Follow-up of an Intervention to Reduce Dental Caries in Indigenous Australian Children A Secondary Analysis of a Randomized Clinical Trial
Follow-up of an Intervention to Reduce Dental Caries in Indigenous Australian Children A Secondary Analysis of a Randomized Clinical Trial
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DOI：
10.1001/jamanetworkopen.2019.0648
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发表时间：
2019-03-01
影响因子：
13.8
通讯作者：
Ju, Xiangqun
中科院分区：
文献类型：
--
作者：
Jamieson, Lisa M.;Smithers, Lisa G.;Ju, Xiangqun
测试儿童干预措施的长期有效性和确定实施的最佳年龄对翻译和政策变化非常重要。目的：在3岁儿童中调查旨在减少南澳大利亚土著儿童龋齿的干预措施的长期有效性，并评估延迟干预（DI）组的儿童是否从2至3岁的干预中获益，以及在怀孕至2岁之间分娩的干预效果是否更大（立即干预[II]与2至3岁[DI]）。一项随机临床试验的二次分析。该研究在基线（2011年2月1日至2012年5月30日）在澳大利亚南澳大利亚招募了448名孕妇，其中223名随机分配到II组，225名随机分配到DI组。2014年11月至2016年2月，随访3年。干预措施干预措施包括对母亲进行牙科治疗，对儿童使用氟化物清漆，以及与预期指导一起进行动机性访谈。II组在怀孕期间和6、12、18个月大的孩子，DI组在24、30、36个月大的孩子。主要结果和测量：儿童3岁时测量的平均蛀牙数。结果3岁儿童324例，其中男性占52.3%。3岁时，II组的平均蛀牙数为1.44 (95% CI, 1.38 ~ 1.50)， DI组的平均蛀牙数为1.86 (95% CI, 1.89 ~ 2.03)（平均差异为-0.41;95% CI, -0.52 ~ -0.10）。DI组预测3岁时平均蛀牙数为2.15颗。2 ~ 3岁时，II组的龋增加为0.82 (95% CI, 0.75 ~ 0.89)，而DI组的龋增加为0.97 (95% CI, 0.87 ~ 1.17) （P = 0.05）。结论及相关性在3年的随访中，II组儿童龋齿发生率低于DI组儿童，在2 ~ 3岁未接受干预的情况下，DI组儿童龋齿发生率低于预期，II组儿童2 ~ 3岁的龋齿增量低于DI组儿童。这项研究表明，实施干预的最佳时间是婴儿期早期而不是婴儿期后期。
IMPORTANCE Testing the long-term usefulness of a childhood intervention and determining the best age of implementation are important for translation and policy change.OBJECTIVES To investigate among children aged 3 years the long-term effectiveness an intervention that aimed to reduce dental caries among South Australian Aboriginal children and to assess if children in the delayed intervention (DI) group had any benefit from the intervention from ages 2 to 3 years and if the intervention usefulness was greater when delivered between pregnancy and age 2 years (immediate intervention [II] vs ages 2 to 3 years [DI]).DESIGN, SETTING, AND PARTICIPANTS Secondary analysis of a randomized clinical trial. The study enrolled 448 pregnant women across South Australia, Australia, at baseline (February 1, 2011, to May 30, 2012), with 223 randomly allocated to the II group and 225 to the DI group. Three-year follow-up data were collected November 2014 to February 2016.INTERVENTIONS The intervention comprised dental treatment to mothers, fluoride varnish application to children, and motivational interviewing delivered together with anticipatory guidance. This was delivered during pregnancy and at child ages 6, 12, and 18 months for the II group and at child ages 24, 30, and 36 months for the DI group.MAIN OUTCOMES AND MEASURES The mean number of decayed teeth measured at child age 3 years.RESULTS There were 324 children at age 3 years (52.3% male). The mean number of decayed teeth at age 3 years was 1.44 (95% CI, 1.38-1.50) for the II group and 1.86 (95% CI, 1.89-2.03) for the DI group (mean difference, -0.41; 95% CI, -0.52 to -0.10). The predicted mean number of decayed teeth at age 3 years for the DI group was 2.15. Between ages 2 and 3 years, the caries increment for the II group was 0.82 (95% CI, 0.75-0.89), compared with 0.97 (95% CI, 0.87-1.17) for the DI group (P = .05).CONCLUSIONS AND RELEVANCE At the 3-year follow-up, II children had less dental caries than DI children, DI children developed dental caries at a lower trajectory than predicted had the intervention not been received at ages 2 to 3 years, and the caries increment was less between ages 2 to 3 years among II children compared with DI children. This study suggests that the best time to implement the intervention is earlier rather than later infancy.