Longitudinal strain analysis for assessment of early cardiotoxicity during anthracycline treatment in childhood sarcoma: A single center experience.

BACKGROUND: The growing population of long-term childhood cancer survivors encounter a substantial burden of cardiovascular complications. The highest risk of cardiovascular complications is associated with exposure to anthracyclines and chest radiation. Longitudinal cardiovascular surveillance is recommended for childhood cancer patients; however, the optimal methods and timing are yet to be elucidated. AIMS: We aimed to investigate the feasibility of different echocardiographic methods to evaluate left ventricular systolic function in retrospective datasets, including left ventricular ejection fraction (LVEF), fractional shortening (FS), global longitudinal strain (GLS) and longitudinal strain (LS) as well as the incidence and timing of subclinical left ventricular dysfunction detected by these methods. METHODS AND RESULTS: A retrospective longitudinal study was performed with re-analysis of longitudinal echocardiographic data, acquired during treatment and early follow-up, including 41 pediatric sarcoma patients, aged 2.1-17.8 years at diagnosis, treated at Astrid Lindgren Children's Hospital, Stockholm, Sweden, during the period 2010-2021. All patients had received treatment according to protocols including high cumulative doxorubicin equivalent doses (≥250 mg/m2 ). In 68% of all 366 echocardiograms, LS analysis was feasible. Impaired LS values (<17%) was demonstrated in >40%, with concomitant impairment of either LVEF or FS in 20% and combined impairment of both LVEF and FS in <10%. Importantly, there were no cases of abnormal LVEF and FS without concomitant LS impairment. CONCLUSION: Our findings demonstrate feasibility of LS in a majority of echocardiograms and a high incidence of impaired LS during anthracycline treatment for childhood sarcoma. We propose inclusion of LS in pediatric echocardiographic surveillance protocols.

Impacts of exhaust gas cleaning systems (EGCS) discharge waters on planktonic biological indicators.

Exhaust Gas Cleaning Systems (EGCS), operating in open-loop mode, continuously release acidic effluents (scrubber waters) to marine waters. Furthermore, scrubber waters contain high concentrations of metals, polycyclic aromatic hydrocarbons (PAHs), and alkylated PAHs, potentially affecting the plankton in the receiving waters. Toxicity tests evidenced significant impairments in planktonic indicators after acute, early-life stage, and long-term exposures to scrubber water produced by a vessel operating with high sulphur fuel. Acute effects on bacterial bioluminescence (Aliivibrio fischeri), algal growth (Phaeodactylum tricornutum, Dunaliella tertiolecta), and copepod survival (Acartia tonsa) were evident at 10 % and 20 % scrubber water, while larval development in mussels (Mytilus galloprovincialis) showed a 50 % reduction at ∼5 % scrubber water. Conversely, larval development and reproductive success of A. tonsa were severely affected at scrubber water concentrations ≤1.1 %, indicating the risk of severe impacts on copepod populations which in turn may result in impairment of the whole food web.

Comparison of pre-treatment methods and heavy density liquids to optimize microplastic extraction from natural marine sediments.

The ubiquitous occurrence of anthropogenic particles, including microplastics in the marine environment, has, over the last years, gained worldwide attention. As a result, many methods have been developed to estimate the amount and type of microplastics in the marine environment. However, there are still no standardized protocols for how different marine matrices should be sampled or how to extract and identify these particles, making meaningful data comparison hard. Buoyant microplastics are influenced by winds and currents, and concentrations could hence be expected to be highly variable over time. However, since both high density and most of the initially buoyant microplastics are known to eventually sink and settle on the seafloor, marine sediments are proposed as a suitable matrix for microplastics monitoring. Several principles, apparatuses, and protocols for extracting microplastics from marine sediments have been presented, but extensive comparison of the different steps in the protocols using real environmental samples is lacking. Thus, in this study, different pre-treatment and subsequent density separation protocols for extraction of microplastics from replicate samples of marine sediment were compared. Two pre-treatment methods, one using inorganic chemicals (NaClO + KOH + Na4P2O7) and one using porcine pancreatic enzymes, as well as one with no pre-treatment of the sediment, were compared in combination with two commonly used high-density saline solutions used for density separation, sodium chloride (NaCl) and zinc chloride (ZnCl2). Both pre-treatment methods effectively removed organic matter, and both saline solutions extracted lighter plastic particles such as polyethylene (PE) and polypropylene (PP). The most efficient combination, chemical pre-treatment and density separation with ZnCl2, was found to extract > 15 times more particles (≥ 100 µm) from the sediment than other treatment combinations, which could largely be explained by the high presence and efficient extraction of PVC particles.

Microplastics (MPs) in urban roadside snowbanks: Quantities, size fractions and dynamics of release.

The microplastics (MP) pollution has been receiving high attention in recent years, because of the massive amounts of plastics it contributes to the environment. Tyre wear and road wear particles (TWP and RWPs) were identified as major sources of MPs, but the observed data on these particles in urban snow deposits and snowmelt is scarce. To contribute to remediation of this situation, a study designed to quantify TWPs and RWPs in urban roadside snowbanks, and assess the MP occurrence in three size fractions, was conducted in the Luleå and Umeå municipalities in Northern Sweden. TWPs and RWPs were determined in three size fractions: 50-100 µm, 100-300 µm, and ≥300 µm, and their release from melting snow was investigated in the laboratory under controlled conditions. Among the MPs identified in snow and the associated snowmelt samples, a majority consisted of both types of particles (T&RWPs) with an average of 20,000 ± 48,000 number/L, whereas other MPs (fibres, fragments, flakes, and films of plastic) were much less plentiful with an average concentration of 24 ± 16 number/L. The largest proportion of T&RWPs was detected in the size fraction 50-100 µm (around 80%), and the smallest proportion was in the fraction ≥300 µm (about 2%). Of the T&RWPs, about 85% were black bitumen particles (RWPs), composed of bitumen, mineral material and polymer modifiers, and 15% were tyre wear particles (TWPs) composed of rubber. The laboratory snow melting experiments demonstrated that urban snow stored MPs, which were eventually released during snowmelt. The ultimate fate of released MPs would depend on snowmelt drainage; it may either drain away from the road pavement and infiltrate into the ground, or enter the road gutter and be conveyed to storm sewers discharging to the receiving waters.

Modelling spatial dispersion of contaminants from shipping lanes in the Baltic Sea.

Major sources of pollution from shipping to marine environments are antifouling paint residues and discharges of bilge, black, grey and ballast water and scrubber discharge water. The dispersion of copper, zinc, naphthalene, pyrene, and dibromochloromethane have been studied using the Ship Traffic Emission Assessment Model, the General Estuarine Transport Model, and the Eulerian tracer transport model in the Baltic Sea in 2012. Annual loads of the contaminants ranged from 10-2 tons for pyrene to 100 s of tons for copper. The dispersion of the contaminants is determined by the surface kinetic energy and vertical stratification at the location of the discharge. The elevated concentration of the contaminants at the surface persists for about two-days and the contaminants are dispersed over the spatial scale of 10-60 km. The Danish Sounds, the southwestern Baltic Sea and the Gulf of Finland are under the heaviest pressure of shipborne contaminants in the Baltic Sea.

Removal of rubber, bitumen and other microplastic particles from stormwater by a gross pollutant trap - bioretention treatment train.

Microplastic particles in stormwater pose significant threats to the environment. This study investigated how effective a stormwater treatment train was at removing rubber, bitumen and other microplastics (incl. fibers, fragments, and paint particles) in the 100-300 µm and >300 µm size fractions from highway runoff. The two treatment trains comprise a gross pollutant trap (GPT) followed by either a vegetated bioretention cell or non-vegetated sand filter. Flow-proportional composite samples were taken from the highway runoff, GPT outflow and the outflow from the two parallel filters during nine rain events to determine overall treatment performance, as well as the performance of individual system components. The identified rubber, bitumen and other microplastic particles mainly represented the 100-300 µm fraction and included high ratios of rubber (30%) and bitumen (60%). Overall, the treatment train efficiently removed rubber, bitumen and other microplastic particles in the 100-300 µm size fraction from the stormwater. The filter cells accounted for a major share of this removal, as the GPT did not reduce microplastic particle concentrations. This observation is likely explained by the fact that the rubber, bitumen and other microplastic particles have a density close to the density of water and thus removal by sedimentation is decreased. This identified an inherent weakness of the system; more specifically, the high microplastic concentrations in the surface water of the GPT means there can be a risk of microplastic release through overflow pits when inflows surpass the system capacity. Despite some differences, both the vegetated bioretention cell and the non-vegetated sand filter removed rubber, bitumen and other microplastic particles to similar extent.

Severe Toxic Effects on Pelagic Copepods from Maritime Exhaust Gas Scrubber Effluents.

To reduce sulfur emission from global shipping, exhaust gas cleaning systems are increasingly being installed on board commercial ships. These so-called scrubbers extract SOX by spraying water into the exhaust gas. An effluent is created which is either released directly to the sea (open-loop system) or treated to remove harmful substances before release (closed-loop system). We found severe toxic effects in the ubiquitous planktonic copepod Calanus helgolandicus of exposure to effluents from two closed-loop systems and one open-loop system on North Sea ships. The effluents contained high concentrations of heavy metals and polycyclic aromatic hydrocarbons (PAHs), including alkylated PAHs. We observed significantly elevated mortality rates and impaired molting already in the lowest tested concentrations of each effluent: 0.04 and 0.1% closed-loop effluents and 1% open-loop effluent. These concentrations correspond to total hydrocarbon concentrations of 2.8, 2.0, and 3.8 µg L-1, respectively, and compared to previous studies on oil toxicity in copepods, scrubber effluents appear more toxic than, for example, crude oil. None of the individual PAHs or heavy metals analyzed in the effluents occurred in concentrations which could explain the high toxicity. The effluents showed unexpected alkylated PAH profiles, and we hypothesize that scrubbers act as witch's cauldrons where undesired toxic compounds form so that the high toxicity stems from compounds we know very little about.

Traffic-related microplastic particles, metals, and organic pollutants in an urban area under reconstruction.

In urban environments, particularly areas under reconstruction, metals, organic pollutants (OP), and microplastics (MP), are released in large amounts due to heavy traffic. Road runoff, a major transport route for urban pollutants, contributes significantly to a deteriorated water quality in receiving waters. This study was conducted in Gothenburg, Sweden, and is unique because it simultaneously investigates the occurrence of OP, metals, and MP on roads and in stormwater from an urban area under reconstruction. Correlations between the various pollutants were also explored. The study was carried out by collecting washwater and sweepsand generated from street sweeping, road surface sampling, and flow-proportional stormwater sampling on several occasions. The liquid and solid samples were analyzed for metals, polycyclic aromatic hydrocarbons (PAH), oxy-PAH, aliphatics, aromatics, phthalates, and MP. The occurrence of OP was also analyzed with a non-target screening method of selected samples. Microplastics, i.e. plastic fragments/fibers, paint fragments, tire wear particles (TWP) and bitumen, were analyzed with a method based on density separation with sodium iodide and identification with a stereo microscope, melt-tests, and tactile identification. MP concentrations amounted to 1500 particles/L in stormwater, 51,000 particles/L in washwater, and 2.6 × 106 particles/kg dw in sweepsand. In stormwater, washwater and sweepsand, MP ≥20 µm were found to be dominated by TWP (38%, 83% and 78%, respectively). The results confirm traffic as an important source to MP, OP, and metal emissions. Concentrations exceeding water and sediment quality guidelines for metals (e.g. Cu and Zn), PAH, phthalates, and aliphatic hydrocarbons in the C16-C35 fraction were found in most samples. The results show that the street sweeper collects large amounts of polluted materials and thereby prevents further spread of the pollutants to the receiving stormwater.

A temporal record of microplastic pollution in Mediterranean seagrass soils.

Plastic pollution is emerging as a potential threat to the marine environment. In the current study, we selected seagrass meadows, known to efficiently trap organic and inorganic particles, to investigate the concentrations and dynamics of microplastics in their soil. We assessed microplastic contamination and accumulation in 210Pb dated soil cores collected in Posidonia oceanica meadows at three locations along the Spanish Mediterranean coast, with two sites located in the Almería region (Agua Amarga and Roquetas) and one at Cabrera Island (Santa Maria). Almería is known for its intense agricultural industry with 30 000 ha of plastic-covered greenhouses, while the Cabrera Island is situated far from urban areas. Microplastics were extracted using enzymatic digestion and density separation. The particles were characterized by visual identification and with Fourier-transformed infrared (FTIR) spectroscopy, and related to soil age-depth chronologies. Our findings showed that the microplastic contamination and accumulation was negligible until the mid-1970s, after which plastic particles increased dramatically, with the highest concentrations of microplastic particles (MPP) found in the recent (since 2012) surface soil of Agua Amarga (3819 MPP kg-1), followed by the top-most layers of the soil of the meadows in Roquetas (2173 kg-1) and Santa Maria (68-362 kg-1). The highest accumulation rate was seen in the Roquetas site (8832 MPP m-2 yr-1). The increase in microplastics in the seagrass soil was associated to land-use change following the intensification of the agricultural industry in the area, with a clear relationship between the development of the greenhouse industry in Almería and the concentration of microplastics in the historical soil record. This study shows a direct linkage between intense anthropogenic activity, an extensive use of plastics and high plastic contamination in coastal marine ecosystems such as seagrass meadows. We highlight the need of proper waste management to protect the coastal environment from continuous pollution.

Occurrence of tire and bitumen wear microplastics on urban streets and in sweepsand and washwater.

Tire and road wear particles have been identified as a potential major source of microplastics in the environment. However, more knowledge of the emissions and their further fate in the environment is needed, and the effectiveness and benefits of potential measures must be investigated to support future risk management efforts. Here the concentrations of tire and bitumen microplastic particles (TBMP) on roads and in nearby in stormwater, sweepsand and washwater were measured for the first time within the same area and time period. The analysis also included plastic, paint and fiber particles. Road dust was sampled on the road surface using a wet dust sampler, before and after street sweeping on two occasions. On each of these occasions, and several occasions during a four-month period with frequent street sweeping, sweepsand and washwater, as well as flow-weighted sampling of stormwater, were collected. TBMP concentrations were operationally defined, using density separation for some samples, followed by analysis by stereo microscopy. Sodium iodide (NaI) was found to be effective for density separation of TBMP. The largest proportion of anthropogenic microplastics detected consisted of tire tread wear and bitumen. The number of TBMP ≥100 µm in the WDS samples was up to 2561 particles/L. Sweepsand and washwater contained high amounts of TBMP ≥100 µm, up to 2170 particles/kg dw and 4500 particles/L, respectively. The results show that the sweeper collects considerable amounts of TBMP, and thus weekly sweeping might prevent further transport of TBMP to the receiving stormwater. In stormwater the number of particles ≥100 µm was up to 3 particles/L and ≥ 20 µm was up to 5900 particles/L showing the importance of analysing smaller microparticle sizes than 100 µm in all samples in future studies. This study also confirms that there is a substantial volume of TBMP generated from traffic that enters the environment.

Summer sea ice melt and wastewater are important local sources of microlitter to Svalbard waters.

Human activities leave traces of marine litter around the globe. The Arctic is, despite its remoteness, emerging as an area of no exception to this environmental issue. Arctic sea ice has previously been found to constitute a temporal sink of microplastics, but the potential release and subsequent fate of microplastics in the marine environment are yet unknown. Furthermore, the relative importance of local sources of microplastics in the Arctic marine environment is under discussion. In this study, the concentration and distribution of anthropogenic microparticles (AMPs, <5 mm, including microplastics) have been investigated in marine waters and sea ice of Svalbard. Seawater samples throughout the water column and floating sea ice samples were collected along a transect originating in Rijpfjorden, reaching northwards to the sea ice-edge. Seawater samples were also collected along a transect extending westwards from head to mouth of Kongsfjorden. Samples were collected throughout the water column with stations positioned to enable detection of potential AMP emissions from the wastewater outlet in Ny-Ålesund. Along both transects, environmental parameters were measured to explore potential correlations with AMP distribution. High concentrations of AMPs were detected in sea ice (158 ±â€¯155 AMPs L-1). Based on both AMP concentrations and characteristics, AMPs identified in seawater of the marginal ice zone are to a large extent likely released during the melting of sea ice. The release of AMPs during summer melting of sea ice was concomitantly taking place with the ice-edge bloom, suggesting increased bioavailability to Arctic marine biota. Concentrations of AMPs were up to an order of magnitude higher in Kongsfjorden (up to 48.0 AMPs L-1) than in Rijpfjorden (up to 7.4 AMPs L-1). The distribution and composition of AMPs in Kongsfjorden suggest the wastewater outlet in Ny-Ålesund to be a likely source. Our results emphasize the importance of local point- and diffuse sources of AMPs in the Arctic and stress the urgency of considering their associated environmental impact. Implementation of regulatory policy is of importance, particularly since human activities and environmental pressures are increasing in the Arctic.

An efficient and gentle enzymatic digestion protocol for the extraction of microplastics from bivalve tissue.

Standardized methods for the digestion of biota for microplastic analysis are currently lacking. Chemical methods can be effective, but can also cause damage to some polymers. Enzymatic methods are known to be gentler, but often laborious, expensive and time consuming. A novel tissue digestion method with pancreatic enzymes and a pH buffer (Tris) is here presented in a comparison to a commonly applied digestion protocol with potassium hydroxide. The novel protocol demonstrates a highly efficient removal of bivalve tissue (97.7 ±â€¯0.2% dry weight loss) already over-night. Furthermore, it induces no impairment in terms of ability to correctly identify four pre-weathered plastic polymers and six textile fiber polymers by Fourier transform infrared spectroscopy after exposure. The high-throughput protocol requires minimal handling, is of low cost and does not pose risk to the performer or the environment. It is therefore suggested as a candidate for a standardized digestion protocol, enabling successful analysis of microplastics ingested by bivalves.

Microplastic in wild populations of the omnivorous crab Carcinus aestuarii: A review and a regional-scale test of extraction methods, including microfibres.

Microplastic (MP) has become ubiquitous in the marine environment. Its threat to marine organisms has been demonstrated under laboratory conditions, yet studies on wild populations still face methodological difficulties. We reviewed the methods used to separate MP from soft animal tissues and highlighted a lack of standardised methodologies, particularly critical for synthetic microfibres. We further compared enzymatic and a potassium hydroxide (KOH)-based alkaline digestion protocols on wild crabs (Carcinus aestuarii) collected from three coastal lagoons in the north Adriatic Sea and on laboratory-prepared synthetic polyester (PES) of different colour and polypropylene (PP). We compared the cost-effectiveness of the two methods, together with the potential for adverse quantitative or qualitative effects on MP that could alter the capability of the polymers to be recognised via microscopic or spectroscopic techniques. Only 5.5% of the 180 examined crabs contained MP in their gastrointestinal tracts, with a notably high quantitative variability between individuals (from 1 to 117 particles per individual). All MP found was exclusively microfibres, mainly PES, with a mean length (±SE) of 0.5 ±â€¯0.03 mm. The two digestion methods provided comparable estimates on wild crabs and did not cause any visible physical or chemical alterations on laboratory-prepared microfibres treated for up to 4 days. KOH solution was faster and cheaper compared to the enzymatic extraction, involving fewer procedural steps and therefore reducing the risk of airborne contamination. With digestion times longer than 4 days, KOH caused morphological alterations of some of the PES microfibres, which did not occur with the enzymatic digestion. This suggests that KOH is effective for the digestion of small marine invertebrates or biological samples for which shorter digestion time is required, while enzymatic extraction should be considered as alternative for larger organisms or sample sizes requiring longer digestion times.

Risk assessment of bilge water discharges in two Baltic shipping lanes.

Environmental concentrations and effects of bilge water contaminants in two Baltic Sea areas were estimated from modelling of discharge rates and analytical data on bilge water from seven ships. Biodegradation of bilge water oil was accounted for and annual water concentrations were estimated to peak in late spring, which coincides with the beginning of a period with extensive biological activities in the sea. Concentrations on bilge water metals were calculated both as water concentrations and as the annual contribution of metals to sediments. The predicted bilge water concentrations of oil and metal in the marine environment were estimated to be 4 to 8 orders of magnitude lower than reported toxic concentrations. However, available toxicity data are based on short term exposure and there is to date limited information on toxic effects of the small but chronically elevated contaminant concentrations derived from bilge water discharge and other operational shipping activities.

Toxicity of treated bilge water: The need for revised regulatory control.

Water accumulating in the bottom of ships (bilge water), contains a mixture of oil, detergents and other compounds from on board activities. To evaluate ecological effects of released bilge water the chemical composition and toxicity of treated bilge water from seven passenger ships was analysed. The oil content was below 15mgL-1, the threshold for legal discharge, in all but one ship. Still, significant reductions in feeding and reproduction of Acartia tonsa were found after 48h exposure in dilutions with 2.5-5% of bilge water. Mortality was significant at dilutions of 5-10% in 4 of the 5 bilge water samples. Surfactants were the most significant contributor to the toxicity on copepod vital rates and survival. Toxicity was also tested with Microtox where an EC50 was found at dilutions between 4.3% and 52%. The results show that ecological effects might occur also in diluted suspensions of bilge water.

Distribution and abundance of surface water microlitter in the Baltic Sea: A comparison of two sampling methods.

Two methods for marine microlitter sampling were compared in the Gulf of Finland, northern Baltic Sea: manta trawl (333µm) and a submersible pump (300 or 100µm). Concentrations of microlitter (microplastics, combustion particles, non-synthetic fibres) in the samples collected with both methods and filter sizes remained <10particlesm(-3). The pump with 100µm filter gave higher microlitter concentrations compared to manta trawl or pump with 300µm filter. Manta sampling covers larger areas, but is potentially subjected to contamination during sample processing and does not give precise volumetric values. Using a submerged pump allows method controls, use of different filter sizes and gives exact volumetric measures. Both devices need relatively calm weather for operation. The choice of the method in general depends on the aim of the study. For monitoring environmentally relevant size fractions of microlitter the use of 100µm or smaller mesh size is recommended for the Baltic Sea.

Tobacco use and caries risk among adolescents--a longitudinal study in Sweden.

BACKGROUND: Smoking and the use of smokeless tobacco have a detrimental impact on general and oral health. The relationship to dental caries is however still unclear. As caries is a multi-factorial disease with clear life-style, socio-economic and socio-demographic gradients, the tobacco use may be a co-variable in this complex rather than a direct etiological factor. Our aim was to analyze the impact of tobacco use on caries incidence among adolescents, with consideration to socio-economic variables by residency, using epidemiological data from a longitudinal study in the region of Halland, Sweden. METHODS: The study population consisted of 10,068 adolescents between 16-19 years of age from whom yearly data on caries and tobacco use (cigarette smoking and use of smokeless tobacco) were obtained during the period 2006-2012. Reported DMFS increment between 16 and 19 years of age (∆DMFS) for an individual was considered as the primary caries outcome. The outcome data were compared for self-reported never vs. ever users of tobacco, with consideration to neighborhood-level socio-economy (4 strata), baseline (i.e., 16 years of age) DMFS and sex. The region consists of 65 parishes with various socio-economic conditions and each study individual was geo-coded with respect to his/her residence parish. Neighborhood (parish-level) socio-economy was assessed by proportion of residing families with low household purchasing power. RESULTS: ∆DMFS differed evidently between ever and never users of tobacco (mean values: 1.8 vs. 1.2; proportion with ∆DMFS > 0: 54.2% vs. 40.5%; p < 0.0001). Significant differences were observed in each neighborhood-level socio-economic stratum. Even after controlling for baseline DMFS and sex, ∆DMFS differed highly significantly between the ever and never users of tobacco (overall p < 0.0001). CONCLUSION: Tobacco use was clearly associated with increased caries increment during adolescence. Hence, this factor is relevant to consider in the clinical caries risk assessment of the individual patient as well as for community health plans dealing with oral health.

Geo-mapping of time trends in childhood caries risk--a method for assessment of preventive care.

BACKGROUND: Dental caries is unevenly distributed within populations with a higher burden in low socio-economy groups. Several attempts have been made to allocate resources to those that need them the most; there is a need for convenient approaches to population-based monitoring of caries risk over time. The aim of this study was to develop the geo-map concept, addressing time trends in caries risk, and demonstrate the novel approach by analyzing epidemiological data from preschool residents in the region of Halland, Sweden. METHODS: The study population consisted of 9,973 (2006) and 10,927 (2010) children between 3 to 6 years of age (~77% of the eligible population) from whom caries data were obtained. Reported dmfs>0 for a child was considered as the primary caries outcome. Each study individual was geo-coded with respect to his/her residence parish (66 parishes in the region). Smoothed caries risk geo-maps, along with corresponding statistical certainty geo-maps, were produced by using the free software Rapid Inquiry Facility and the ESRI® ArcGIS system. Parish-level socioeconomic data were available. RESULTS: The overall proportion of caries-free (dmfs=0) children improved from 84.0% in 2006 to 88.6% in 2010. The ratio of maximum and minimum (parish-level) smoothed relative risks (SmRRs) increased from 1.76/0.44=4.0 in 2006 to 2.37/0.33=7.2 in 2010, which indicated an increased geographical polarization of early childhood caries in the population. Eight parishes showed evidential, positional changes in caries risk between 2006 and 2010; their corresponding SmRRs and statistical certainty ranks changed markedly. No considerable parallel changes in parish-level socioeconomic characteristics were seen during the same time period. CONCLUSION: Geo-maps based on caries risk can be used to monitor changes in caries risk over time. Thus, geo-mapping offers a convenient tool for evaluating the effectiveness of tailored health promotion and preventive care in child populations.

Geo-mapping of caries risk in children and adolescents - a novel approach for allocation of preventive care.

BACKGROUND: Dental caries in children is unevenly distributed within populations with a higher burden in low socio-economy groups. Thus, tools are needed to allocate resources and establish evidence-based programs that meet the needs of those at risk. The aim of the study was to apply a novel concept for presenting epidemiological data based on caries risk in the region of Halland in southwest Sweden, using geo-maps. METHODS: The study population consisted of 46,536 individuals between 3-19 years of age (75% of the eligible population) from whom caries data were reported in 2010. Reported dmfs/DMFS>0 for an individual was considered as the primary caries outcome. Each study individual was geo-coded with respect to his/her residence parish. A parish-specific relative risk (RR) was calculated as the observed-to-expected ratio, where the expected number of individuals with dmfs/DMFS>0 was obtained from the age- and sex-specific caries (dmfs/DMFS>0) rates for the total study population. Smoothed caries risk geo-maps, along with corresponding statistical certainty geo-maps, were produced by using the free software Rapid Inquiry Facility and the ESRI® ArcGIS system. RESULTS: The geo-maps of preschool children (3-6 years), schoolchildren (7-11 years) and adolescents (12-19 years) displayed obvious geographical variations in caries risk, albeit most marked among the preschoolers. Among the preschool children the smoothed relative risk (SmRR) varied from 0.33 to 2.37 in different parishes. With increasing age, the contrasts seemed to diminish although the gross geographical risk pattern persisted also among the adolescents (SmRR range 0.75-1.20). CONCLUSION: Geo-maps based on caries risk may provide a novel option to allocate resources and tailor supportive and preventive measures within regions with sections of the population with relatively high caries rates.