Associations between caries levels and BMI measures among five-year-old children. Analysis and cross-sectional multi-variable analysis at individual child level.

OBJECTIVES: To establish the existence and directions of any associations between measures of body mass index (BMI) with caries levels using individual measures of each as derived from national surveys in England. METHODS: The BMIs of five-year-old children calculated from the 2017 National Child Measurement Programme and caries measures from the 2016-17 Public Health England (PHE) National dental epidemiology survey were securely linked at a child level. Comparison at individual level of caries levels and BMI z scores was done using multivariable regression. RESULTS: Records for 67,033 children were linked and allocated a deprivation quintile. An association between BMI Z score categories and caries levels was established. Caries prevalence was higher among overweight (24.4%) and very overweight (27.6%) children compared with those of average BMI (22.5%). Odds ratios were statistically significant at 1.08 and 1.14 for prevalence among overweight and very overweight children. Children of low BMI were found to have higher caries severity (1.2 d3mft) and extent (4.4 d3mft among those with any caries) compared to children of healthy BMI (0.7 d3mft, 3.3 d3mft) with statistically significant Incidence Rate Ratio of 1.24. Underweight children were more likely to have caries experience and more severe attack compared with children of healthy weight. Deprivation and ethnicity were confounding factors. CONCLUSIONS: There is some association between child BMI status and caries levels whereby caries prevalence among children of higher BMI is increased. The associations are over and above those of deprivation, ethnicity and water fluoridation individually, but these factors impact on the strength of the link between BMI and caries.

A multi-variable analysis of four factors affecting caries levels among five-year-old children; deprivation, ethnicity, exposure to fluoridated water and geographic region.

OBJECTIVE: To assess the role of factors posited to affect population caries levels across England. BASIC RESEARCH DESIGN: Multivariable regression analysis assessing four potential determinants of caries severity and prevalence: deprivation, exposure to fluoridated water, ethnicity and geographic region Participants: Random sample of 121,875 five-year-old children in England in the 2014/15 academic year. MAIN OUTCOME MEASURES: Decayed, missing and filled teeth, with decay measured at the dentinal level, (d3mft), presented as prevalence (dmft⟩0) and extent of decay among children who have any (d3mft if d3mft>0). INDEPENDENT VARIABLES: Parental reported ethnicity from school records, index of multiple deprivation (IMD) scores, region and exposure to water fluoridation calculated utilising home postcodes. RESULTS: The data support wider literature displaying associations between caries and deprivation across a social gradient. The important, new findings are deprivation, some ethnic groups and lack of exposure to water fluoridation are all associated with increased prevalence and severity of caries when considered together and independently. New evidence supports the impact of water fluoridation on health inequalities in that the greatest impact of exposure to fluoridated water was seen in the most deprived children and those from an Asian / Asian British ethnic group. CONCLUSIONS: Five-year-old children who were from the most deprived areas, not exposed to fluoridated water, of an Eastern European ethnic group and living in the North West demonstrated the highest prevalence and severity of caries in the survey under scrutiny. This is of public health importance, providing evidence for population groups to target with health improvement activities.

An analysis of influenza outbreaks in institutions and enclosed societies.

This paper considers the reported attack ratio arising from outbreaks of influenza in enclosed societies. These societies are isolated from the wider community and have greater opportunities for contact between members which would aid the spread of disease. While the particular kind of society (prison, care home, school, barracks, etc.) was not a significant factor in an adjusted model of attack ratio, a person's occupation within the society was. In particular, children and military personnel suffer a greater attack ratio than other occupational types (staff, prisoners, etc.). There was no temporal trend in final attack ratio nor, with the exception of 1918, do pandemic years show abnormal attack ratios. We also observed that as community size increases, the attack ratio undergoes steep nonlinear decline. This statistical analysis draws attention to how the organization of such societies, their size and the occupations of individuals within them affect the final attack ratio.

Investigation of healthcare-acquired infections associated with Pseudomonas aeruginosa biofilms in taps in neonatal units in Northern Ireland.

BACKGROUND: In December 2011 and early 2012 four neonates died from Pseudomonas aeruginosa bacteraemia in hospitals in Northern Ireland. AIM: To assess whether P. aeruginosa was associated with the neonatal unit taps and whether waterborne isolates were consistent with patient isolates. METHODS: Thirty taps and eight flow straighteners from the relevant hospitals were categorized and dismantled into 494 components and assessed for aerobic colony and P. aeruginosa counts using non-selective and selective agars. P. aeruginosa isolates were typed by variable number tandem repeat (VNTR) analysis. Selected tap components were subjected to epifluorescence and scanning electron microscopy to visualize biofilm. FINDINGS: The highest P. aeruginosa counts were from the flow straighteners, metal support collars and the tap bodies surrounding these two components. Complex flow straighteners had a significantly higher P. aeruginosa count than other types of flow straighteners (P < 0.05). Highest aerobic colony counts were associated with integrated mixers and solenoids (P < 0.05), but there was not a strong correlation (r = 0.33) between the aerobic colony counts and P. aeruginosa counts. Representative P. aeruginosa tap isolates from two hospital neonatal units had VNTR profiles consistent with strains from the tap water and infected neonates. CONCLUSION: P. aeruginosa was predominantly found in biofilms in flow straighteners and associated components in the tap outlets and was a possible source of the infections observed. Healthcare providers should be aware that water outlets can be a source of P. aeruginosa contamination and should take steps to reduce such contamination, monitor it and have strategies to minimize risk to susceptible patients.

A case-association cluster detection and visualisation tool with an application to Legionnaires' disease.

Statistical methods used in spatio-temporal surveillance of disease are able to identify abnormal clusters of cases but typically do not provide a measure of the degree of association between one case and another. Such a measure would facilitate the assignment of cases to common groups and be useful in outbreak investigations of diseases that potentially share the same source. This paper presents a model-based approach, which on the basis of available location data, provides a measure of the strength of association between cases in space and time and which is used to designate and visualise the most likely groupings of cases. The method was developed as a prospective surveillance tool to signal potential outbreaks, but it may also be used to explore groupings of cases in outbreak investigations. We demonstrate the method by using a historical case series of Legionnaires' disease amongst residents of England and Wales.

Woodland biodiversity management as a tool for reducing human exposure to Ixodes ricinus ticks: a preliminary study in an english woodland.

This paper presents preliminary findings towards developing a UK-specific approach to reducing public exposure to woodland questing Ixodes ricinus tick populations by harnessing existing biodiversity-enhancing woodland ride (i.e., linear non-wooded herbaceous habitat either side of track within woodland) management strategies. This preliminary study in an English woodland firstly assesses whether ecological and environmental factors determine presence and density of questing Ixodes ricinus along woodland rides. Secondly, it sets these findings in the context of woodland ride management guidelines in England in order to understand what impact ride management strategies might have on numbers of questing ticks and tick survival. Nymph and adult I. ricinus presence and abundance were modelled in relation to relevant microclimate and ecological parameter variables. Predictor variables for increased questing nymph abundance included ride orientation, mat depth, occurrence of bracken/bramble and animal tracks, ride/path width, and sward height. Ticks thrive in the ecotonal habitat of a woodland ride, therefore we urge woodland managers to consider the impact of their ride management on ticks and human exposure to ticks. Possible recommendations for mitigating questing I. ricinus in line with biodiversity management guidelines rides are discussed in this paper and include seasonal mowing regimes, management of mulch/mat, and bracken/bramble management through use of scalloped ride edges.