Fluoridation cessation and oral health equity: a 7-year post-cessation study of Grade 2 schoolchildren in Alberta, Canada.

OBJECTIVE: Community water fluoridation, because of its universal scope and passive mechanism of uptake, is one component of a multifaceted approach to promoting equity in dental health. The objective of this study was to examine social inequities in children's dental health in the Canadian cities of Calgary (fluoridation cessation in 2011) and Edmonton (still fluoridated). METHODS: We analyzed data from surveys of population-based samples of Grade 2 (approx. age 7) children in Calgary in 2009/2010 (pre-cessation; n=557) and in both Calgary and Edmonton in 2013/2014 (Calgary, n=3230; Edmonton, n=2304) and 2018/2019 (Calgary, n=2649; Edmonton, n=2600) (post-cessation). We estimated associations between several socioeconomic indicators and dental caries indicators (i.e., dental caries experience [deft, DMFT] and untreated decay in two or more teeth [untreated decay]) using zero-inflated Poisson, binary logistic regression, and the concentration index of inequality. We compared those associations over time (between survey waves) and between cities at post-cessation. RESULTS: Persistent social inequities in deft and untreated decay were evident; for example, having no dental insurance was significantly associated with higher odds of untreated decay across city and survey wave. In most (but not all) cases, differences between cities and survey waves were consistent with an adverse effect of fluoridation cessation on dental health inequities. For example, the association between no dental insurance and higher odds of untreated decay in Calgary was greater in 2018/2019 (later post-cessation) than in 2009/2010 (pre-cessation; odds ratio [OR] for comparison of coefficients = 1.89 [1.36-2.63], p<0.001) and 2013/2014 (early post-cessation; OR for comparison of coefficients = 1.67 [1.22-2.28], p=0.001); that same association in 2018/2019 was greater in Calgary (fluoridation cessation) than in Edmonton (still fluoridated) (OR for comparison of coefficients = 1.44 [1.03-2.02], p=0.033). CONCLUSION: Social inequities in dental caries were present in both Calgary and Edmonton. Those inequities tended to be worse in Calgary where fluoridation was ceased. Our findings may be relevant to other settings where income inequality is high, dental services are costly, and dental public health infrastructure is limited.

RéSUMé: OBJECTIF: En raison de sa portée universelle et de son mécanisme de réception passif, la fluoration de l'eau des communautés s'inscrit dans une démarche multidimensionnelle de promotion de l'équité en santé dentaire. Notre étude visait à examiner les iniquités sociales en santé dentaire chez les enfants dans les villes canadiennes de Calgary (où la fluoration a cessé en 2011) et d'Edmonton (où l'eau est encore enrichie en fluor). MéTHODE: Nous avons analysé les données d'enquêtes menées auprès d'échantillons populationnels d'élèves de 2e année (environ 7 ans) à Calgary en 2009-2010 (avant l'arrêt; n = 557), et à Calgary et Edmonton en 2013-2014 (Calgary, n = 3 230; Edmonton, n = 2 304) et en 2018-2019 (Calgary, n = 2 649; Edmonton, n = 2 600) (après l'arrêt). Nous avons estimé les associations entre plusieurs indicateurs socioéconomiques et indicateurs de caries dentaires (c.-à-d. l'expérience de caries dentaires [dceo, DCMO] et de dégradation non traitée dans deux dents ou plus [dégradation non traitée]) à l'aide de la régression de Poisson à surreprésentation de zéros, de la régression logistique binaire et de l'indice de concentration des inégalités. Nous avons comparé ces associations dans le temps (entre les cycles de l'enquête) et entre les deux villes après l'arrêt de la fluoration. RéSULTATS: Des iniquités sociales persistantes selon l'indice dceo [dents cariées, extraites et obturées] et la dégradation non traitée étaient manifestes; par exemple, l'absence d'assurance dentaire présentait une corrélation significative avec une probabilité accrue de dégradation non traitée d'une ville à l'autre et d'un cycle à l'autre de l'enquête. Dans la plupart des cas (mais pas tous), les différences entre les villes et entre les cycles de l'enquête correspondaient à un effet indésirable de l'arrêt de la fluoration sur les iniquités en santé dentaire. Par exemple, l'association entre l'absence d'assurance dentaire et la probabilité accrue de dégradation non traitée à Calgary était plus importante en 2018-2019 (longtemps après l'arrêt) qu'en 2009-2010 (avant l'arrêt; rapport de cotes [RC] pour comparaison des coefficients = 1,89 [1,36-2,63], p < 0,001) et qu'en 2013-2014 (peu après l'arrêt; RC pour comparaison des coefficients = 1,67 [1,22-2,28], p = 0,001); cette même association en 2018-2019 était plus importante à Calgary (où la fluoration a cessé) qu'à Edmonton (où l'eau est encore enrichie en fluor) (RC pour comparaison des coefficients = 1,44 [1,03-2,02], p = 0,033). CONCLUSION: Des iniquités sociales relativement aux caries dentaires étaient présentes tant à Calgary qu'à Edmonton. Ces iniquités avaient tendance à être plus importantes à Calgary, où la fluoration a cessé. Nos constatations pourraient être pertinentes dans les autres endroits où l'inégalité des revenus est élevée, où les soins dentaires coûtent cher et où les infrastructures en santé publique dentaire sont limitées.

Fluoridation cessation and children's dental caries: A 7-year follow-up evaluation of Grade 2 schoolchildren in Calgary and Edmonton, Canada.

OBJECTIVES: We examined the effect of fluoridation cessation on children's dental caries experience in the Canadian cities of Calgary (cessation in 2011) and Edmonton (still fluoridated). METHODS: We used a pre-post cross-sectional design with comparison group. We studied Grade 2 schoolchildren (approximately 7 years old) 7-8 years after fluoridation cessation in Calgary, thus capturing children born after cessation occurred. Data collection included a dental examination conducted in school by calibrated dental hygienists, a questionnaire completed by parents, and fingernail clippings for a small subsample. Our overall analytic approach was twofold. We first examined differences in dental caries experience (deft and DMFT, and smooth surface caries based on defs and DMFS) between Calgary and Edmonton and over time (comparing 2018/2019 data to pre-cessation and early post-cessation surveys in our setting). Second, we evaluated whether differences were likely to reflect fluoridation cessation in Calgary, rather than other factors. RESULTS: The prevalence of caries in the primary dentition was significantly higher (P < .05) in Calgary (fluoridation cessation) than in Edmonton (still fluoridated). For example, crude deft prevalence in 2018/2019 was 64.8% (95% CI 62.3-67.3), n = 2649 in Calgary and 55.1% (95% CI 52.3-57.8), n = 2600 in Edmonton. These differences were consistent and robust: they persisted with adjustment for potential confounders and in the subset of respondents who were lifelong residents and reported usually drinking tap water; they had widened over time since cessation; and they were corroborated by assessments of dental fluorosis and estimates of total fluoride intake from fingernail clippings. Findings for permanent teeth were less consistent, which likely reflects that 7-year-olds have not had the time to accumulate enough permanent dentition caries experience for differences to have become apparent. CONCLUSIONS: Our findings are consistent with an adverse impact of fluoridation cessation on children's dental health in Calgary and point to the need for universal, publicly funded prevention activities-including but not limited to fluoridation.

The Effectiveness of Tobacco Dependence Education in Health Professional Students' Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The objective of this study was to perform a systematic review to examine the effectiveness of tobacco dependence education versus usual or no tobacco dependence education on entry-level health professional student practice and client smoking cessation. Sixteen published databases, seven grey literature databases/websites, publishers' websites, books, and pertinent reference lists were searched. Studies from 16 health professional programs yielded 28 RCTs with data on 4343 healthcare students and 3122 patients. Two researchers independently assessed articles and abstracted data about student knowledge, self-efficacy, performance of tobacco cessation interventions, and patient smoking cessation. All forms of tobacco were included. We did not find separate interventions for different kinds of tobacco such as pipes or flavoured tobacco. We computed effect sizes using a random-effects model and applied meta-analytic procedures to 13 RCTs that provided data for meta-analysis. Students' counseling skills increased significantly following the 5As model (SMD = 1.03; 95% CI 0.07, 1.98; p < 0.00001, I2 94%; p = 0.04) or motivational interviewing approach (SMD = 0.90, 95% CI 0.59, 1.21; p = 0.68, I2 0%; p < 0.00001). With tobacco dependence counseling, 78 more patients per 1000 (than control) reported quitting at 6 months (OR 2.02; 95% CI 1.49, 2.74, I² = 0%, p = 0.76; p < 0.00001), although the strength of evidence was moderate or low. Student tobacco cessation counseling improved guided by the above models, active learning strategies, and practice with standardized patients.

Fostering interprofessional learning in a rehabilitation setting: development of an interprofessional clinical learning unit.

PURPOSE: The development and implementation of interprofessional (IP) clinical learning units as a method to enhance IP clinical education and improve patient care in a rehabilitation setting are described. METHODS: Using a community-based participatory research approach, academia and healthcare delivery agencies formed a partnership to create an IP clinical learning unit in a rehabilitation setting. Preimplementation data from surveys and focus group data identified areas for improvement to enhance IP understanding and collaboration. A working group developed and implemented initiatives to enhance IP practice. FINDINGS: Preimplementation, eight themes emerged from which the working group identified goals and implemented strategies to strengthen IP learning. Goals included Creation of an IP Learning Environment, Increased Awareness of IP Practice, Role Clarification, Enhanced IP Communication, and Reflection and Evaluation. Postimplementation data revealed six themes: Communication, Informal IP Learning, Role Awareness, Positive Learning Environment, Logistics, and Challenges. CONCLUSIONS: The development of the IP clinical learning unit was successful and rewarding, but not without its challenges. Formal IP education was necessary to enhance collaborative practice, even in a multidisciplinary environment. Commitment and support from all participants, particularly managers and administrators from the healthcare agency, were critical to success. CLINICAL RELEVANCE: The focus of this unit was on a stroke rehabilitation unit; however, the development and implementation principles identified may be applicable to any team-based clinical setting.

Creating interprofessional clinical learning units: developing an acute-care model.

In exploring innovative approaches to enhanced patient care, an acute care interprofessional clinical learning unit (IPCLU) was established in a medical unit of a large metropolitan hospital in Edmonton, Alberta, Canada. Part of a larger, community based, participatory mixed method research project, this acute-care model involved several post-secondary institution health science faculties, students, academics, and other post-secondary institutions partnering with the hospital to coordinate and enhance student clinical learning and improve patient care. Pre-implementation data collected from the existing acute-care unit patient-care team, students, and faculty identified areas of strength and enhancement opportunities in interprofessional education (IPE). Interested members of several professions from the patient-care units and students constituted the working group that developed the model. This paper discusses clinical IPE and its relevance in nursing education, explains the processes and mechanisms in creating the IPCLU, details the initiatives that were developed to facilitate enhanced interprofessional care, and offers considerations in advancing IPE in an acute-care setting. The work plan included initiatives that enhance interprofessional teaching and learning culture, increase awareness surrounding interprofessional teamwork and professional roles, promote interprofessional communication and decision-making strategies, and further develop clinical reflection. Insights regarding sustainability are offered.