly stronger role for the social causation pathway. Recognize the social determinants of healthy ageing is more relevant than ever. A life course approach was used to explore health and socioeconomic pathways. Structural equation models were used to test social causation and health selection. Childhood and adult socioeconomic position shape general and oral health at old age. There is a bidirectional relationship between life course circumstances and health.
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Affiliation(s)
- Alejandra Letelier
- Instituto de Odontoestomatología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile, Postal Address: Rudloff 1640, Valdivia, 5111710, Chile
- Department of Epidemiology and Public Health, University College London, UCL, London, UK. Postal Address:, Gower Street Campus, 1 - 19 Torrington Place, WC1E 6BT, UK
- Corresponding author. Instituto de Odontoestomatologia UACh, Rudloff 1640, Valdivia, Chile, 5111710.
| | - Stephen Jivraj
- Department of Epidemiology and Public Health, University College London, UCL, London, UK. Postal Address:, Gower Street Campus, 1 - 19 Torrington Place, WC1E 6BT, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, UCL, London, UK. Postal Address:, Gower Street Campus, 1 - 19 Torrington Place, WC1E 6BT, UK
| | - Richard G. Watt
- Department of Epidemiology and Public Health, University College London, UCL, London, UK. Postal Address:, Gower Street Campus, 1 - 19 Torrington Place, WC1E 6BT, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, UCL, London, UK. Postal Address:, Gower Street Campus, 1 - 19 Torrington Place, WC1E 6BT, UK
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Lodder A, Mehay A, Pavlickova H, Hoare Z, Box L, Butt J, Weaver T, Crawford MJ, Clutterbuck D, Westbrook N, Manning K, Karlsen S, Morris S, Brand A, Ramchandani P, Kelly Y, Heilmann A, Watt RG. Evaluating the effectiveness and cost effectiveness of the 'strengthening families, strengthening communities' group-based parenting programme: study protocol and initial insights. BMC Public Health 2021; 21:1887. [PMID: 34666724 PMCID: PMC8524224 DOI: 10.1186/s12889-021-11912-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Up to 20% of UK children experience socio-emotional difficulties which can have serious implications for themselves, their families and society. Stark socioeconomic and ethnic inequalities in children’s well-being exist. Supporting parents to develop effective parenting skills is an important preventive strategy in reducing inequalities. Parenting interventions have been developed, which aim to reduce the severity and impact of these difficulties. However, most parenting interventions in the UK focus on early childhood (0–10 years) and often fail to engage families from ethnic minority groups and those living in poverty. Strengthening Families, Strengthening Communities (SFSC) is a parenting programme designed by the Race Equality Foundation, which aims to address this gap. Evidence from preliminary studies is encouraging, but no randomised controlled trials have been undertaken so far. Methods/design The TOGETHER study is a multi-centre, waiting list controlled, randomised trial, which aims to test the effectiveness of SFSC in families with children aged 3–18 across seven urban areas in England with ethnically and socially diverse populations. The primary outcome is parental mental well-being (assessed by the Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes include child socio-emotional well-being, parenting practices, family relationships, self-efficacy, quality of life, and community engagement. Outcomes are assessed at baseline, post intervention, three- and six-months post intervention. Cost effectiveness will be estimated using a cost-utility analysis and cost-consequences analysis. The study is conducted in two stages. Stage 1 comprised a 6-month internal pilot to determine the feasibility of the trial. A set of progression criteria were developed to determine whether the stage 2 main trial should proceed. An embedded process evaluation will assess the fidelity and acceptability of the intervention. Discussion In this paper we provide details of the study protocol for this trial. We also describe challenges to implementing the protocol and how these were addressed. Once completed, if beneficial effects on both parental and child outcomes are found, the impact, both immediate and longer term, are potentially significant. As the intervention focuses on supporting families living in poverty and those from minority ethnic communities, the intervention should also ultimately have a beneficial impact on reducing health inequalities. Trial registration Prospectively registered Randomised Controlled Trial ISRCTN15194500.
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Affiliation(s)
- Annemarie Lodder
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Anita Mehay
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Zoe Hoare
- NWORTH Clinical Trials Unit, Bangor University, Bangor, UK
| | | | | | - Tim Weaver
- School of Health and Education, Middlesex University, London, UK
| | | | | | - Nicola Westbrook
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Saffron Karlsen
- Centre for the Study of Ethnicity and Citizenship, University of Bristol, Bristol, UK
| | - Steve Morris
- Department of Public Health & Primary Care, Cambridge University, Cambridge, UK
| | - Andrew Brand
- NWORTH Clinical Trials Unit, Bangor University, Bangor, UK
| | - Paul Ramchandani
- PEDAL Research Centre, Faculty of Education, Cambridge University, Cambridge, UK
| | - Yvonne Kelly
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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Cooray U, Watt RG, Tsakos G, Heilmann A, Hariyama M, Yamamoto T, Kuruppuarachchige I, Kondo K, Osaka K, Aida J. Importance of socioeconomic factors in predicting tooth loss among older adults in Japan: Evidence from a machine learning analysis. Soc Sci Med 2021; 291:114486. [PMID: 34700121 DOI: 10.1016/j.socscimed.2021.114486] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/30/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 01/21/2023]
Abstract
Prevalence of tooth loss has increased due to population aging. Tooth loss negatively affects the overall physical and social well-being of older adults. Understanding the role of socio-demographic and other predictors associated with tooth loss that are measured in non-clinical settings can be useful in community-level prevention. We used high-dimensional epidemiological data to investigate important factors in predicting tooth loss among older adults over a 6-year period of follow-up. Data was from participants of 2010 and 2016 waves of the Japan Gerontological Evaluation Study (JAGES). A total of 19,407 community-dwelling functionally independent older adults aged 65 and older were included in the analysis. Tooth loss was measured as moving from a higher number of teeth category at the baseline to a lower number of teeth category at the follow-up. Out of 119 potential predictors, age, sex, number of teeth, denture use, chewing difficulty, household income, employment, education, smoking, fruit and vegetable consumption, community participation, time since last health check-up, having a hobby, and feeling worthless were selected using Boruta algorithm. Within the 6-year follow-up, 3013 individuals (15.5%) reported incidence of tooth loss. People who experienced tooth loss were older (72.9 ± 5.2 vs 71.8 ± 4.7), and predominantly men (18.3% vs 13.1%). Extreme gradient boosting (XGBoost) machine learning prediction model had a mean accuracy of 90.5% (±0.9%). A visual analysis of machine learning predictions revealed that the prediction of tooth loss was mainly driven by demographic (older age), baseline oral health (having 10-19 teeth, wearing dentures), and socioeconomic (lower household income, manual occupations) variables. Predictors related to wide a range of determinants contribute towards tooth loss among older adults. In addition to oral health related and demographic factors, socioeconomic factors were important in predicting future tooth loss. Understanding the behaviour of these predictors can thus be useful in developing prevention strategies for tooth loss among older adults.
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Affiliation(s)
- Upul Cooray
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Masanori Hariyama
- Intelligent Integrated Systems Laboratory, Graduate School of Information Sciences, Tohoku University, Miyagi, Japan
| | - Takafumi Yamamoto
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Isuruni Kuruppuarachchige
- Department of Dental and Digital Forensics Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan; Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Division for Regional Community Development, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan
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Bomfim RA, Watt RG, Tsakos G, Heilmann A, Frazão P. Does water fluoridation influence ethnic inequalities in caries in Brazilian children and adolescents? Community Dent Oral Epidemiol 2021; 50:321-332. [PMID: 34342029 DOI: 10.1111/cdoe.12676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/27/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to investigate the influence of community water fluoridation on ethnic inequalities in untreated dental caries among children and adolescents in Brazil while taking the human development context into account. METHODS Data from a nationwide Brazilian epidemiological population oral health survey were used (SB Brazil 2010). Outcomes were caries prevalence measured by the proportion of individuals with one or more untreated decayed teeth and caries severity defined by the mean number of untreated decayed teeth (DT). Three different contexts were considered: 1-cities with no water fluoridation; 2-cities with water fluoridation and low Human Development Index (HDI); and 3-cities with water fluoridation and high HDI. The exposure was ethnic/racial group (White, Pardo, Black) and covariates were age, sex and household income. Multilevel logistic and negative binomial regressions were performed with 6696 children (aged 5 years) and 11 585 adolescents (aged 12 and 15-19 years). RESULTS For both children and adolescents, ethnic differences in caries prevalence and mean DT were found in the nonfluoridated cities with low HDI and also in cities with high HDI, most of which were fluoridated. For example in nonfluoridated cities with low HDI, 5-year-old Pardo children were more likely to have untreated decay (OR = 1.22; 95% CI: 1.02, 1.46) and had more decayed teeth (RR = 1.18; 95% CI: 1.04, 1.34) than their White counterparts after adjusting for sex and household income. No statistically significant differences were observed in fluoridated cities with low HDI. CONCLUSION Water fluoridation appears to be associated with reduced ethnic inequalities in dental caries prevalence and mean DT among children and adolescents in more disadvantaged settings.
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Affiliation(s)
- Rafael Aiello Bomfim
- Department of Community Health, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Brazil.,Public Health School, University of São Paulo, São Paulo, Brazil
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Paulo Frazão
- Public Health School, University of São Paulo, São Paulo, Brazil
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12
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Heilmann A, Mehay A, Watt RG, Kelly Y, Durrant JE, van Turnhout J, Gershoff ET. Physical punishment and child outcomes: a narrative review of prospective studies. Lancet 2021; 398:355-364. [PMID: 34197808 PMCID: PMC8612122 DOI: 10.1016/s0140-6736(21)00582-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/18/2021] [Accepted: 03/01/2021] [Indexed: 12/21/2022]
Abstract
Physical punishment is increasingly viewed as a form of violence that harms children. This narrative review summarises the findings of 69 prospective longitudinal studies to inform practitioners and policy makers about physical punishment's outcomes. Our review identified seven key themes. First, physical punishment consistently predicts increases in child behaviour problems over time. Second, physical punishment is not associated with positive outcomes over time. Third, physical punishment increases the risk of involvement with child protective services. Fourth, the only evidence of children eliciting physical punishment is for externalising behaviour. Fifth, physical punishment predicts worsening behaviour over time in quasi-experimental studies. Sixth, associations between physical punishment and detrimental child outcomes are robust across child and parent characteristics. Finally, there is some evidence of a dose-response relationship. The consistency of these findings indicates that physical punishment is harmful to children and that policy remedies are warranted.
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Affiliation(s)
- Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Anita Mehay
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Yvonne Kelly
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Joan E Durrant
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Elizabeth T Gershoff
- Population Research Center and Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
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13
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Tsakos G, Brocklehurst PR, Watson S, Verey A, Goulden N, Jenkins A, Hoare Z, Pye K, Wassall RR, Sherriff A, Heilmann A, O'Neill C, Smith CJ, Langley J, Venturelli R, Cairns P, Lievesley N, Watt RG, Kee F, McKenna G. Improving the oral health of older people in care homes (TOPIC): a protocol for a feasibility study. Pilot Feasibility Stud 2021; 7:138. [PMID: 34215322 PMCID: PMC8249429 DOI: 10.1186/s40814-021-00872-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/03/2020] [Accepted: 06/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background Evidence for interventions promoting oral health amongst care home residents is weak. The National Institute for Health and Care Excellence (NICE) guideline NG48 aims to maintain and improve the oral health of care home residents. A co-design process that worked with residents and care home staff to understand how the NG48 guideline could be best implemented in practice has been undertaken to refine a complex intervention. The aim of this study is to assess the feasibility of the intervention to inform a future larger scale definitive trial. Methods This is a protocol for a pragmatic cluster randomised controlled trial with a 12-month follow-up that will be undertaken in 12 care homes across two sites (six in London, six in Northern Ireland). Care homes randomised to the intervention arm (n = 6) will receive the complex intervention based on the NG48 guideline, whilst care homes randomised to the control arm (n = 6) will continue with routine practice. The intervention will include a training package for care home staff to promote knowledge and skills in oral health promotion, the use of the Oral Health Assessment Tool on residents by trained care home staff, and a ‘support worker assisted’ daily tooth-brushing regime with toothpaste containing 1500 ppm fluoride. An average of ten residents, aged 65 years or over who have at least one natural tooth, will be recruited in each care home resulting in a recruited sample of 120 participants. Assessments will be undertaken at baseline, 6 months and 12 months, and will include a dental examination and questionnaires on general health and oral health administered by a research assistant. A parallel process evaluation involving semi-structured interviews will be undertaken to explore how the intervention could be embedded in standard practice. Rates of recruitment and retention, and intervention fidelity will also be recorded. A cost-consequence model will determine the relevance of different outcome measures in the decision-making context. Discussion The study will provide valuable information for trialists, policymakers, clinicians and care home staff on the feasibility and associated costs of oral health promotion in UK care homes. Trial registration ISRCTN10276613. Registered on 17th April 2020. http://www.isrctn.com/ISRCTN10276613.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Sinead Watson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
| | - Anna Verey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Nia Goulden
- NWORTH Clinical Trials Unit, Bangor University, Bangor, UK
| | - Alison Jenkins
- NWORTH Clinical Trials Unit, Bangor University, Bangor, UK
| | - Zoe Hoare
- NWORTH Clinical Trials Unit, Bangor University, Bangor, UK
| | - Kirstie Pye
- NWORTH Clinical Trials Unit, Bangor University, Bangor, UK
| | | | | | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Craig J Smith
- Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.,Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal Foundation NHS Trust, Salford, UK
| | - Joe Langley
- Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Renato Venturelli
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Peter Cairns
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,BELONG PPI Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Nat Lievesley
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,Centre for Policy on Ageing, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Gerald McKenna
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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14
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Heilmann A, Ziller S. [Reducing sugar consumption to improve oral health-which strategies are effective?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:838-846. [PMID: 34014353 PMCID: PMC8241649 DOI: 10.1007/s00103-021-03349-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/06/2021] [Indexed: 12/02/2022]
Abstract
Strategien zur Gesundheitsförderung können einen wesentlichen Beitrag leisten, um nichtübertragbare chronische Krankheiten zu verhindern. Die wesentlichen nichtübertragbaren Erkrankungen in der Zahnmedizin sind Zahnkaries und Parodontalerkrankungen. Zucker spielt sowohl bei der Entstehung von Zahnkaries als auch von Übergewicht und dessen Folgen für die Allgemeingesundheit eine ursächliche Rolle und ist daher als wichtige kommerzielle Gesundheitsdeterminante mehr und mehr ins Blickfeld von Wissenschaft und Gesundheitspolitik gerückt. Existierende Strategien zur Reduktion des Zuckerkonsums zielen jedoch häufig auf Maßnahmen zur individuellen Verhaltensänderung ab und lassen dabei die Rolle von gesellschaftlichen und kommerziellen Einflüssen außer Acht. In diesem Artikel beschreiben wir die aktuellen Empfehlungen der Weltgesundheitsorganisation (WHO) zum Zuckerkonsum, Daten zum Zuckerverzehr in Deutschland sowie die sozialen und kommerziellen Faktoren, welche den Zuckerkonsum beeinflussen. Grundlegende Prinzipien der Gesundheitsförderung werden dargelegt und sich daraus ergebende Strategien zur Zuckerreduzierung diskutiert. Dabei werden konkrete Beispiele für Upstream- und Downstream-Ansätze benannt und Möglichkeiten der Einflussnahme durch die zahnmedizinische Community in Politik und Praxis aufgezeigt.
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Affiliation(s)
- Anja Heilmann
- Department of Epidemiology and Public Health, University College London, WC1E 6BT, London, Großbritannien.
| | - Sebastian Ziller
- Abteilung Prävention und Gesundheitsförderung, Bundeszahnärztekammer (BZÄK), Berlin, Deutschland
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15
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Venturelli R, Ntouva A, Porter J, Stennett M, Crawford MJ, Britton A, Gratus C, Tsakos G, Heilmann A, Newton T, Redican C, Pikhart H, Watt RG. Use of AUDIT-C alcohol screening tool in NHS general dental practices in North London. Br Dent J 2021:10.1038/s41415-021-2964-5. [PMID: 33986481 DOI: 10.1038/s41415-021-2964-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022]
Abstract
Background The numerous health risks of excessive alcohol consumption are well documented. Individuals at risk of harm from alcohol consumption can be identified through alcohol screening tools; however, there is limited research regarding their use in general dental practices.Methods Data were collected as part of a feasibility trial evaluating delivery of brief alcohol advice in general dental practices in North London. Patient demographics and health-related behaviours were collected, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool was used to assess alcohol consumption patterns.Results The analytical sample comprised 552 dental patients, of whom approximately half (46%) were drinking alcohol at hazardous levels. Males, younger adults, those who consumed red meat weekly and smokers all had significantly increased risks of excessive alcohol consumption. Smokers were more likely to consume excessive levels of alcohol irrespective of smoking frequency. Notable sex differences in alcohol consumption were identified, with males being more likely to consume alcohol frequently and in larger quantities than females.Conclusion The AUDIT-C tool can be used in general dental practice to screen for harmful levels of alcohol consumption. Clear associations exist between patient demographics, health behaviours and excessive alcohol consumption.
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Affiliation(s)
| | | | - Jessie Porter
- Department of Epidemiology and Public Health, UCL, UK
| | | | | | - Annie Britton
- Department of Epidemiology and Public Health, UCL, UK
| | | | | | - Anja Heilmann
- Department of Epidemiology and Public Health, UCL, UK
| | - Tim Newton
- King's College London Dental Institute, King's College London, UK
| | - Caillin Redican
- , General Dental Practitioner and Health Education England, UK
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, UCL, UK
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16
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Abstract
BACKGROUND There are stark ethnic inequalities in the prevalence of UK childhood obesity. However, data on adolescent overweight in different ethnic groups are limited. This study assessed ethnic inequalities in overweight prevalence during mid-adolescence using body mass index (BMI) and explored the contribution of socioeconomic and behavioural factors. METHODS We analyzed data from 10 500 adolescents aged between 13 and 15 years who participated in sweep six of the Millennium Cohort Study. Ethnic inequalities in overweight and mean BMI were assessed using multiple regression models. Results were stratified by sex and adjusted for socioeconomic and behavioural factors. RESULTS Black Caribbean males had significantly higher BMI than White males after full adjustment [excess BMI 2.94, 95% confidence interval (CI) 0.70-5.19] and were over three times more likely to be overweight [odds ratio (OR): 3.32, 95% CI 1.95-5.66]. Black Africans females had significantly higher BMI compared with White females (excess BMI 1.86, 95% CI 0.89-2.83; OR for overweight 2.74, 95% CI 1.64-4.56), while Indian females had significantly lower BMI compared with White females (reduced BMI -0.73, 95% CI -1.37 to -0.09). Socioeconomic and behavioural factors often considered to be associated with overweight were more prevalent in some ethnic minority groups (lower socioeconomic position, lack of breakfast consumption, low fruit and vegetable intake, high sugar-sweetened beverage and fast-food consumption, and infrequent physical activity), but adjustment for these factors did not fully explain ethnic differences in overweight/BMI. CONCLUSION Ethnic inequalities in overweight prevalence are evident in mid-adolescence and vary according to sex. Differences in overweight/BMI between ethnic groups were not fully accounted for by socioeconomic or behavioural factors.
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Affiliation(s)
- Michelle Stennett
- Department of Epidemiology and Public Health,
University College London, London, UK
| | - Alex Blokland
- Department of Epidemiology and Public Health,
University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health,
University College London, London, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health,
University College London, London, UK
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17
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Guarnizo-Herreño CC, Scholes S, Heilmann A, O'Connor R, Fuller E, Shen J, Watt RG, Morris S, Wildman J, Tsakos G. Dental attendance and behavioural pathways to adult oral health inequalities. J Epidemiol Community Health 2021; 75:1063-1069. [PMID: 33893184 DOI: 10.1136/jech-2020-216072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/18/2020] [Revised: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND While inequalities in oral health are documented, little is known about the extent to which they are attributable to potentially modifiable factors. We examined the role of behavioural and dental attendance pathways in explaining oral health inequalities among adults in England, Wales and Northern Ireland. METHODS Using nationally representative data, we analysed inequalities in self-rated oral health and number of natural teeth. Highest educational attainment, equivalised household income and occupational social class were used to derive a latent socioeconomic position (SEP) variable. Pathways were dental attendance and behaviours (smoking and oral hygiene). We used structural equation modelling to test the hypothesis that SEP influences oral health directly and also indirectly via dental attendance and behavioural pathways. RESULTS Lower SEP was directly associated with fewer natural teeth and worse self-rated oral health (standardised path coefficients, -0.21 (SE=0.01) and -0.10 (SE=0.01), respectively). We also found significant indirect effects via behavioural factors for both outcomes and via dental attendance primarily for self-rated oral health. While the standardised parameters of total effects were similar between the two outcomes, for number of teeth, the estimated effect of SEP was mostly direct while for self-rated oral health, it was almost equally split between direct and indirect effects. CONCLUSION Reducing inequalities in dental attendance and health behaviours is necessary but not sufficient to tackle socioeconomic inequalities in oral health.
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Affiliation(s)
- Carol C Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Shaun Scholes
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rhiannon O'Connor
- School of Dental Sciences and Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jing Shen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,GlaxoSmithKline, Wavre, Belgium (Although Jing Shen works now for GSK, the work associated with the paper was conducted during her time at Newcastle University)
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Steve Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
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18
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Mishu MP, Watt RG, Heilmann A, Tsakos G. Cross cultural adaptation and psychometric properties of the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). Health Qual Life Outcomes 2021; 19:46. [PMID: 33546712 PMCID: PMC7866745 DOI: 10.1186/s12955-021-01681-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The oral health related quality of life (OHRQoL) of children in Bangladesh has not yet been measured, as there is no validated OHRQoL measure for that population. The aim of this study was to cross-culturally adapt the child self-report and parental proxy report versions of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) into Bengali and test their psychometric properties: face validity, construct validity (convergent and discriminant validity) and reliability (internal consistency and test-retest reliability), among 5-9-year-old children and their parents in Bangladesh and assess associations between dental caries/sepsis and OHRQoL in this population. METHODS The forward-backward translated Bengali SOHO-5 was piloted among 272 children and their parents to test its face validity. The questionnaire was administered to 788 children and their parents to evaluate its psychometric properties. Internal consistency of Bengali SOHO-5 was assessed using Cronbach's alpha, and test-retest reliability was assessed using Kappa. Convergent and discriminant validity were assessed through nonparametric tests. The calculation of effect sizes and standard error of measurement facilitated the assessment of minimally important difference (MID) for SOHO-5. The associations of reporting an oral impact with caries and sepsis were assessed via logistic regression models. RESULTS Both child self-report and parental proxy report questionnaires showed good face validity. Cronbach's alpha scores were 0.79 and 0.87 for child and parental questionnaire, respectively. A weighted Kappa score of 0.85 demonstrated test-retest reliability of child questionnaire. SOHO-5 scores were significantly associated with subjective oral health outcomes and discriminated clearly between different caries severity and sepsis groups. These differences were considerably higher than the MID. After adjusting for child's age, sex, setting, maternal education and family income, the odds of reporting an oral impact were 2.25 (95% CI 1.98-2.56) and 4.44 (95% CI 3.14-6.28) times higher for each additional tooth with caries and sepsis, respectively. CONCLUSION This study provided strong evidence supporting the validity and reliability of both versions of Bengali SOHO-5 as OHRQoL measures. Dental caries and sepsis were associated with poor OHRQoL in this population. The Bengali SOHO-5 is expected to be a useful outcome measure for research and clinical purposes in Bengali speaking child populations.
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Affiliation(s)
- Masuma Pervin Mishu
- Department of Health Science, Faculty of Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Richard G Watt
- Research Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Anja Heilmann
- Research Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Georgios Tsakos
- Research Department of Epidemiology and Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 6BT, UK.
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Bevilacqua L, Kelly Y, Heilmann A, Priest N, Lacey RE. Adverse childhood experiences and trajectories of internalizing, externalizing, and prosocial behaviors from childhood to adolescence. Child Abuse Negl 2021; 112:104890. [PMID: 33454138 DOI: 10.1016/j.chiabu.2020.104890] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/15/2020] [Accepted: 12/10/2020] [Indexed: 05/18/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) predict poorer mental health across the life course but most of the extant research has employed ACE scores or individual adversities using retrospective data. OBJECTIVES To study the impact of ACEs on later mental health using not only ACEs scores and individual ACEs, but also latent class analysis (LCA), which respects the clustering of adversities. PARTICIPANTS AND SETTING 8823 members from the UK Millennium Cohort Study. METHODS We investigated the impact of prospectively reported ACEs on mental health trajectories derived using the Strengths and Difficulties Questionnaire at age 3, 5, 7, 11 and 14. Associations between LCA-derived ACE clusters, ACE scores, individual ACEs and mental health trajectories were tested using linear mixed effects models. RESULTS With statistical significance set at 5% level, ACE scores showed a graded association with internalizing (ACE score of 1: β = 0.057; ACE score of 2: β = 0.108; ACE score of 3: β = 0.202), externalizing (ACE score of 1: β = 0.142; ACE score of 2: β = 0.299; ACE score of 3: β = 0.415) and prosocial behaviors (ACE score of 1: β=-0.019; ACE score of 2: β=-0.042; ACE score of 3: β=-0.059). Harsh parenting and physical punishment were particularly strongly associated with externalizing (β = 0.270 and β = 0.256) and negatively associated with prosocial behaviors (β=-0.046 and β=-0.058). Parental discord and parental depression showed the strongest associations with internalizing problems (β = 0.125 and β = 0.113). LCA did not discriminate ACE clusters in this dataset. CONCLUSIONS ACEs have an important impact on mental health from childhood to adolescence. ACEs score approach yielded useful results, which were further enhanced by exploring individual ACEs.
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Affiliation(s)
- Leonardo Bevilacqua
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, United Kingdom.
| | - Yvonne Kelly
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, United Kingdom
| | - Anja Heilmann
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, United Kingdom
| | - Naomi Priest
- Australian National University, Centre for Social Research and Methods, Australian National University, Canberra, Australia; Population Health, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Rebecca E Lacey
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, United Kingdom
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Cooray U, Aida J, Watt R, Tsakos G, Heilmann A, Kato H, Kiuchi S, Kondo K, Osaka K. Effect of Copayment on Dental Visits: A Regression Discontinuity Analysis. J Dent Res 2020; 99:1356-1362. [DOI: 10.1177/0022034520946022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite their prevalence and burdens, oral diseases are neglected in universal health coverage. In Japan, a 30% copayment (out of pocket) by the user and a 70% contribution by Japan’s universal health insurance (JUHI) are required for dental and medical services. From the age of 70 y, an additional 10% is offered by JUHI (copayment, 20%; JUHI, 80%). This study aimed to investigate the effect of cost on dental service use among older adults under the current JUHI system. A regression discontinuity quasi-experimental method was used to investigate the causal effect of the JUHI discount policy on dental visits based on cross-sectional data. Data were derived from the 2016 Japan Gerontological Evaluation Study. This analysis contained 7,161 participants who used JUHI, were aged 68 to 73 y, and responded to questions regarding past dental visits. Analyses were controlled for age, sex, number of teeth, and equalized household income. Mean ± SD age was 72.1 ± 0.79 y for the discount-eligible group and 68.9 ± 0.78 y for the noneligible group. During the past 12 mo, significantly more discount-eligible participants had visited dental services than noneligible participants (66.0% vs. 62.1% for treatment visits, 57.7% vs. 53.1% for checkups). After controlling for covariates, the effect of discount eligibility was significant on dental treatment visits (odds ratio [OR], 1.36; 95% CI, 1.32 to 1.40) and dental checkups (OR, 1.49; 95% CI, 1.44 to 1.54) in the regression discontinuity analysis. Similar findings were observed in triangular kernel-weighted models (OR, 1.38 [95% CI, 1.34 to 1.44]; OR, 1.52 [95% CI, 1.47 to 1.56], respectively). JUHI copayment discount policy increases oral health service utilization among older Japanese. The price elasticity for dental checkup visits appears to be higher than for dental treatment visits. Hence, reforming the universal health coverage system to improve the affordability of relatively inexpensive preventive care could increase dental service utilization in Japan.
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Affiliation(s)
- U. Cooray
- Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, Sendai, Japan
- Department of Epidemiology and Public Health, University College London, London, UK
| | - J. Aida
- Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - R.G. Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - G. Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A. Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - H. Kato
- Graduate School of Business Administration, Keio University, Yokohama, Japan
| | - S. Kiuchi
- Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - K. Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - K. Osaka
- Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, Sendai, Japan
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21
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Ntouva A, Porter J, Crawford MJ, Britton A, Gratus C, Newton T, Tsakos G, Heilmann A, Pikhart H, Watt RG. Alcohol Screening and Brief Advice in NHS General Dental Practices: A Cluster Randomized Controlled Feasibility Trial. Alcohol Alcohol 2019; 54:235-242. [PMID: 30882135 DOI: 10.1093/alcalc/agz017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/12/2019] [Accepted: 03/01/2019] [Indexed: 11/12/2022] Open
Abstract
AIM To assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice to eligible patients attending NHS dental practices in London. METHODS A two-arm cluster randomized controlled feasibility trial was conducted. Twelve dental practices were recruited and randomized to intervention and control arms. Participants attending for a dental check were recruited into the study and were eligible if they consumed alcohol above recommended levels assessed by the AUDIT-C screening tool. All eligible participants were asked to complete a baseline socio-demographic questionnaire. Six months after the completion of baseline measures, participants were contacted via telephone by a researcher masked to their allocation status. The full AUDIT tool was then administered. Alcohol consumption in the last 90 days was also assessed using the Form 90. A process evaluation assessed the acceptability of the intervention. RESULTS Over a 7-month period, 229 participants were recruited (95.4% recruitment rate) and at the 6 months follow-up, 176 participants were assessed (76.9% retention rate). At the follow-up, participants in the intervention arm were significantly more likely to report a longer abstinence period (3.2 vs. 2.3 weeks respectively, P = 0.04) and non-significant differences in AUDIT (44.9% vs. 59.8% AUDIT positive respectively, P = 0.053) and AUDIT C difference between baseline and follow-up (-0.67 units vs. -0.29 units respectively, P = 0.058). Results from the process evaluation indicated that the intervention and study procedures were acceptable to dentists and patients. CONCLUSIONS This study has demonstrated the feasibility and acceptability of dentists screening for alcohol misuse and providing brief advice.
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Affiliation(s)
| | - Jessie Porter
- Department of Epidemiology and Public Health, UCL, UK
| | | | - Annie Britton
- Department of Epidemiology and Public Health, UCL, UK
| | | | - Tim Newton
- King's College London Dental Institute, Kings College London, UK
| | | | - Anja Heilmann
- Department of Epidemiology and Public Health, UCL, UK
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, UCL, UK
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23
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Chu L, Kelly K, Gandara D, Lara P, Borowsky A, Meyers F, Mcpherson J, Erlich R, Almog N, Schrock A, Ali S, Ross J, Miller V, Heilmann A, Riess J. P3.13-26 Outcomes of Patients with Metastatic Lung Cancer Presented in a Multidisciplinary Molecular Tumor Board. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Mishu MP, Tsakos G, Heilmann A, Watt RG. Dental caries and anthropometric measures in a sample of 5- to 9-year-old children in Dhaka, Bangladesh. Community Dent Oral Epidemiol 2018; 46:449-456. [PMID: 30080262 DOI: 10.1111/cdoe.12412] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 03/13/2018] [Accepted: 07/14/2018] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to assess associations between dental caries and anthropometric measures among a sample of children aged 5-9 years in Dhaka, Bangladesh. METHODS A cross-sectional observational study was conducted among 5- to 9-year-old children in Dhaka, Bangladesh. Data were collected from children and their parents attending the Dhaka Dental College Hospital and from three nearby primary schools. The outcome measures were as follows: age and sex adjusted height-z-scores (HAZ), weight-z-scores (WAZ) and BMI-z-scores (BAZ). Multiple linear regressions were used to assess the associations between caries and anthropometric measures, adjusted for maternal education, family income, study setting, birth weight and childhood diseases as potential confounders. RESULTS The final sample comprised 788 children, and the overall response rate was 96.7%. The majority (73.2%) had experience of dental caries. The mean dmft + DMFT score was 2.84 (95% CI 2.64, 3.03) and 35.8% experienced dental sepsis. Dental caries and sepsis were negatively associated with HAZ, WAZ and BAZ scores. After adjustment for potential confounders, children with severe levels of caries had lower HAZ scores (coefficient: -0.40; 95% CI -0.69, -0.10), lower WAZ scores (coefficient: -0.59; 95% CI -0.94, -0.24) and lower BAZ scores (coefficient: -0.50; 95% CI -0.87, -0.13) than those who were caries free. Children with moderate levels of caries also had lower WAZ scores (coefficient: -0.43; 95% CI -0.72, -0.15) and lower BAZ scores (coefficient: -0.43; 95% CI -0.72, -0.13) than caries-free children. Children with dental sepsis had lower HAZ (coefficient: -0.23; 95% CI -0.42, -0.03), WAZ (coefficient: -0.33; 95% CI -0.56, -0.10) and BAZ scores (coefficient: -0.29; 95% CI -0.53, -0.05) than dental sepsis-free children. CONCLUSIONS Dental caries was associated with lower height, weight and BMI among this sample of Bangladeshi children, even after adjusting for age and sex and a number of potential confounders.
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Affiliation(s)
- Masuma Pervin Mishu
- Department of Health Science, Faculty of Sciences, University of York, Heslington, UK
| | - Georgios Tsakos
- Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Anja Heilmann
- Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Richard G Watt
- Research Department of Epidemiology and Public Health, University College London (UCL), London, UK
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Peregrino AB, Watt RG, Heilmann A, Jivraj S. Breastfeeding practices in the United Kingdom: Is the neighbourhood context important? Matern Child Nutr 2018; 14:e12626. [PMID: 29888866 DOI: 10.1111/mcn.12626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 03/23/2018] [Accepted: 04/20/2018] [Indexed: 01/27/2023]
Abstract
Breastfeeding is an important public health issue worldwide. Breastfeeding rates in the United Kingdom, particularly for exclusive breastfeeding, are low compared with other OECD countries, despite its wide-ranging health benefits for both mother and child. There is evidence that deprivation in the structural and social organisation of neighbourhoods is associated with adverse child outcomes. This study aimed to explore whether breastfeeding initiation, exclusive breastfeeding for at least 3 months, and any type of breastfeeding for at least 6 months were associated with neighbourhood context measured by neighbourhood deprivation and maternal neighbourhood perceptions in a nationally representative U.K. SAMPLE A cross-sectional analysis was conducted using data from the Millennium Cohort Study. Logistic regression was carried out on a sample of 17,308 respondents, adjusting for individual- and familial-level socio-demographic characteristics. Neighbourhood deprivation was independently and inversely associated with breastfeeding initiation. Compared with the least deprived areas, the likelihood of initiating breastfeeding was 40% lower in the most deprived neighbourhoods (OR: 0.60, 95% CI [0.50, 0.72]). The relationship between both exclusive and any type of breastfeeding at 3 and 6 months respectively with neighbourhood deprivation after adjustment for potential confounders was not entirely linear. Breastfeeding initiation (OR: 0.78, 95% CI [0.71, 0.85]), exclusivity for 3 months (OR: 0.84, 95% CI [0.75, 0.95]), and any breastfeeding for 6 months (OR: 0.82, 95% CI [0.73, 0.93]) were each reduced by about 20% among mothers who perceived their neighbourhoods lacking safe play areas for children. Policies to improve breastfeeding rates should consider area-based approaches and the broader determinants of social inequalities.
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Affiliation(s)
- Andressa B Peregrino
- Research Department of Epidemiology and Public Health, University College London, Torrington Place, London, UK
| | - Richard G Watt
- Research Department of Epidemiology and Public Health, University College London, Torrington Place, London, UK
| | - Anja Heilmann
- Research Department of Epidemiology and Public Health, University College London, Torrington Place, London, UK
| | - Stephen Jivraj
- Research Department of Epidemiology and Public Health, University College London, Torrington Place, London, UK
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Dittrich S, Graf E, Neudorf U, Heilmann A, Schara U, Kirschner J, Stiller B. Effect and Safety of Treatment with ACE-Inhibitor Enalapril and β-Blocker Metoprolol on the Onset of Left Ventricular Dysfunction in Duchenne Muscular Dystrophy: Results from a Six Years, Double-blind, Randomized Placebo-controlled Trial. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S. Dittrich
- Pediatric Cardiology, Erlangen University Hospital, Erlangen, Germany
| | - E. Graf
- Clinical Trials Unit of the Medical Center, University of Freiburg, Freiburg, Germany
| | - U. Neudorf
- Clinic for Pediatrics III, University Hospital Essen, Essen, Germany
| | - A. Heilmann
- Department of Pediatrics, University Hospital Carl Gustav Carus, Dresden, Germany
| | - U. Schara
- Pediatric Neurology, University Hospital Essen, Essen, Germany
| | - J. Kirschner
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
| | - B. Stiller
- Congenital Heart Defects and Pediatric Cardiology, Heart Center Freiburg University, Freiburg, Germany
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27
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Schwan S, Ludtka C, Friedmann A, Mendel T, Meisel HJ, Heilmann A, Kaden I, Goehre F. Calcium Microcrystal Formation in Recurrent Herniation Patients After Autologous Disc Cell Transplantation. Tissue Eng Regen Med 2017; 14:803-814. [PMID: 30603529 DOI: 10.1007/s13770-017-0076-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/25/2017] [Revised: 07/04/2017] [Accepted: 07/12/2017] [Indexed: 12/25/2022] Open
Abstract
Autologous disc cell transplantation (ADCT) is a cell-based therapy aiming to initiate regeneration of intervertebral disc (IVD) tissue, but little is known about potential risks. This study aims to investigate the presence of structural phenomena accompanying the transformation process after ADCT treatment in IVD disease. Structural phenomena of ADCT-treated patients (Group 1, n = 10) with recurrent disc herniation were compared to conventionally-treated patients with recurrent herniation (Group 2, n = 10) and patients with a first-time herniation (Group 3, n = 10). For ethical reasons, a control group of ADCT patients who did not have a recurrent disc herniation was not possible. Tissue samples were obtained via micro-sequestrectomy after disc herniation and analyzed by micro-computed tomography, scanning electron microscopy, energy dispersive spectroscopy, and histology in terms of calcification zones, tissue structure, cell density, cell morphology, and elemental composition. The major differentiator between sample groups was calcium microcrystal formation in all ADCT samples, not found in any of the control group samples, which may indicate disc degradation. The incorporation of mineral particles provided clear contrast between the different materials and chemical analysis of a single particle indicated the presence of magnesium-containing calcium phosphate. As IVD calcification is a primary indicator of disc degeneration, further investigation of ADCT and detailed investigations assessing each patient's Pfirrmann degeneration grade following herniation is warranted. Structural phenomena unique to ADCT herniation prompt further investigation of the therapy's mechanisms and its effect on IVD tissue. However, the impossibility of a perfect control group limits the generalizable interpretation of the results.
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Affiliation(s)
- S Schwan
- 1Translational Centre of Regenerative Medicine TRM, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.,2Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Huelse-Str. 1, 06120 Halle (Saale), Germany
| | - C Ludtka
- 1Translational Centre of Regenerative Medicine TRM, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.,2Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Huelse-Str. 1, 06120 Halle (Saale), Germany.,3Department of Chemical and Biomolecular Engineering, University of Tennessee, 1512 Middle Drive, Knoxville, TN 37996 USA
| | - A Friedmann
- 1Translational Centre of Regenerative Medicine TRM, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.,2Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Huelse-Str. 1, 06120 Halle (Saale), Germany
| | - T Mendel
- 4Department of Trauma Surgery, Friedrich-Schiller-University, Am Klinikum 1, 07747 Jena, Germany.,Department of Trauma Surgery, BG-Klinikum Bergmannstrost Halle, Merseburger Straße 165, 06112 Halle (Saale), Germany
| | - H J Meisel
- Department of Neurosurgery, BG-Klinikum Bergmannstrost Halle, Merseburger Straße 165, 06112 Halle (Saale), Germany
| | - A Heilmann
- 2Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Walter-Huelse-Str. 1, 06120 Halle (Saale), Germany
| | - I Kaden
- Department of Diagnostic Imaging and Interventional Radiology, BG-Klinikum Bergmannstrost Halle, Merseburger Straße 165, 06112 Halle (Saale), Germany
| | - F Goehre
- 1Translational Centre of Regenerative Medicine TRM, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.,Department of Neurosurgery, BG-Klinikum Bergmannstrost Halle, Merseburger Straße 165, 06112 Halle (Saale), Germany.,Department of Neurosurgery, Helsinki University Central Hospital, University of Helsinki, Topeliuksenkatu 5, 00029 Helsinki, Finland
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Listl S, Broadbent JM, Thomson WM, Stock C, Shen J, Steele J, Wildman J, Heilmann A, Watt RG, Tsakos G, Peres MA, van der Heijden G, Jürges H. Childhood socioeconomic conditions and teeth in older adulthood: Evidence from SHARE wave 5. Community Dent Oral Epidemiol 2017; 46:78-87. [PMID: 28925509 DOI: 10.1111/cdoe.12332] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 11/02/2016] [Accepted: 08/02/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Dental diseases are the most common chronic diseases worldwide. Healthy teeth are vital for quality of life, particularly diet and nutrition. However, little information exists to inform health policymakers about potentially long-lasting influences of early-life conditions. The purpose of this study was to investigate the relation between early-life socioeconomic conditions and number of natural teeth at age 50 and above. METHODS Analyses were conducted on cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE wave 5), which includes information on 41 560 respondents aged 50 years or older from 14 European countries and Israel. Using SHARE life history information, a series of regression models (OLS, Tobit) were estimated to analyse the relationship between socioeconomic conditions in earlier life and the number of teeth at age 50+. RESULTS Childhood socioeconomic background was associated with the number of natural teeth at age 50 and above, even after controlling for current determinants of oral health. Respondents who had had more than 25 books in their childhood household had a mean 1.4 (95% CI: 1.2-1.5) more teeth than respondents with fewer books. Respondents who reported poor financial conditions during childhood had a mean 0.6 (95% CI: 0.3-0.9) fewer teeth than respondents who reported better financial conditions in childhood. CONCLUSION These findings substantiate the association between socioeconomic conditions in the early years of life and tooth retention to older adulthood and highlight the long-lasting relation between childhood living conditions and oral health through the lifecourse.
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Affiliation(s)
- Stefan Listl
- Department of Quality and Safety of Oral Health Care, Radboud University Nijmegen, Nijmegen, The Netherlands.,Department of Conservative Dentistry, Translational Health Economics Group (THE Group), Heidelberg University, Heidelberg, Germany
| | - Jonathan M Broadbent
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Christian Stock
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Jing Shen
- Newcastle upon Tyne, Newcastle University, Newcastle, UK
| | - Jimmy Steele
- Newcastle upon Tyne, Newcastle University, Newcastle, UK
| | - John Wildman
- Newcastle upon Tyne, Newcastle University, Newcastle, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Marco A Peres
- Australian Research Centre for Population Oral Health (ARCPOH), University of Adelaide, Adelaide, SA, Australia
| | - Geert van der Heijden
- Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
| | - Hendrik Jürges
- Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
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Heilmann A, Rouxel P, Fitzsimons E, Kelly Y, Watt RG. Longitudinal associations between television in the bedroom and body fatness in a UK cohort study. Int J Obes (Lond) 2017; 41:1503-1509. [PMID: 28566749 PMCID: PMC5630663 DOI: 10.1038/ijo.2017.129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 04/28/2017] [Accepted: 05/16/2017] [Indexed: 11/16/2022]
Abstract
Objective: To assess longitudinal associations between screen-based media use (television (TV) and computer hours, having a TV in the bedroom) and body fatness among UK children. Methods: Participants were 12 556 children from the UK Millennium Cohort Study who were followed from age 7 to age 11 years. Associations were assessed between screen-based media use and the following outcomes: body mass index (BMI), fat mass index (FMI), and overweight. Results: In fully adjusted models, having a bedroom TV at age 7 years was associated with significantly higher BMI and FMI (excess BMI for boys=0.29, 95% confidence interval (CI) 0.06–0.52; excess BMI for girls=0.57, 95% CI 0.31–0.84; excess FMI for boys=0.20, 95% CI 0.04–0.37; excess FMI for girls=0.39, 95% CI 0.21–0.57) and increased risk of being overweight (relative risk (RR) for boys=1.21, 95% CI 1.07–1.36; RR for girls=1.31, 95% CI 1.15–1.48) at age 11 years, compared with having no bedroom TV. Hours spent watching TV or digital versatile disks were associated with increased risk of overweight among girls only. Computer use at age 7 years was not related to later body fatness for either gender. Conclusion: Having a TV in the child’s bedroom was an independent risk factor for overweight and increased body fatness in this nationally representative sample of UK children. Childhood obesity prevention strategies should consider TVs in children’s bedrooms as a risk factor for obesity.
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Affiliation(s)
- A Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - P Rouxel
- Department of Epidemiology and Public Health, University College London, London, UK.,Eastman Dental Institute, University College London, London, UK
| | - E Fitzsimons
- Institute of Education, University College London, London, UK
| | - Y Kelly
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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30
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Le Dortz J, Heilmann A, Antier M, Bourderionnet J, Larat C, Fsaifes I, Daniault L, Bellanger S, Simon Boisson C, Chanteloup JC, Lallier E, Brignon A. Highly scalable femtosecond coherent beam combining demonstrated with 19 fibers. Opt Lett 2017; 42:1887-1890. [PMID: 28504751 DOI: 10.1364/ol.42.001887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Coherent beam combining in the femtosecond regime of a record number of 19 fibers is demonstrated. The interferometric phase measurement technique, particularly well suited to phase-lock a very large number of fibers, is successfully demonstrated in the femtosecond regime. A servo loop is implemented to control piezoelectric fiber stretchers for both phase and delay variation compensation. The residual phase errors are below λ/60 rms. Nearly 50% of the total energy is contained in the far-field central lobe. After compression, we obtain a combined pulse width of 300 fs identical to the master oscillator pulse width.
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31
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Holz C, Benning J, Schaudt M, Heilmann A, Schultchen J, Goelling D, Lang C. Novel bioactive from Lactobacillus brevis DSM17250 to stimulate the growth of Staphylococcus epidermidis: a pilot study. Benef Microbes 2016; 8:121-131. [PMID: 27824277 DOI: 10.3920/bm2016.0073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Commensal skin microbiota plays an important role in both influencing the immune response of the skin and acting as a barrier against colonisation of potentially pathogenic microorganisms and overgrowth of opportunistic pathogens. Staphylococcus epidermidis is a key constituent of the normal microbiota on human skin. It balances the inflammatory response after skin injury and produces antimicrobial molecules that selectively inhibit skin pathogens. Here we describe Lactobacillus brevis DSM17250 that was identified among hundreds of Lactobacillus strains to exhibit an anti-inflammatory effect in human keratinocytes in vitro and specific stimulatory impact on the growth of S. epidermidis. The aqueous cell-free extract of L. brevis DSM17250 was used in an ointment formulation and tested in a randomized placebo-controlled double blinded human pilot study. Healthy volunteers with diagnosed dry skin were treated for four weeks. The study data shows that L. brevis DSM17250 extract induces re-colonisation of the skin by protective commensal microorganisms as judged from selective bacterial cultivation of surface-associated skin microorganism of the lower leg. Furthermore, the 4 week administration of the L. brevis DSM17250 extract significantly improved the transepidermal water loss value (TEWL), reduced the xerosis cutis symptoms and stinging. The data shows that daily application of L. brevis DSM17250 extract in a topical product significantly improves the microbial skin microbiota by promoting the growth of species which possess beneficial regulatory and protective properties such as S. epidermidis. Restoring the natural skin microbiota leads to significantly improved skin barrier function (as transepidermal water loss) and decrease of xeroderma (xerosis cutis) symptoms (as measured by dry skin area and severity index, DASI). We propose that improving and stabilizing the natural skin microbiota by specifically stimulating the growth of S. epidermidis is an important and novel concept to manage skin diseases associated with microbiota dysbiosis.
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Affiliation(s)
- C Holz
- 1 Organobalance GmbH, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - J Benning
- 1 Organobalance GmbH, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - M Schaudt
- 2 Analyse & Realize GmbH, Waldseeweg 6, 13467 Berlin, Germany.,3 PRA health Sciences, Gottlieb-Daimler-Straβe 10, 68165 Mannheim, Germany
| | - A Heilmann
- 1 Organobalance GmbH, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - J Schultchen
- 1 Organobalance GmbH, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - D Goelling
- 1 Organobalance GmbH, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - C Lang
- 1 Organobalance GmbH, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
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Mishu MP, Watt R, Tsakos G, Heilmann A. Associations between dental caries and BMI among 5-9 year old Bangladeshi children. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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33
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Letelier A, Heilmann A, Watt RG, Jivraj S, Tsakos G. Does intergenerational social mobility affect health, oral health and function among British adults? Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw166.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Watt RG, Heilmann A, Rouxel P, Williams DM, Tsakos G. Aubrey Sheiham: Iconoclast and Dental Public Health Pioneer. J Dent Res 2016; 95:1441-1444. [PMID: 27625356 DOI: 10.1177/0022034516664478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- R G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - P Rouxel
- Department of Epidemiology and Public Health, University College London, London, UK.,UCL Eastman Dental Institute, London, UK
| | - D M Williams
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, London, UK
| | - G Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
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Letelier A, Heilmann A, Watt RG, Jivraj S, Tsakos G. P84 Does intergenerational social mobility affect general health, oral health and physical function among older adults in England? Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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36
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Blokland A, Watt RG, Tsakos G, Heilmann A. Traumatic dental injuries and socioeconomic position - findings from the Children's Dental Health Survey 2013. Community Dent Oral Epidemiol 2016; 44:586-591. [DOI: 10.1111/cdoe.12252] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Alex Blokland
- Department of Epidemiology and Public Health; University College London; London UK
| | - Richard G. Watt
- Department of Epidemiology and Public Health; University College London; London UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health; University College London; London UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health; University College London; London UK
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Abstract
Loneliness is a serious concern in aging populations. The key risk factors include poor health, depression, poor material circumstances, and low social participation and social support. Oral disease and tooth loss have a significant negative impact on the quality of life and well-being of older adults. However, there is a lack of studies relating oral health to loneliness. This study investigated the association between oral health-related quality of life (through the use of the oral impact on daily performances—OIDP—measure) and loneliness amongst older adults living in England. Data from respondents aged 50 and older from the third (2006–2007) and fifth (2010–2011) waves of the English Longitudinal Study of Ageing were analyzed. In the cross-sectional logistic regression model that adjusted for socio-demographic, socio-economic, health, and psychosocial factors, the odds of loneliness were 1.48 (1.16–1.88; p < 0.01) higher amongst those who reported at least one oral impact compared to those with no oral impact. Similarly, in the fully adjusted longitudinal model, respondents who reported an incident oral impact were 1.56 times (1.09–2.25; p < 0.05) more likely to become lonely. The association between oral health-related quality of life and loneliness was attenuated after adjusting for depressive symptoms, low social participation, and social support. Oral health-related quality of life was identified as an independent risk factor for loneliness amongst older adults. Maintaining good oral health in older age may be a protective factor against loneliness.
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Affiliation(s)
- Patrick Rouxel
- UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD UK.,UCL, Epidemiology and Public Health, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Anja Heilmann
- UCL, Epidemiology and Public Health, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Panayotes Demakakos
- UCL, Epidemiology and Public Health, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Jun Aida
- Division of International and Community Oral Health, Tohoku University, 4-1 Seiryo-machi, Sendai, Japan
| | - Georgios Tsakos
- UCL, Epidemiology and Public Health, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Richard G Watt
- UCL, Epidemiology and Public Health, 1-19 Torrington Place, London, WC1E 6BT UK
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Affiliation(s)
- R G Watt
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - A Heilmann
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - S Listl
- Translational Health Economics Group, Department of Conservative Dentistry, Heidelberg University, Heidelberg, Germany Munich Center for the Economics of Aging, Max Planck Institute for Social Law and Social Policy, Munich, Germany
| | - M A Peres
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
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Ntouva A, Porter J, Crawford MJ, Britton A, Gratus C, Newton T, Tsakos G, Heilmann A, Pikhart H, Watt RG. Assessing the feasibility of screening and providing brief advice for alcohol misuse in general dental practice: a clustered randomised control trial protocol for the DART study. BMJ Open 2015; 5:e008586. [PMID: 26443659 PMCID: PMC4606386 DOI: 10.1136/bmjopen-2015-008586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Alcohol misuse is a significant public health problem with major health, social and economic consequences. Systematic reviews have reported that brief advice interventions delivered in various health service settings can reduce harmful drinking. Although the links between alcohol and oral health are well established and dentists come into contact with large numbers of otherwise healthy patients regularly, no studies have been conducted in the UK to test the feasibility of delivering brief advice about alcohol in general dental settings. METHODS AND ANALYSIS The Dental Alcohol Reduction Trial (DART) aims to assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice in patients attending National Health Service (NHS) general dental practices in North London. DART is a cluster randomised control feasibility trial and uses a mixed methods approach throughout the development, design, delivery and evaluation of the intervention. It will be conducted in 12 NHS general dental practices across North London and will include dental patients who drink above the recommended guidance, as measured by the Alcohol Use Disorders Identification Test (AUDIT-C) screening tool. The intervention involves 5 min of tailored brief advice delivered by dental practitioners during the patient's appointment. Feasibility and acceptability measures as well as suitability of proposed primary outcomes of alcohol consumption will be assessed. Initial economic evaluation will be undertaken. Recruitment and retention rates as well as acceptability of the study procedures from screening to follow-up will be measured. ETHICS AND DISSEMINATION Ethical approval was obtained from the Camden and Islington Research Ethics Committee. Study outputs will be disseminated via scientific publications, newsletters, reports and conference presentations to a range of professional and patient groups and stakeholders. Based on the results of the trial, recommendations will be made on the conduct of a definitive randomised controlled trial. TRIAL REGISTRATION NUMBER ISRCTN81193263.
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Affiliation(s)
- Antiopi Ntouva
- UCL Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Jessie Porter
- UCL Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Mike J Crawford
- Faculty of Medicine, Department of Medicine,Imperial College London, London, UK
| | - Annie Britton
- UCL Research Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Tim Newton
- Division of Health and Social Care Research, King's College London, Dental Institute, London, UK
| | - Georgios Tsakos
- UCL Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Anja Heilmann
- UCL Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Hynek Pikhart
- UCL Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- UCL Research Department of Epidemiology and Public Health, University College London, London, UK
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Heilmann A, Sheiham A, Watt RG, Jordan RA. [The Common Risk Factor Approach - An Integrated Population- and Evidence-Based Approach for Reducing Social Inequalities in Oral Health]. Gesundheitswesen 2015; 78:672-677. [PMID: 26335657 DOI: 10.1055/s-0035-1548933] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Worldwide, non-communicable diseases including dental caries and periodontal diseases, remain a major public health problem. Moreover, there is a social gradient in health across society that runs from the top to the bottom in a linear, stepwise fashion. Health promoting behaviours become more difficult to sustain further down the social ladder. Oral health inequalities also exist in Germany. Earlier explanations of social inequalities have mainly focused on individual lifestyle factors, ignoring the broader social determinants of health and disease. Until recently, the dominant approaches to general health promotion focused on actions to reduce specific diseases, separating oral health from general health. An alternative approach is the common risk factor approach (CRFA) where risk factors common to a number of major chronic diseases, including diseases of the mouth and teeth, are tackled. The CRFA focuses on the common underlying determinants of health to improve the overall health of populations, thereby reducing social inequalities. The main implication of the CRFA for oral health policies is to work in partnership with a range of other sectors and disciplines. Oral health issues need to be integrated with recommendations to promote general health. Improvements in oral health and a reduction in oral health inequalities are more likely by working in partnership across sectors and disciplines using strategies that focus upstream on the underlying determinants of oral diseases.
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Affiliation(s)
- A Heilmann
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - A Sheiham
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - R G Watt
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - R A Jordan
- Institut der Deutschen Zahnärzte, (IDZ), Köln
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Ali S, Wang K, Johnson A, Suh J, Heilmann A, Lipson D, Yelensky R, Chmielecki J, Elvin J, Konduri K, Subbiah V, Stephens P, Ross J, Miller V. 3007 Comprehensive genomic profiling characterizes the cpectrum of non-V600E activating BRAF alterations Including BRAF fusions in lung cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31652-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rapp AE, Bindl R, Heilmann A, Erbacher A, Müller I, Brenner RE, Ignatius A. Systemic mesenchymal stem cell administration enhances bone formation in fracture repair but not load-induced bone formation. Eur Cell Mater 2015; 29:22-34. [PMID: 25552426 DOI: 10.22203/ecm.v029a02] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Mesenchymal stem cells (MSC) were shown to support bone regeneration, when they were locally transplanted into poorly healing fractures. The benefit of systemic MSC transplantation is currently less evident. There is consensus that systemically applied MSC are recruited to the site of injury, but it is debated whether they actually support bone formation. Furthermore, the question arises as to whether circulating MSC are recruited only in case of injury or whether they also participate in mechanically induced bone formation. To answer these questions we injected green fluorescent protein (GFP)-labelled MSC into C57BL/6J mice, which were subjected either to a femur osteotomy or to non-invasive mechanical ulna loading to induce bone formation. We detected GFP-labelled MSC in the early (day 10) and late fracture callus (day 21) by immunohistochemistry. Stromal cell-derived factor 1 (SDF-1 or CXCL-12), a key chemokine for stem cell attraction, was strongly expressed by virtually all cells near the osteotomy--indicating that SDF-1 may mediate cell migration to the site of injury. We found no differences in SDF-1 expression between the groups. Micro-computed tomography (µCT) revealed significantly more bone in the callus of the MSC treated mice compared to untreated controls. The bending stiffness of callus was not significantly altered after MSC-application. In contrast, we failed to detect GFP-labelled MSC in the ulna after non-invasive mechanical loading. Histomorphometry and µCT revealed a significant load-induced increase in bone formation; however, no further increase was found after MSC administration. Concluding, our results suggest that systemically administered MSC are recruited and support bone formation only in case of injury but not in mechanically induced bone formation.
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Affiliation(s)
- A E Rapp
- Institute of Orthopaedic Research and Biomechanics, Helmholtzstr. 14, 89081 Ulm,
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Rouxel PL, Heilmann A, Aida J, Tsakos G, Watt RG. Social capital: theory, evidence, and implications for oral health. Community Dent Oral Epidemiol 2014; 43:97-105. [DOI: 10.1111/cdoe.12141] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Anja Heilmann
- Department of Epidemiology and Public Health; UCL; London UK
| | - Jun Aida
- Department of International and Community Oral Health; Tohoku University; Sendai Japan
| | - Georgios Tsakos
- Department of Epidemiology and Public Health; UCL; London UK
| | - Richard G. Watt
- Department of Epidemiology and Public Health; UCL; London UK
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Watt RG, Heilmann A, Sabbah W, Newton T, Chandola T, Aida J, Sheiham A, Marmot M, Kawachi I, Tsakos G. Social relationships and health related behaviors among older US adults. BMC Public Health 2014; 14:533. [PMID: 24885507 PMCID: PMC4046043 DOI: 10.1186/1471-2458-14-533] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health behaviors are a key determinant of health and well-being that are influenced by the nature of the social environment. This study examined associations between social relationships and health-related behaviors among a nationally representative sample of older people. METHODS We analyzed data from three waves (1999-2004) of the US National Health and Nutrition Examination Survey (NHANES). Participants were 4,014 older Americans aged 60 and over. Log-binomial regression models estimated prevalence ratios (PR) for the associations between social relationships and each of the following health behaviors: alcohol use, smoking, physical activity and dental attendance. RESULTS Health-compromising behaviors (smoking, heavy drinking and less frequent dental visits) were related to marital status, while physical activity, a health-promoting behavior, was associated with the size of friendship networks. Smoking was more common among divorced/separated (PR = 2.1; 95% CI: 1.6, 2.7) and widowed (PR = 1.7; 95% CI: 1.3, 2.3) respondents than among those married or cohabiting, after adjusting for socio-demographic background. Heavy drinking was 2.6 times more common among divorced/separated and 1.7 times more common among widowed men compared to married/cohabiting men, while there was no such association among women. For women, heavy drinking was associated with being single (PR = 1.7; 95% CI: 1.0, 2.9). Being widowed was related to a lower prevalence of having visited a dentist compared to being married or living with a partner (PR = 0.92; 95% CI 0.86, 0.99). Those with a larger circle of friends were more likely to be physically active (PR = 1.17; 95% CI:1.06, 1.28 for 5-8 versus less than 5 friends). CONCLUSIONS Social relationships of older Americans were independently associated with different health-related behaviors, even after adjusting for demographic and socioeconomic determinants. Availability of emotional support did not however mediate these associations. More research is needed to assess if strengthening social relationships would have a significant impact on older people's health behaviors and ultimately improve their health.
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Affiliation(s)
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Lohse J, Stächele J, Heilmann A, Schwier F, Schmidt U, Erfurt C, Knöfler R. Significance of platelet function diagnostics for clarification of suspected battered child syndrome. Hamostaseologie 2014; 34 Suppl 1:S53-6. [DOI: 10.5482/hamo-14-02-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 06/18/2014] [Indexed: 11/05/2022] Open
Abstract
SummarySummary: The manifestation of an unclear bleeding tendency in childhood calls for an extended coagulation work-up, particularly when a battered child syndrome is suspected and typical concomitant injuries are absent. The chosen diagnostic tests should be able to detect the presence of relatively common coagulation defects such as von Willebrand syndrome or hemophilia, but also rare diseases such as inherited thrombocytopathies. The PFA-100® test does not help to provide a definite diagnosis especially in cases of mild inherited thrombocytopathies, since in most cases the PFA-100® test results are normal. For this purpose, specific platelet function testing is needed. However, the methods are only available in some coagulation laboratories. Also, other limitations need to be taken into consideration such as pre-analytical problems and difficulties in the interpretation of test results especially in infants.We present two cases that were diagnosed with an aspirin-like defect as an inherited thrombocytopathy, even though their PFA-100 closure times were within the normal range. Based on pathological findings in the platelet aggregometry test, this diagnosis could be made.
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Heilmann A, Kelly Y, Stafford M, Watt RG. OP57 The Contribution of Neighbourhoods and Schools to Cognitive Test Performance at Age Seven - Findings from the UK Millennium Cohort Study. J Epidemiol Community Health 2013. [DOI: 10.1136/jech-2013-203126.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Biermann D, Heilmann A, Didié M, Schlossarek S, Wahab A, Donzelli S, Carrier L, Ehmke H, Zimmermann WH, Reichenspurner H, Böger RH, Benndorf RA. The role of AT2-receptors in neonatal cardiovascular development. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mayr H, Klehm J, Schwan S, Hube R, Südkamp N, Niemeyer P, Salzmann G, von Eisenhardt-Rothe R, Heilmann A, Bohner M, Bernstein A. Microporous calcium phosphate ceramics as tissue engineering scaffolds for the repair of osteochondral defects: biomechanical results. Acta Biomater 2013; 9:4845-55. [PMID: 22885682 DOI: 10.1016/j.actbio.2012.07.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/23/2012] [Accepted: 07/26/2012] [Indexed: 10/28/2022]
Abstract
This work investigated the suitability of microporous β-tricalcium phosphate (TCP) scaffolds pre-seeded with autologous chondrocytes for treatment of osteochondral defects in a large animal model. Microporous β-TCP cylinders (Ø 7 mm; length 25 mm) were seeded with autologous chondrocytes and cultured for 4 weeks in vitro. Only the upper end of the cylinder was seeded with chondrocytes. Chondrocytes formed a multilayer on the top. The implants were then implanted in defects (diameter 7 mm) created in the left medial femoral condyle of ovine knees. The implants were covered with synovial membrane from the superior recess of the same joint. For the right knees, an empty defect with the same dimensions served as control. Twenty-eight sheep were split into 6-, 12-, 26- and 52 week groups of seven animals. Indentation tests with a spherical (Ø 3mm) indenter were used to determine the biomechanical properties of regenerated tissue. A software-based limit switch was implemented to ensure a maximal penetration depth of 200 μm and maximal load of 1.5 N. The achieved load, the absorbed energy and the contact stiffness were measured. Newly formed cartilage was assessed with the International Cartilage Repair Society Visual Assessment Scale (ICRS score) and histomorphometric analysis. Results were analysed statistically using the t-test, Mann-Whitney U-test and Wilcoxon test. Statistical significance was set at p<0.05. After 6 weeks of implantation, the transplanted area tolerated an indentation load of 0.05±0.20 N. This value increased to 0.10±0.06 N after 12 weeks, to 0.27±0.18 N after 26 weeks, and 0.27±0.11 N after 52 weeks. The increase in the tolerated load was highly significant (p<0.0001), but the final value was not significantly different from that of intact cartilage (0.30±0.12 N). Similarly, the increase in contact stiffness from 0.87±0.29 N mm-(1) after 6 weeks to 3.14±0.86 N mm(-1) after 52 weeks was highly significant (p<0.0001). The absorbed energy increased significantly (p=0.02) from 0.74×10(-6)±0.38×10(-6) Nm after 6 weeks to 2.83×10(-6)±1.35×10(-6) Nm after 52 weeks. At 52 weeks, the International Cartilage Repair Society (ICRS) scores for the central area of the transplanted area and untreated defects were comparable. In contrast, the score for the area from the edge to the centre of the transplanted area was significantly higher (p=0.001) than the score for the unfilled defects. A biomechanically stable cartilage was built outside the centre of defect. After 52 weeks, all but one empty control defect were covered by bone and a very thin layer of cartilage (ICRS 7 points). The empty hole could still be demonstrated beneath the bone. The histomorphometric evaluation revealed that 81.0±10.6% of TCP was resorbed after 52 weeks. The increase in TCP resorption and replacement by spongy bone during the observation period was highly significant (p<0.0001). In this sheep trial, the mechanical properties of microporous TCP scaffolds seeded with transplanted autologous chondrocytes were similar to those of natural cartilage after 52 weeks of implantation. However, the central area of the implants had a lower ICRS score than healthy cartilage. Microporous TCP was almost fully resorbed at 52 weeks and replaced by bone.
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Olofsson J, Pettersson M, Teuscher N, Heilmann A, Larsson K, Grandfield K, Persson C, Jacobson S, Engqvist H. Fabrication and evaluation of SixNy coatings for total joint replacements. J Mater Sci Mater Med 2012; 23:1879-1889. [PMID: 22689010 DOI: 10.1007/s10856-012-4625-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/17/2012] [Indexed: 06/01/2023]
Abstract
Wear particles from the bearing surfaces of joint implants are one of the main limiting factors for total implant longevity. Si(3)N(4) is a potential wear resistant alternative for total joint replacements. In this study, Si(x)N(y)-coatings were deposited on cobalt chromium-discs and Si-wafers by a physical vapour deposition process. The tribological properties, as well as surface appearance, chemical composition, phase composition, structure and hardness of these coatings were analysed. The coatings were found to be amorphous or nanocrystalline, with a hardness and coefficient of friction against Si(3)N(4) similar to that found for bulk Si(3)N(4). The low wear rate of the coatings indicates that they have a potential as bearing surfaces of joint replacements. The adhesion to the substrates remains to be improved.
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Affiliation(s)
- J Olofsson
- Applied Materials Science, Uppsala University, Uppsala, Sweden.
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