Predicting Caries Lesion Patterns and Trajectories in Underserved Children, from Infancy to Early Adolescence, in Primary Healthcare Settings

预测初级医疗机构中从婴儿期到青春期早期服务不足的儿童的龋齿病变模式和轨迹

• 批准号: 10659577
• 负责人: Margherita R Fontana
• 金额: $ 184.64万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-23 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10659577
• 关键词: 15 year old; 19 year old; Acceleration; Address; Adolescence; Adolescent; Adopted; Adult; Affect; Age; Alcohol consumption; Anterior; Behavior; Beverages; Biological; Caring; Child; Childhood; Chronic; Communities; Data; Dental Care; Dental Research; Dental caries; Development; Disease; Disparity; Enrollment; Ensure; Family Demographies; Food Preferences; Future; Goals; Health; Health Planning; Health Services Accessibility; Health behavior; Healthcare; Historical Demography; Incidence; Individual; Intervention; Lesion; Life; Life Cycle Stages; Longitudinal Studies; Medical; Medical History; Medical Research; Methods; National Institute of Dental and Craniofacial Research; Nursing Research; Obesity; Oral; Oral health; Outcome; Pattern; Personal Satisfaction; Persons; Pharmaceutical Preparations; Phase; Policies; Policy Developments; Prevalence; Preventive; Primary Dentition; Primary Health Care; Public Health; Publishing; Questionnaires; Recommendation; Reporting; Research; Research Design; Risk; Risk Behaviors; Risk Factors; School-Age Population; Screening procedure; Smoking; Sports; Strategic Planning; Surface; Therapeutic; Time; Tooth structure; Translational Research; Work; access disparities; adolescent health; anxiety symptoms; behavioral health; clinical decision-making; cohort; comorbidity; cost; cost effective; cost effectiveness; craniofacial; deciduous tooth; depressive symptoms; design; disparity reduction; early adolescence; experience; follow-up; future implementation; health care delivery; health care model; health care settings; health disparity; health inequalities; implementation efforts; improved; infancy; innovation; longitudinal, prospective study; neglect; novel; permanent tooth; person centered; personalized care; predictive modeling; prevent; primary caregiver; recruit; risk stratification; sex; sociodemographics; soft drink; success; uptake; vaping

PROJECT SUMMARY The recent NIDCR Oral Health in America report highlighted adolescence as a largely neglected life stage in oral health research and practice, with persistent and largely unchanged high caries experience, and called for strong actions to address this age cohort’s needs.1 Our team has been following a diverse cohort of children from age 1-9.5 years, and proposes now to follow them into early adolescence, providing a unique opportunity to assess U.S. children longitudinally culminating with much needed access and focus on adolescence. Given the large persistent disparities in caries rates and inequities in access to care for adolescents, targeted, risk-based healthcare delivery could be an important strategy to reduce disparities in adolescent health, while containing costs. The problem is that there have been almost no U.S. studies following the life-course progression of caries in children through adolescence to assess and predict caries patterns and disease trajectories over time, and relationships between these and changing oral and systemic health patterns in risk factors and behaviors. This is critical for targeting preventive, person-centered care in interprofessional settings that can adapt to changes in the life-course. The aims of this innovative U.S. study renewal are: 1) To define dental caries patterns (teeth and surfaces affected, e.g., pit-and-fissure vs. proximal, anterior vs. posterior) in early adolescence, including the trajectories of changes in caries patterns and counts (e.g., dmfs/DMFS) across the age-span (ages 1-15 years) (sub-aim 1a), in both primary and permanent teeth. 2) To identify patterns of caries risk factors and behaviors in the cohort when they were preschoolers (ages 1- 4), school-age (ages 6.5-9.5) and early adolescents (ages 12-15), and changes over time (sub-aim 2a). 3) To characterize the interplay among longitudinal caries patterns and risk factor/behavior patterns that lead to future caries development, we aim to develop risk screening tools to predict caries patterns, and predict caries incidence (sub-aim 3a), in early adolescence. This will be accomplished by following a diverse cohort of 500 primary caregiver (PCG)-child pairs enrolled in our ongoing U01 study. The PCGs will provide medical history and socio-demographic family information, while the adolescents will complete risk behavior questionnaires, and will have caries examinations at 12, 13.5 and 15 years of age to determine caries incidence, patterns, and trajectories. A great strength of this proposal is that it involves experienced medical/nursing and dental research groups, who have successfully worked together for the past 11 years and can facilitate follow-up of the cohort, while bringing new expertise in adolescent and behavioral health, and clinical decision-making. The overall impact and significance of this interdisciplinary project is that accurate risk stratification can optimize cost-effectiveness of personalized care, policy development, and public health planning. We will also be able to identify targets for intervention, and relationships with systemic health risk factors and comorbidities that can impact how we intervene to provide collaborative interprofessional care to improve adolescents' health.

项目摘要 最近的NIDCR美国口腔健康报告强调青春期是一个很大程度上被忽视的生活 口腔健康研究和实践阶段，具有持续且基本不变的高龋齿经验，以及 呼吁采取强有力的行动来满足这一年龄组的需求。1我们的团队一直在跟踪一个多样化的队列， 从1-9.5岁的儿童，现在建议跟踪他们到青春期早期，提供一个独特的 有机会纵向评估美国儿童，最终获得急需的访问和关注 青春期由于龋齿发病率的巨大持续差异和获得保健的不平等， 青少年，有针对性的，基于风险的医疗保健提供可能是一个重要的战略，以减少差距， 青少年健康，同时控制成本。问题是，美国几乎没有研究 跟踪儿童至青春期龋齿的生命过程进展，以评估和预测龋齿 随着时间的推移，模式和疾病轨迹，以及这些与口腔和全身变化之间的关系 危险因素和行为的健康模式。这对于以人为本的预防性护理至关重要， 能够适应生命过程变化的跨专业环境。美国这项创新研究的目的是 更新是：1）定义龋齿模式（牙齿和受影响的表面，例如，窝沟与近端， 前与后），包括龋齿模式和计数变化的轨迹 (e.g., dmfs/DMFS）（子目标1a）。 2)确定学龄前儿童（1- 10岁）的龋病危险因素和行为模式， （a）儿童的年龄（6岁至9岁）和青少年（12岁至15岁），以及随着时间的推移而发生的变化（次级目标2a）。3)到 描述纵向龋齿模式和导致以下情况的风险因素/行为模式之间的相互作用： 未来龋齿的发展，我们的目标是开发风险筛查工具，以预测龋齿模式， 发生率（次级目标3a），青春期早期。这将通过跟踪500个不同的队列来实现 在我们正在进行的U 01研究中招募的主要照顾者（PCG）-儿童对。PCG将提供病史 和社会人口学家庭信息，而青少年将完成危险行为问卷， 并将在12岁、13.5岁和15岁时进行龋齿检查，以确定龋齿发病率、模式和 轨迹这项建议的一大优点是，它涉及经验丰富的医疗/护理和牙科 研究小组，他们在过去的11年里成功地合作，可以促进后续行动， 队列，同时带来了青少年和行为健康，以及临床决策的新的专业知识。的 这一跨学科项目的总体影响和意义在于，准确的风险分层可以优化 个性化护理、政策制定和公共卫生规划的成本效益。我们也将能够 确定干预目标，以及与系统性健康风险因素和合并症的关系， 影响我们如何干预，以提供协作的跨专业护理，以改善青少年的健康。