The Oral Health of Refugees and Asylum Seekers in Canada: A Mixed Methods Study Protocol.

Canada received over 140,000 refugees and asylum seekers between 2015 and 2017. This paper presents a protocol with the purpose of generating robust baseline data on the oral health of this population and build a long-term program of research to improve their access to dental care in Canada. The three-phase project uses a sequential mixed methods design, with the Behavioral Model for Vulnerable Populations as the conceptual framework. In Phase 1a, we will conduct five focus groups (six to eight participants per group) in community organizations in Ontario, Canada, to collect additional sociocultural data for the research program. In Phase 1b, we will use respondent-driven sampling to recruit 420 humanitarian migrants in Ontario and Quebec. Participants will complete a questionnaire capturing socio-demographic information, perceived general health, diet, smoking, oral care habits, oral symptoms, and satisfaction with oral health. They will then undergo dental examination for caries experience, periodontal health, oral pain, and traumatic dental injuries. In Phase 2, we will bring together all qualitative and quantitative results by means of a mixed methods matrix. Finally, in Phase 3, we will hold a one-day meeting with policy makers, dentists, and community leaders to refine interpretations and begin designing future oral health interventions for this population.

Oral Health-Promoting School Environments and Dental Caries in Québec Children.

INTRODUCTION: Dental caries are highly prevalent among children and have negative health consequences. Their occurrence may depend in part on school-based environmental or policy-related factors, but few researchers have explored this subject. This study aimed to identify oral health promoting school environment types and estimate their relation with 2-year dental caries incidence among Québec children aged 8-10 years. METHODS: This study used data from two visits (completed in 2008 and 2011) of the QUALITY (Québec Adipose Lifestyle Investigation in Youth) cohort, which recruited white children at risk of obesity and their families from Greater Montreal schools. Measures included school and neighborhood characteristics, and Decayed, Missing, Filled-Surfaces index scores. Principal component and cluster analyses, and generalized estimating equations were conducted. RESULTS: Data were available for 330 children attending 200 schools. Based on a series of statistical analyses conducted in 2016, the authors identified three distinct school environment types. Type 1 and 2 schools had strong healthy eating programs, whereas Type 3 had weak programs. Type 1 schools had favorable neighborhood food environments, whereas Type 2 and 3 had unfavorable ones. Adjusting for potential confounders, children attending Type 1 and 2 schools had 21% (incidence rate ratio=0.79, 95% CI=0.68, 0.90) and 6% (incidence rate ratio=0.94, 95% CI=0.83, 1.07) lower 2-year incidence of dental caries, respectively, compared with Type 3 schools. CONCLUSIONS: School-based oral health promotion programs combined with a favorable neighborhood can lower dental caries incidence in school children.

Bacillus Calmette-Guérin (BCG) vaccination patterns in the province of Québec, Canada, 1956-1974.

BACKGROUND: In the province of Québec, Canada, the Bacillus Calmette-Guérin (BCG) vaccine was offered to newborns and school-age children from the 1950s to mid-1970s in an organized tuberculosis prevention program. OBJECTIVE: We aimed to describe the annual rates of skin test administration, proportion of skin tests that were positive, and rates of BCG vaccination from 1956 to 1974 according to age, sex, and administrative region. METHODS: For rates, numerators were extracted from the Québec BCG Vaccination Registry whereas population denominators were obtained from the Canadian Census and governmental publications. Time trends were assessed with linear regression. RESULTS: A total of 2,755,336 skin tests and 2,531,366 BCG vaccinations were administered. Yearly rates of skin tests, routinely administered before vaccination among all except newborns, were highest among children aged 5-9 (9.3 per 100) and 10-14years (7.9 per 100). The proportion of positive skin tests varied greatly by age, ranging from 10.2% among children <1year to 67.2% among adults ≥20years. The vast majority of individuals who had a negative skin test were subsequently vaccinated, whereas those with a positive result were not, as per recommended guidelines. The average annual vaccination rate was highest among children aged <1year (43.8 per 100) and 5-9year-olds (6.9 per 100). There were salient differences in immunization rates, including positive skin tests and vaccinations, across administrative regions but no difference by sex. CONCLUSION: This is the first comprehensive description of the tuberculosis prevention program in Québec which offered free, non-mandatory BCG vaccination. Our results confirm that the targeted groups, newborns and school-age children, were preferentially reached. Socioeconomic, demographic, and organizational factors may explain regional differences in immunization rates. Beyond presenting a historical context for this vaccination campaign, our findings are relevant to contemporary uses of the Québec BCG Vaccination Registry in epidemiological research.

Sex-specific trajectories of systolic and diastolic blood pressure in youth.

BACKGROUND AND OBJECTIVE: High blood pressure early in life is associated with cardiovascular disease morbidity and mortality in adulthood. The objective was to identify sex-specific trajectories of SBP and DBP from early adolescence to early adulthood and to assess the impact of modifiable factors on the trajectories, including BMI, smoking, alcohol use, physical activity, and screen-time. METHODS: Data were drawn from four waves of a prospective investigation of 1294 youth aged 12-13 years at inception and followed until age 24 years. Group-based trajectory models were used to identify trajectories and assess the impact of modifiable factors in 403 men and 432 women. RESULTS: Three SBP trajectories were identified in men [corresponding to low (43.2%), medium (45.2%), and high SBP (11.7%)] and women [corresponding to low (48.1%), medium (44.7%), and high SBP (7.2%)]. Similar results were observed for DBP in both sexes. BMI and smoking were associated with higher SBP and DBP values in most trajectory groups, whereas screen-time in both sexes and physical activity in women were associated with high SBP trajectories only. CONCLUSION: There is heterogeneity in the sex-specific natural course of SBP and DBP in youth and in the magnitude of the effect of modifiable factors on SBP and DBP across trajectories. Distinguishing trajectories allows identification of subgroups at risk of hypertension and cardiovascular disease later in life and in addition can inform the design of targeted interventions to attenuate high SBP and DBP trajectories over time and maintain normal trajectories.

Circulating undercarboxylated osteocalcin and gingival crevicular fluid tumour necrosis factor-α in children.

BACKGROUND: Osteocalcin, a protein secreted by osteoblasts during bone formation, is negatively associated with adult periodontal disease. Little is known about this association in children. AIM: To examine the extent to which plasma undercarboxylated osteocalcin (ucOC) is associated with gingival crevicular fluid tumour necrosis factor-alpha (GCF TNF-α) - a potential marker of gingival inflammation - in children. METHODS: We used data from the Quebec Adipose and Lifestyle InvesTigation in Youth cohort, an ongoing longitudinal study on the natural history of obesity among Caucasian children with a family history of obesity in Quebec, Canada. This cross-sectional analysis from the baseline visit includes 120 children aged 8-10 years. Plasma ucOC and GCF TNF-α levels were determined by enzyme-linked immunosorbent assay. Linear regression analyses, adjusting for age, gender, family income, sexual maturity stage, daily physical activity, obesity, and fasting glucose were conducted, with TNF-α level as the dependent variable. RESULTS: A 1-ng/ml increase in ucOC was associated with a 0.96% decrease (95% confidence interval (CI): -1.69, -0.23) in GCF TNF-α level. CONCLUSION: A negative association between a marker of bone formation and a marker of gingival inflammation was observed as early as childhood among Caucasian children with a family history of obesity.

Tumor necrosis factor- α and interleukin-6: potential interorgan inflammatory mediators contributing to destructive periodontal disease in obesity or metabolic syndrome.

Obesity has become a worldwide health burden in the last two decades. Obesity has been associated with increased comorbidities, such as coronary artery disease, diabetes, and destructive periodontal disease. Obesity is also part of a group of risk factors occurring together in an individual, which is referred to as metabolic syndrome. Clinical studies have shown higher risk for destructive periodontal disease in obesity and metabolic syndrome. However, the role of obesity and metabolic syndrome in the onset and development of destructive periodontal disease has not yet been fully understood. In this review, we discuss a working model, which focuses on interorgan inflammation as a common etiological factor for destructive periodontal disease associated with obesity and metabolic syndrome. Specifically, we suggest that elevated levels of tumor necrosis factor- α (TNF- α ) or interleukin 6 (IL-6)--both adipokines and known risk factors for destructive periodontal disease--in obesity and metabolic syndrome contribute to the onset and development of destructive periodontal disease. The connections between destructive periodontal disease and systemic conditions, such as obesity or metabolic syndrome, are complex and potentially multidirectional. This review largely focuses on TNF- α and IL-6, inflammatory mediators, as potential common risk factors and does not exclude other biological mechanisms.

Metabolic syndrome and gingival inflammation in Caucasian children with a family history of obesity.

AIM: To investigate whether metabolic syndrome (MetS) and its components are associated with gingival inflammation in children. MATERIALS AND METHODS: This is a cross-sectional analysis from the baseline visit of the QUebec Adipose and Lifestyle InvesTigation in Youth cohort, an ongoing longitudinal study investigating the natural history of obesity in children of Quebec, Canada. The analytic sample includes 448 children aged 8-10 years, 39% of whom were overweight or obese. MetS was defined according to the International Diabetes Federation recommendations. Gingival inflammation was defined by the level of gingival crevicular fluid (GCF) tumour necrosis factor alpha (TNF-α) and the extent of gingival bleeding. Sex-specific linear regression analyses estimated the associations between MetS and gingival inflammation, adjusting for potential confounders. RESULTS: Twenty-five children had MetS. Boys with MetS compared to those without, had a 49.5% (p-value = 0.001) higher GCF TNF-α level and 13.7% (p-value = 0.033) more sites with gingival bleeding. Moreover, for three of the five components of MetS - waist circumference, fasting plasma triglycerides, systolic blood pressure - an increase was associated with increased GCF TNF-α level in boys. No such findings were seen in girls. CONCLUSION: An association between MetS and gingival inflammation was observed as early as in childhood, and may differ by sex.

Association between lean and fat mass and indicators of bone health in prepubertal caucasian children.

BACKGROUND/AIMS: Childhood and adolescence are critical periods for bone growth. The independent association between lean and fat mass and indicators of bone health in children is not yet known. We aim to examine the association between each of lean and fat mass and indicators of bone health in 8- to 10-year-old prepubertal Caucasian children. METHODS: We present a cross-sectional analysis of baseline data from the QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort which study the natural history of obesity. Study participants (n = 483) included prepubertal children aged 8-10 years and their biological parents. Whole-body bone mineral content (BMC, g), bone area (cm²), bone mineral density (BMD, g/cm²), lean mass (kg), and fat mass (kg) were measured by dual-energy X-ray absorptiometry. Data analyses include multiple linear regressions adjusted for potential confounding variables. RESULTS: A 1-kg increase in lean mass was associated with 28.42 g, 19.88 cm², and 0.007 g/cm² increase in whole-body BMC, bone area and BMD respectively. A 1-kg increase in fat mass was associated with 9.32 g, 8.02 cm², and 0.002 g/cm² increase in whole-body BMC, bone area and BMD, respectively. CONCLUSION: Increasing lean mass in children may help optimize bone acquisition and prevent future osteoporosis.

Socio-cultural aspects of oral health among the Fulani in Ferlo (Senegal): a qualitative study.

OBJECTIVES: Health is a subjective concept that considers the social, cultural, environmental and behavioural problems of the individual. This study was conducted with the objective of better understanding the sociocultural aspects related to the oral health of the Fulani populations of Ferlo, Senegal. METHODS: The study was qualitative and based in the area of the Great Green Wall (GGW) in the region known as Ferlo, northern Senegal. Data were collected by semi-structured interviews in a sample of the population and through discussions with a focus group. It concerned health and aesthetics of the teeth, care and traditional herbal recipes, teeth and superstitions. RESULTS: It appears that people were using the toothpick, the chewing stick and/or charcoal to clean their teeth. Confusion persisted with respect to the types of food consumed that were implicated in the occurrence of dental caries: tea, rice, 'jumbo' (a seasoning spice) and tobacco. 'Borom bop', which means 'master of the head', was the most commonly reported cause of caries. Healthy, beautiful teeth were attributes of beauty and elegance, enhanced by tattoos and crafted crowns in the Fulani. Their health problems were generally managed by healers or traditional practitioners who based their practices on empirical and 'handed down' knowledge. Socio-anthropological meanings were given to children with neonatal teeth. CONCLUSIONS: It is therefore important to consider the sociocultural aspects in oral health projects and programmes; the place of herbal medicine in dentistry should be recognized and maybe researched in the region of the Great Green Wall.

History of asthma or eczema and cancer risk among men: a population-based case-control study in Montreal, Quebec, Canada.

BACKGROUND: Epidemiologic evidence regarding the association between a history of allergic diseases and different cancer types has been inconsistent. OBJECTIVE: To examine whether a history of asthma or eczema is associated with various cancers among Canadian men in a population based case-control study conducted in the 1980s. METHODS: Questionnaire-based interviews were performed by a team of trained interviewers from August 1979 to March 1986. Information collected included self-reported history of a prior medical diagnosis of asthma and of eczema, medication use, and several covariates among 3,300 cancer cases and 512 population controls. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between asthma or eczema and more than 20 cancer types combined, as well as for each of the 8 most common cancer types (stomach, colon, rectum, lung, prostate, bladder, skin, and lymph nodes). RESULTS: Considering study participants who reported a prior medical diagnosis of the disease and medication use, a history of asthma was negatively associated with all cancer types combined (OR, 0.72; 95% CI, 0.5-1.1) and similarly for a history of eczema (OR, 0.66; 95% CI, 0.4-1.1). Although ORs between asthma and eczema and most individual types were below 1.0, only 2 ORs were significantly below 1.0: that between asthma and stomach cancer (OR, 0.27; 95% CI, 0.1-0.9) and that between eczema and lung cancer (OR, 0.34; 95% CI, 0.2-0.7). CONCLUSION: Allergic conditions that result from a hyperreactive immune system might lead to a more efficient elimination of abnormal cells, thus lowering cancer risks.

Adiposity and gingival crevicular fluid tumour necrosis factor-alpha levels in children.

AIM: To investigate whether adiposity is associated with gingival crevicular fluid (GCF) tumour necrosis factor-alpha (TNF-alpha) levels in children. We also examined whether this relationship is mediated through plasma fasting insulin. MATERIALS AND METHODS: This preliminary study used cross-sectional data from the baseline-visit of the Quebec Adipose and Lifestyle InvesTigation in Youth cohort, which is an ongoing longitudinal study investigating the natural history of obesity in Quebec children. Study participants (76 girls and 102 boys) include children aged 8-10 years and their families, living in the Montreal and Quebec City areas. TNF-alpha level was measured in pooled samples (N=4) for each child by enzyme-linked immunosorbant assay. Height and weight were measured. Body mass index (BMI) was calculated as weight/height(2) (kg/m(2)). Sex/age-specific BMI was categorized into normal (<85th percentile), overweight (85th-95th percentile) and obese (>or=95th percentile) defined by the 2000 US-CDC growth charts. Insulin resistance was measured using fasting plasma insulin in children. Data analysis involved descriptive and multiple linear regression analyses. RESULTS: Our results suggest that obesity in boys was associated with a 37% increase of GCF-TNF-alpha level. However, when accounting for insulin resistance this association was reduced and disappeared while the model's goodness of fit improved. CONCLUSIONS: These findings provide support for the link between adiposity in children and GCF-TNF-alpha level, which appears to be mediated by insulin resistance.