Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland.
Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland.
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DOI：
10.1136/bmjopen-2020-038116
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发表时间：
2020-11-24
期刊：
影响因子：
2.9
通讯作者：
Conway DI
中科院分区：
文献类型：
--
作者：
Kidd JB;McMahon AD;Sherriff A;Gnich W;Mahmoud A;Macpherson LM;Conway DI
儿童龋齿是一个全球性的公共卫生挑战，具有高患病率和广泛的不平等。制定了一项综合公共卫生方案（儿童微笑）。我们的目的是评估该计划的覆盖范围及其对儿童口腔健康的影响。教育、卫生和社区环境，苏格兰范围内。Childsmile（国家口腔健康改善计划）干预措施：基于托儿所的氟化物保护漆应用（FVA）和监督日常刷牙，基于社区的牙科健康支持工作者（DHSW）接触和初级保健牙科实践访问-通过按比例普及的方法提供给人口。50379名儿童（平均年龄=5.5岁，SD=0.3）在地方政府学校上学（2014/2015）。基于人口的四个Childsmile干预措施的个体儿童水平数据与牙科检查调查数据相关联，以形成纵向队列。Logistic回归评估干预范围和每种干预措施对龋病经验的独立影响，调整年龄，性别和基于地区的苏格兰多元发育指数（SIMD）。该方案的覆盖面被定义为到单一人口监测数据五分之一时接受每种干预措施至少一次的儿童的百分比。明显的龋齿经历（存在/不存在）定义为存在龋齿（进入牙本质）、由于龋齿或填充乳牙而缺失（拔除）。15032名（29.8%）有患龋史。普遍干预措施的人群覆盖率较高：托儿所刷牙（89.1%），牙科诊所就诊（70.5%）。有针对性的干预措施非常有利于来自最贫困地区的儿童：卫生和社会福利部接触者（SIMD 1：29.5% vs SIMD 5：7.7%），托儿所FVA（SIMD 1：75.2% vs SIMD 5：23.2%）。参加幼儿园刷牙（>3年，校正OR（aOR）=0.60; 95% CI 0.55至0.66）和参加牙科实践（≥6次就诊，aOR=0.55; 95% CI 0.50至0.61）的儿童患龋齿的几率明显较低。卫生和社会福利部接触者的调查结果不太清楚。幼儿FVA与龋齿经验无关。普遍的干预措施，幼儿园刷牙和定期牙科实践访问是独立的，最强烈的相关性降低龋齿的经验，与幼儿园刷牙有最大的影响，在儿童中的高度贫困地区。
Child dental caries is a global public health challenge with high prevalence and wide inequalities. A complex public health programme (Childsmile) was established. We aimed to evaluate the reach of the programme and its impact on child oral health. Education, health and community settings, Scotland-wide. Childsmile (national oral health improvement programme) interventions: nursery-based fluoride varnish applications (FVAs) and supervised daily toothbrushing, community-based Dental Health Support Worker (DHSW) contacts and primary care dental practice visits—delivered to the population via a proportionate universal approach. 50 379 children (mean age=5.5 years, SD=0.3) attending local authority schools (2014/2015). Population-based individual child-level data on four Childsmile interventions linked to dental inspection survey data to form a longitudinal cohort. Logistic regression assessed intervention reach and the independent impact of each intervention on caries experience, adjusting for age, sex and area-based Scottish Index of Multiple Deprivation (SIMD). Reach of the programme is defined as the percentage of children receiving each intervention at least once by SIMD fifth. Obvious dental caries experience (presence/absence) is defined as the presence of decay (into dentine), missing (extracted) due to decay or filled deciduous teeth. 15 032 (29.8%) children had caries experience. The universal interventions had high population reach: nursery toothbrushing (89.1%), dental practice visits (70.5%). The targeted interventions strongly favoured children from the most deprived areas: DHSW contacts (SIMD 1: 29.5% vs SIMD 5: 7.7%), nursery FVAs (SIMD 1: 75.2% vs SIMD 5: 23.2%). Odds of caries experience were markedly lower among children participating in nursery toothbrushing (>3 years, adjusted OR (aOR)=0.60; 95% CI 0.55 to 0.66) and attending dental practice (≥6 visits, aOR=0.55; 95% CI 0.50 to 0.61). The findings were less clear for DHSW contacts. Nursery FVAs were not independently associated with caries experience. The universal interventions, nursery toothbrushing and regular dental practice visits were independently and most strongly associated with reduced odds of caries experience in the cohort, with nursery toothbrushing having the greatest impact among children in areas of high deprivation.
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影响因子：
4.4
作者：
Pavis, Stephen;Morris, Andrew D.
通讯作者：
Morris, Andrew D.
影响因子：
7.6
作者：
Macpherson, L. M. D.;Anopa, Y.;McMahon, A. D.
通讯作者：
McMahon, A. D.
影响因子：
2.6
作者：
Macpherson, L. M. D.;Ball, G. E.;Conway, D. I.
通讯作者：
Conway, D. I.
影响因子：
7.6
作者：
Kassebaum NJ;Smith AGC;Bernabé E;Fleming TD;Reynolds AE;Vos T;Murray CJL;Marcenes W;GBD 2015 Oral Health Collaborators
通讯作者：
GBD 2015 Oral Health Collaborators
影响因子：
168.9
作者：
Peres, Marco A.;Macpherson, Lorna M. D.;Watt, Richard G.
通讯作者：
Watt, Richard G.