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Trends and disparities in arrhythmia-related deaths among older adults in the United States, 1999–2020 1999-2020 年美国老年人心律失常相关死亡的趋势和差异
Pub Date : 2024-06-10 DOI: 10.1016/j.glmedi.2024.100119
Muhammad Rafay Shahzad Cheema , Abdulqadir J. Nashwan

This study examines mortality trends and disparities in arrhythmia-related deaths among older adults in the United States from 1999 to 2020. Utilizing mortality data from the CDC WONDER database, we analyzed over 3 million arrhythmia-related deaths identified by ICD-10 codes I47.0-I49.9. The study computed age-standardized mortality rates (ASMR) to assess trends across demographic groups and geographical locations. Statistical techniques, including Joinpoint regression analysis, were employed to examine demographic and regional trends in mortality rates. The overall ASMR for arrhythmia-related deaths increased from 38.0 per 10,000 in 1999 to 47.0 in 2020. The trend showed a decline from 1999 to 2009 (APC: −0.9), followed by increases from 2009 to 2018 (APC: 1.5) and a significant rise from 2018 to 2020 (APC: 7.4). Men had higher ASMRs than women (45.2 vs. 33.0), with significant increases observed in both sexes in recent years. Racial disparities were evident, with Non-Hispanic (NH) Whites having the highest ASMR (40.5), followed by NH Blacks (31.1), NH American Indians/Alaska Natives (28.3), Hispanics (22.7), and NH Asians/Pacific Islanders (19.7). Geographic disparities were also prominent, with Vermont exhibiting the highest ASMR (55.8) and Nevada the lowest (24.9). The Midwest region had the highest regional ASMR (41.2), while nonmetropolitan areas consistently showed higher rates than metropolitan areas (42.1 vs. 37.2). These findings highlight significant disparities in arrhythmia-related mortality, underscoring the need for targeted interventions to address these public health challenges.

本研究探讨了 1999 年至 2020 年美国老年人心律失常相关死亡的死亡率趋势和差异。利用疾病预防控制中心 WONDER 数据库中的死亡率数据,我们分析了超过 300 万例与心律失常相关的死亡病例,这些病例均由 ICD-10 编码 I47.0-I49.9 确定。研究计算了年龄标准化死亡率 (ASMR),以评估不同人口群体和地理位置的趋势。研究采用了包括联点回归分析在内的统计技术,以检查死亡率的人口和地区趋势。心律失常相关死亡的总体 ASMR 从 1999 年的万分之 38.0 上升到 2020 年的万分之 47.0。趋势显示,1999 年至 2009 年期间死亡率有所下降(APC:-0.9),2009 年至 2018 年期间死亡率有所上升(APC:1.5),2018 年至 2020 年期间死亡率显著上升(APC:7.4)。男性的 ASMRs 比女性高(45.2 对 33.0),近年来观察到男性和女性的 ASMRs 都显著增加。种族差异明显,非西班牙裔(NH)白人的 ASMR 最高(40.5),其次是 NH 黑人(31.1)、NH 美洲印第安人/阿拉斯加原住民(28.3)、西班牙裔(22.7)和 NH 亚洲人/太平洋岛民(19.7)。地域差异也很明显,佛蒙特州的 ASMR 最高(55.8),内华达州最低(24.9)。中西部地区的 ASMR 最高(41.2),而非大都市地区的 ASMR 一直高于大都市地区(42.1 对 37.2)。这些发现凸显了心律失常相关死亡率的显著差异,强调了有必要采取有针对性的干预措施来应对这些公共卫生挑战。
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引用次数: 0
The adjacent possible: Rural anesthesia 邻近的可能:农村麻醉
Pub Date : 2024-06-04 DOI: 10.1016/j.glmedi.2024.100117
Benjamin L. Antonio , Mitchell H. Tsai

Recently, Menezes and Zahalka commented on the shortage of anesthesia providers across the United States. With broad strokes, they explore various perspectives of the issue, from the limitations in training positions to the continued growth in demand for surgery. Although rural health care systems face unprecedented challenges, rural residents deserve perioperative care managed by anesthesiologists at the systems level. Physicians, hospital administrators, and health care regulators need to lead the way by exploring different staffing models, lobbying for new legislation that ensures the safety of the most complex patients. And perhaps, by understanding how we can build a different system in the rural setting, we can better health care for American citizens.

最近,梅内泽斯(Menezes)和扎哈尔卡(Zahalka)就全美麻醉服务人员短缺问题发表了评论。从培训职位的限制到手术需求的持续增长,他们以宽泛的笔触从不同角度探讨了这一问题。尽管农村医疗保健系统面临着前所未有的挑战,但农村居民应该得到由麻醉科医生在系统层面管理的围手术期护理。医生、医院管理者和医疗监管者需要带头探索不同的人员配置模式,游说新的立法以确保最复杂病人的安全。也许,通过了解如何在农村地区建立一个不同的系统,我们可以为美国公民提供更好的医疗服务。
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引用次数: 0
Lemierre’s syndrome: A clinician's dilemma – A case report 勒米尔综合征:临床医生的两难选择--病例报告
Pub Date : 2024-05-31 DOI: 10.1016/j.glmedi.2024.100116
Usamah Al-Anbagi , Mohamed I. Abdelrahim , Mohamad G. Safieh , Aya M. Abdelgadir , Rania F. Eisa , Claret C. Isabirye , Abdulqadir J. Nashwan

Lemierre's syndrome (LS) is a life-threatening, rare condition that starts with an oropharyngeal infection leading to internal jugular vein septic thrombophlebitis and potentially severe systemic complications, highlighting the need for prompt recognition and treatment by healthcare professionals. We present a case of LS in a 37-year-old male who initially presented with a sore throat, cough, and high-grade fever. A diagnostic workup revealed a positive blood culture with Fusobacterium necrophorum, and an ultrasound examination demonstrated internal jugular vein thrombophlebitis, confirming the diagnosis of LS. Treatment commenced with oral antibiotics planned for 6 weeks, alongside oral anticoagulation scheduled for 12 weeks. Our case underscores the need for vigilance and multidisciplinary collaboration in managing LS, highlighting the importance of prompt recognition, targeted therapies, and ongoing research to optimize outcomes and enhance diagnosis and management.

莱米埃尔综合征(Lemierre's syndrome,LS)是一种危及生命的罕见疾病,起病于口咽部感染,可导致颈内静脉化脓性血栓性静脉炎和潜在的严重全身并发症,因此需要医护人员及时识别和治疗。我们介绍了一例37岁男性的LS病例,患者最初表现为咽喉痛、咳嗽和高烧。诊断性检查显示坏死镰刀菌血液培养呈阳性,超声检查显示颈内静脉血栓性静脉炎,确诊为 LS。治疗开始后,患者计划口服抗生素 6 周,同时口服抗凝药 12 周。我们的病例强调了在管理 LS 时保持警惕和多学科合作的必要性,突出了及时识别、靶向治疗和持续研究对优化治疗效果、加强诊断和管理的重要性。
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引用次数: 0
Association between severe periodontitis and sleep quality: Results from the NHANES, 2009–2014 严重牙周炎与睡眠质量之间的关系:2009-2014 年国家健康调查(NHANES)结果
Pub Date : 2024-05-20 DOI: 10.1016/j.glmedi.2024.100114
Yilin Bao , Luying Qin , Mengxuan Hao , Zhiwei Jiang , Ying Wang , Rui Pu

Periodontitis has a high global prevalence, and sleep may impact both the occurrence and the severity of the condition. With an emphasis on sex disparities, this study examined the association between sleep and severe periodontitis in a population sample that was representative of the United States. This study used a sample of 5495 people from the National Health and Nutrition Examination Survey (NHANES) and conducted univariate and multivariate logistic regression analyses before and after adjusting for age, sex, ethnicity, poverty-income ratio (PIR), body mass index (BMI), smoking status, and diabetes mellitus (DM) status. Furthermore, this study included a stratified sex-based analysis to investigate potential sex differences between severe periodontitis and sleep. The results are presented with odds ratios (ORs) and 95% confidence intervals (95% CIs). The results of multivariate logistic regression revealed a significant association between the recommended sleep duration each night (seven to nine hours) and the prevalence of severe periodontitis in women (ORad = 0.68, p = 0.003). Furthermore, in women, urinating twice or three times per night was significantly associated with severe periodontitis (ORad = 1.44, p = 0.011), whereas the association was more significant in women who urinated at least four times per night (ORad = 1.68, p = 0.035). In men, these associations were not observed. There was no significant association between poor sleep quality and severe periodontitis, but the association differed by sex. Severe periodontitis in women was found to be significantly associated with poor sleep quality, but not in men.

牙周炎在全球的发病率很高,而睡眠可能会影响牙周炎的发生和严重程度。本研究以性别差异为重点,在具有代表性的美国人口样本中研究了睡眠与严重牙周炎之间的关系。该研究使用了美国国家健康与营养调查(NHANES)中的 5495 个样本,并在调整年龄、性别、种族、贫困收入比(PIR)、体重指数(BMI)、吸烟状况和糖尿病(DM)状况前后进行了单变量和多变量逻辑回归分析。此外,本研究还进行了基于性别的分层分析,以调查严重牙周炎与睡眠之间的潜在性别差异。结果以几率比(OR)和 95% 置信区间(95% CI)表示。多变量逻辑回归结果显示,推荐的每晚睡眠时间(7 至 9 小时)与女性严重牙周炎患病率之间存在显著关联(ORad = 0.68,p = 0.003)。此外,在女性中,每晚排尿两次或三次与严重牙周炎显著相关(ORad = 1.44,p = 0.011),而在每晚至少排尿四次的女性中,这种关联更为显著(ORad = 1.68,p = 0.035)。在男性中,没有观察到这些关联。睡眠质量差与严重牙周炎之间没有明显的关联,但这种关联因性别而异。研究发现,女性的严重牙周炎与睡眠质量差明显相关,而男性则不然。
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引用次数: 0
Strengths, weaknesses, opportunities and threats (SWOT) analysis of artificial intelligence adoption in nursing care 护理领域采用人工智能的优势、劣势、机会和威胁 (SWOT) 分析
Pub Date : 2024-05-13 DOI: 10.1016/j.glmedi.2024.100113
Moustaq Karim Khan Rony , Khadiza Akter , Mitun Debnath , Md Moshiur Rahman , Fateha tuj Johra , Fazila Akter , Dipak Chandra Das , Sujit Mondal , Mousumi Das , Muhammad Join Uddin , Mst Rina Parvin

The primary objective of this commentary was to identify the strengths and weaknesses of AI technologies, uncover opportunities for improvement, and recognize potential threats that could impede their successful implementation in nursing care. This commentary involved constructing a SWOT matrix to analyze AI adoption, identifying internal strengths and weaknesses, and external opportunities and threats. The analysis revealed several strengths of AI adoption in nursing care, including enhanced data analysis capabilities, improved patient monitoring, and increased efficiency in routine tasks. However, weaknesses such as the high initial costs of implementation and concerns about data security were identified. Opportunities included the potential for AI to reduce healthcare costs and improve patient outcomes. Nonetheless, threats such as resistance to technological change and ethical dilemmas related to AI decision-making processes were recognized as potential barriers to successful adoption. This article sheds light on the intricate landscape of AI adoption in nursing care. While AI brings forth substantial strengths, it simultaneously poses challenges that healthcare systems should confront. To fully harness AI's potential, healthcare organizations should thoughtfully deliberate on the identified weaknesses and threats, actively seeking avenues for seamless integration. In this concerted effort, the healthcare industry is poised to unlock the transformative capabilities of AI, elevating nursing care standards, and ultimately, advancing patient outcomes.

本评论的主要目的是确定人工智能技术的优缺点,发掘改进机会,并认识到可能阻碍其在护理工作中成功实施的潜在威胁。本评论通过构建 SWOT 矩阵来分析人工智能的应用,确定内部优势和劣势,以及外部机遇和威胁。分析表明了在护理工作中采用人工智能的几个优势,包括增强数据分析能力、改善病人监护和提高日常工作效率。然而,也发现了一些不足之处,如实施初期成本较高以及对数据安全的担忧。机遇包括人工智能降低医疗成本和改善患者疗效的潜力。然而,技术变革的阻力和与人工智能决策过程相关的伦理困境等威胁被认为是成功采用人工智能的潜在障碍。本文揭示了护理领域采用人工智能的复杂情况。人工智能在带来巨大优势的同时,也提出了医疗保健系统应该面对的挑战。为了充分利用人工智能的潜力,医疗机构应深思熟虑地考虑已发现的弱点和威胁,积极寻求无缝整合的途径。在这种共同努力下,医疗保健行业将释放出人工智能的变革能力,提升护理标准,并最终改善患者的治疗效果。
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引用次数: 0
Trends in simultaneous alcohol and marijuana use among US adult recent drinkers: Differences by sexual identity, 2015–2020 美国近期成年饮酒者同时使用酒精和大麻的趋势:2015-2020 年按性别身份划分的差异
Pub Date : 2024-05-08 DOI: 10.1016/j.glmedi.2024.100112
R. Andrew Yockey , Rachel A. Hoopsick , Jennifer L. Brown , Phillip W. Schnarrs

Simultaneous alcohol and marijuana (SAM) use has become increasingly prevalent among young adult populations. Moreover, lesbian, gay, and bisexual populations are at increased risk for substance use initiation. To date, little research has examined trends in SAM use by sexual identity. This study aimed to investigate trends in SAM use among recent drinkers using nationally representative data. Pooled data from the 2015–2019 and 2020 National Survey on Drug Use and Health (NSDUH) were examined among 120,061 individuals (5.75% LGB) 18 years or older who reported using alcohol in the past month. Given the methodological changes in the study design, we analyzed these waves separately. Covariates included age, race, biological sex, sexual identity, rurality, and past month use of tobacco. Weighted logistic regression models and trend analyses were conducted. An estimated 11,952 of the sample reported using marijuana during their last episode of drinking. A significant linear trend (b = 0.12) of increasing SAM use among recent drinkers from 2015 to 2019. When compared to heterosexual individuals, lesbian or gay (aPR: 1.44, 95% CI 1.26, 1.63) and bisexual (aPR: 1.92, 95% CI 1.77, 2.09) individuals were more likely to report SAM use. Among the entire sample, females had a lower risk of SAM use than males (aPR: 0.68, 95% CI 0.65, 0.72). For 2020, a total of 25,679 adults 18 years or older participated in the survey, with 2622 identifying as LGB and 54.1% reporting past month alcohol use. An estimated 1503 individuals reported SAM use. Consistent with our findings, of those reporting past month alcohol use, LGB populations were at higher risk for SAM use, with gay individuals (aPR: 1.59, 95% CI 1.11, 2.30) at increased risk and bisexual individuals having higher risk (aPR: 2.12, 95% CI 1.73, 2.60). SAM use among individuals presents several critical health concerns, especially for at-risk populations. Findings from the present study can inform tailored interventions to reduce minority stress and stigmatized identities are needed.

同时使用酒精和大麻(SAM)在年轻人群中越来越普遍。此外,女同性恋、男同性恋和双性恋人群开始使用药物的风险也在增加。迄今为止,很少有研究按照性别身份来调查 SAM 的使用趋势。本研究旨在利用具有全国代表性的数据,调查近期饮酒者使用 SAM 的趋势。本研究对 2015-2019 年和 2020 年全国药物使用和健康调查(NSDUH)中报告在过去一个月内使用过酒精的 120,061 名 18 岁或 18 岁以上的个人(5.75% LGB)的汇总数据进行了研究。考虑到研究设计方法的变化,我们对这些波次进行了单独分析。协变量包括年龄、种族、生理性别、性身份、居住地和过去一个月的烟草使用情况。我们建立了加权逻辑回归模型并进行了趋势分析。估计有 11,952 名样本报告在最后一次饮酒时使用过大麻。从 2015 年到 2019 年,近期饮酒者中吸食大麻的人数呈明显的线性增长趋势(b = 0.12)。与异性恋者相比,女同性恋或男同性恋(aPR:1.44,95% CI 1.26,1.63)和双性恋者(aPR:1.92,95% CI 1.77,2.09)更有可能报告使用 SAM。在所有样本中,女性使用 SAM 的风险低于男性(aPR:0.68,95% CI 0.65,0.72)。2020 年,共有 25,679 名 18 岁或以上的成年人参与了调查,其中 2622 人自称为 LGB,54.1% 的人报告在过去一个月中饮酒。估计有 1503 人报告使用过 SAM。与我们的研究结果一致,在报告过去一个月饮酒情况的人群中,LGB 群体使用 SAM 的风险较高,其中同性恋者(aPR:1.59,95% CI 1.11,2.30)的风险较高,双性恋者的风险较高(aPR:2.12,95% CI 1.73,2.60)。个人使用 SAM 会带来一些严重的健康问题,尤其是对高危人群而言。本研究的结果可为有针对性的干预措施提供依据,以减轻少数群体的压力,并减少他们被污名化的身份。
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引用次数: 0
Association of depression with widowhood, loneliness, and social non-participation among older women in India 印度老年妇女抑郁与丧偶、孤独和不参与社会活动的关系
Pub Date : 2024-05-05 DOI: 10.1016/j.glmedi.2024.100111
Priya Das , Subhadeep Saha , Tanu Das , Partha Das , Tamal Basu Roy

Background

Widowhood is a disastrous incident occurring at any stage of life for surviving oneself particularly the older women having critical reflexes on their physical, emotional and as well as socio-economic well-bring. Living alone and being cornered to home may also have serious repercussions on psychological health conditions of geriatric population, a public health concern in recent times.The main essence of this present study was to investigate the impact of widowhood, loneliness and social non-participation on older women depression in Indian context.

Methods

Data for the present study were obtained from the first wave of the Longitudinal Ageing Study in India (LASI), conducted during 2017–2018. A total of 15,559 older adult women were availed for this present study. Descriptive analyses, association studies and finally multinominal logistic regression analyses were performed to fulfill the study objectives.

Result

Currently, 5 % of total study participant’s suffered from depression for most of the times. Findings suggested that widowhood is a catastrophic event giving rise to depression for most of the old women in their later life. With this, living alone in old age period also had a great impact on the prevalence of depression. Preponderance of older women depression is also found among those, not getting involved any social events.

Conclusion

This study suggested that to reduce the prevalence of older women depression, targeted interventions in the form of psychological counseling, screening services and community involvement are very much needed.

背景丧偶是人生任何阶段都会发生的灾难性事件,尤其是对老年妇女而言,对她们的身体、情感和社会经济福利都有至关重要的影响。独居和被困在家中也可能对老年人的心理健康状况产生严重影响,这也是近来的一个公共卫生问题。本研究的主要目的是调查印度丧偶、孤独和不参与社会活动对老年妇女抑郁症的影响。方法本研究的数据来自 2017-2018 年期间开展的第一波印度老龄化纵向研究(LASI)。共有 15559 名老年妇女参与了本研究。为实现研究目标,研究人员进行了描述性分析、关联研究,最后进行了多项式逻辑回归分析。研究结果表明,丧偶是大多数老年妇女晚年抑郁的灾难性事件。此外,晚年独居对抑郁症的发病率也有很大影响。结论这项研究表明,要降低老年妇女抑郁症的发病率,非常需要以心理咨询、筛查服务和社区参与的形式进行有针对性的干预。
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引用次数: 0
Factors associated with underweight and overweight prevalence among children in Bangladesh 孟加拉国儿童体重不足和超重的相关因素
Pub Date : 2024-04-26 DOI: 10.1016/j.glmedi.2024.100110
Sorif Hossain , Tonmoy Alam Shuvo, Nahid Mia

Background

Bangladesh is not excluded from the global issue of children being underweight or overweight. This study examined the relationship between underweight, overweight, and sociodemographic variables in children.

Methods

Data from the Multiple Indicator Cluster Survey (MICS) 2019 were used for this study. We employed chi-square and one-way analysis of variance (ANOVA) tests to identify significant variables. Subsequently, we fitted a multilevel mixed-effects logistic regression model and reported odds ratios (OR), confidence intervals (CI), and p-values. STATA version 17 was used for analysis.

Results

The sample size for our study consisted of 10,875 Bangladeshi children under five years of age. From a total of 10,875 children, 20.57% were underweight and 6.80% were overweight. Data were available for 8858 rural and 2017 urban under-five children. The prevalence of underweight was greatly influenced by age, and in rural regions, it consistently increased from 12 months to 59 months. Male children were more likely to be overweight and underweight than female children. Children in the Sylhet division were likelier to be underweight and overweight. Educated mothers reduce the risk of underweight children in urban and rural areas. The richest family children were more likely to be overweight in urban areas. In rural areas, children born with a smaller size were more likely to become underweight and less likely to become overweight.

Conclusions

Our research revealed that the poorest sociodemographic category, the Sylhet division, small newborns, and illiterate mothers were the most vulnerable to child weight problems.

背景孟加拉国也存在儿童体重不足或超重的全球性问题。本研究探讨了儿童体重不足、超重与社会人口变量之间的关系。 方法 本研究使用了 2019 年多指标类集调查(MICS)的数据。我们采用了卡方检验和单因子方差分析(ANOVA)来确定重要变量。随后,我们拟合了多层次混合效应逻辑回归模型,并报告了几率比(OR)、置信区间(CI)和 P 值。我们使用 STATA 17 版本进行分析。在 10,875 名儿童中,20.57% 的儿童体重不足,6.80% 的儿童超重。我们获得了 8858 名农村五岁以下儿童和 2017 名城市五岁以下儿童的数据。体重不足的发生率受年龄影响很大,在农村地区,体重不足的发生率在 12 个月至 59 个月期间持续上升。男性儿童比女性儿童更容易超重和体重不足。锡尔赫特省的儿童更容易体重不足和超重。受过教育的母亲会降低城市和农村地区儿童体重不足的风险。在城市地区,最富有家庭的儿童更容易超重。在农村地区,出生时体型较小的儿童更有可能体重不足,而体重超重的可能性较小。结论我们的研究表明,最贫穷的社会人口类别、锡尔赫特省、新生儿体型较小以及文盲母亲最容易出现儿童体重问题。
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引用次数: 0
Advancements and applications of Artificial Intelligence in cardiology: Current trends and future prospects 人工智能在心脏病学中的进展与应用:当前趋势与未来展望
Pub Date : 2024-04-23 DOI: 10.1016/j.glmedi.2024.100109
David B. Olawade , Nicholas Aderinto , Gbolahan Olatunji , Emmanuel Kokori , Aanuoluwapo C. David-Olawade , Manizha Hadi

Using Artificial intelligence technologies in cardiology has witnessed rapid advancements across various domains, fostering innovation and reshaping clinical practices. The study aims to provide a comprehensive overview of these AI-driven advancements and their implications for enhancing cardiovascular healthcare. A systematic approach was adopted to conduct an extensive review of scholarly articles and peer-reviewed literature focusing on the application of AI in cardiology. Databases including PubMed/MEDLINE, ScienceDirect, IEEE Xplore, and Web of Science were systematically searched. Articles were screened following a defined selection criteria. These articles' synthesis highlighted AI's diverse applications in cardiology, including but not limited to diagnostic innovations, precision medicine, remote monitoring technologies, drug discovery, and clinical decision support systems. The review shows the significant role of AI in reshaping cardiovascular medicine by revolutionising diagnostics, treatment strategies, and patient care. The diverse applications of AI in cardiology showcased in this study reflect the transformative potential of these technologies. However, challenges such as algorithm accuracy, interoperability, and integration into clinical workflows persist. AI's continued advancements and strategic integration in cardiology promise to deliver more personalised, efficient, and effective cardiovascular care, ultimately improving patient outcomes and shaping the future of cardiology practice.

人工智能技术在心脏病学领域的应用见证了各个领域的快速发展,促进了创新并重塑了临床实践。本研究旨在全面概述这些人工智能驱动的进步及其对加强心血管医疗保健的影响。本研究采用了一种系统方法,对学术文章和同行评审文献进行了广泛的综述,重点关注人工智能在心脏病学中的应用。系统地检索了包括 PubMed/MEDLINE、ScienceDirect、IEEE Xplore 和 Web of Science 在内的数据库。文章按照规定的筛选标准进行筛选。这些文章的综述强调了人工智能在心脏病学中的各种应用,包括但不限于诊断创新、精准医疗、远程监控技术、药物发现和临床决策支持系统。综述显示,人工智能通过彻底改变诊断、治疗策略和患者护理,在重塑心血管医学方面发挥着重要作用。本研究中展示的人工智能在心脏病学中的各种应用反映了这些技术的变革潜力。然而,算法准确性、互操作性以及与临床工作流程的整合等挑战依然存在。人工智能在心脏病学领域的不断进步和战略整合有望提供更加个性化、高效和有效的心血管护理,最终改善患者预后并塑造心脏病学实践的未来。
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引用次数: 0
Pocket money and the risk of dental caries and oral pain in children 零花钱与儿童患龋齿和口腔疼痛的风险
Pub Date : 2024-04-18 DOI: 10.1016/j.glmedi.2024.100106
Margaret Trimble , Sita Manasa Susarla , Claudia Campos , Bathsheba Turton , Karen Sokal-Gutierrez

Background

Tooth decay affects 40–90 % of children in low- and middle-income countries (LMICs), contributing to adverse consequences, including oral pain, difficulty focusing in school, lifelong dental problems, and overall lower quality of life. Few studies have examined the relationship between pocket money given to children, their purchase of sugary snacks and drinks with that money, and the risk for tooth decay.

Methods

This secondary cross-sectional analysis utilized data which were collected in 2014 as part of an oral health promotion program in rural El Salvador. A convenience sample of 279 children and their mothers who participated in the program were recruited to complete an interview with trained community health workers, and children received a dental examination from trained and licensed Salvadoran and U.S. dentists. Only children with teeth (primary, mixed, or permanent dentition) were included in this analysis; as such, children ranged in age from 6 months through 14 years. Descriptive, multivariate logistic regression, and Zero-Inflated Negative Binomial analyses were used to identify associations between pocket money given to children and three oral health outcomes: number of decayed, missing/extracted due to decay, and filled teeth (dmft for primary teeth and DMFT for permanent teeth); presence of deep decay; and occurrence of oral pain.

Results

Overall, almost two-thirds of children received daily pocket money with which over 70 % purchased unhealthy snacks/drinks; 83 % of children had tooth decay, with a mean dmft/DMFT of 6.0. After adjusting for covariates, receiving pocket money was associated with 0.18 (95 % CI: 0.05–0.54) times the odds of having zero-dmft/DMFT (i.e., being cavity-free) (p = 0.002). Among children with at least one decayed tooth, receiving pocket money was associated with 1.22 (95 % CI: 1.01–1.53) times the expected dmft/DMFT count (p = 0.04), 3.39 (95 % CI: 1.59–7.22) times the odds of deep decay (p < 0.001), and 2.66 (95 % CI: 1.24–5.70) times the odds of oral pain (p = 0.007) compared to children who did not receive pocket money.

Conclusion

Interventions to reduce the prevalence and severity of tooth decay should include nutrition and oral health education for children and families—including addressing pocket money and healthy vs. unhealthy purchases—in schools, communities, and primary health clinics; school programs to provide healthy foods and beverages for children; and enforcement of policies to prohibit the sale of ultra-processed foods and sugary drinks in and around schools.

背景蛀牙影响着中低收入国家(LMICs)40%-90%的儿童,造成不良后果,包括口腔疼痛、学习注意力难以集中、终身牙科问题和整体生活质量下降。这项二级横断面分析利用了 2014 年收集的数据,这些数据是萨尔瓦多农村地区口腔健康促进项目的一部分。我们招募了 279 名参加该计划的儿童及其母亲作为便利样本,让他们与经过培训的社区卫生工作者完成访谈,并由经过培训、持有执照的萨尔瓦多和美国牙医为儿童进行牙科检查。只有长有牙齿(初级、混合或恒牙)的儿童才被纳入分析范围;因此,儿童的年龄从 6 个月到 14 岁不等。通过描述性分析、多元逻辑回归分析和零膨胀负二项分析,确定了给儿童零花钱与三种口腔健康结果之间的关系:蛀牙、蛀牙缺失/脱落和补牙的数量(乳牙为 dmft,恒牙为 DMFT);是否存在深度蛀牙;以及是否出现口腔疼痛。结果总体而言,近三分之二的儿童每天都会收到零花钱,其中超过 70% 的儿童会用零花钱购买不健康的零食/饮料;83% 的儿童有蛀牙,平均蛀牙量/蛀牙时间为 6.0。在对辅助变量进行调整后,获得零花钱与零蛀牙/DMFT(即无蛀牙)几率的 0.18 倍(95 % CI:0.05-0.54)相关(p = 0.002)。在至少有一颗蛀牙的儿童中,与没有收到零用钱的儿童相比,收到零用钱的儿童的dmft/DMFT数量是预期的1.22(95 % CI:1.01-1.53)倍(p = 0.04),深龋几率是预期的3.39(95 % CI:1.59-7.22)倍(p <0.001),口腔疼痛几率是预期的2.66(95 % CI:1.24-5.70)倍(p = 0.007)。结论减少蛀牙发生率和严重程度的干预措施应包括:在学校、社区和初级卫生诊所对儿童和家庭进行营养和口腔健康教育,包括解决零花钱问题和健康与不健康购物的问题;为儿童提供健康食品和饮料的学校计划;以及执行禁止在学校内和学校周围销售超加工食品和含糖饮料的政策。
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Journal of Medicine, Surgery, and Public Health
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