Refugee child oral health.

The number of people forced to flee their homes and move around the world is increasing rapidly. Such refugee populations are not only more likely to have poor physical, mental and social health outcomes but also to experience difficulties accessing health services in their new country. In particular, children from refugee backgrounds are at increased risk of poor oral health which in time is associated with poor adult oral health and impacts on child health (e.g. growth and development) and well-being. To date, there is little evidence about the nature and extent of their oral health problems nor interventions to improve their oral health status. This article summarises the evidence surrounding the oral health status of children from refugee backgrounds. In addition, a systematic review of the international literature over the past 10 years is presented which identifies interventions to improve the oral health of these vulnerable paediatric populations. Based on this evidence, potential strategies available to dental service providers to optimise provision of responsive dental care are discussed.

Child oral health in migrant families: A cross-sectional study of caries in 1-4 year old children from migrant backgrounds residing in Melbourne, Australia.

UNLABELLED: Early Childhood Caries (ECC) is the most common, preventable disease of childhood. It can affect children's health and wellbeing and children from migrant families may be at greater risk of developing ECC. OBJECTIVE: To describe ECC in children from migrant families, and explore possible influences. BASIC RESEARCH DESIGN: Cross-sectional analysis of caries data collected as baseline data for an oral health promotion study. PARTICIPANTS: The analysis sample included 630 1-4 year-old children clustered within 481 Iraqi, Lebanese and Pakistani families in Melbourne, Australia. METHOD: Child participants received a community-based visual dental examination. Parents completed a self-administered questionnaire on demographics, ethnicity, and oral health knowledge, behaviour and attitudes. MAIN OUTCOME MEASURE: Child caries experience. Bivariate associations between oral health behaviours and ethnicity were tested for significance using chi-square. Multivariate logistic regression analyses were performed to identify associations with ECC, adjusting for demographic variables and accounting for clustering by family. RESULTS: Overall, 34% of children in the sample experienced caries (both non-cavitated and cavitated). For all caries lesions, parent' length of residence in Australia, consumption of sweet drinks and parental education remained as independent predictors of child caries experience. Adding sugar to drinks was an additional risk factor for cavitation. Ethnicity was associated with some individual oral health behaviours suggesting cultural influences on health, however the relationship was not independent of other predictors. CONCLUSION: Culturally competent oral health promotion interventions should aim to support migrant families with young children, and focus on reducing sweet drink consumption.

Chromosomal microarray impacts clinical management.

Chromosomal microarray analysis (CMA) is standard of care, first-tier clinical testing for detection of genomic copy number variation among patients with developmental disabilities. Although diagnostic yield is higher than traditional cytogenetic testing, management impact has not been well studied. We surveyed genetic services providers regarding CMA ordering practices and perceptions about reimbursement. Lack of insurance coverage because of perceived lack of clinical utility was cited among the most frequent reasons why CMA was not ordered when warranted. We compiled a list of genomic regions where haploinsufficiency or triplosensitivity cause genetic conditions with documented management recommendations, estimating that at least 146 conditions potentially diagnosable by CMA testing have published literature supporting specific clinical management implications. Comparison with an existing clinical CMA database to determine the proportion of cases involving these regions showed that CMA diagnoses associated with such recommendations are found in approximately 7% of all cases (n = 28,526). We conclude that CMA impacts clinical management at a rate similar to other genetic tests for which insurance coverage is more readily approved. The information presented here can be used to address barriers that continue to contribute to inequities in patient access and care in regard to CMA testing.

Towards an evidence-based process for the clinical interpretation of copy number variation.

The evidence-based review (EBR) process has been widely used to develop standards for medical decision-making and to explore complex clinical questions. This approach can be applied to genetic tests, such as chromosomal microarrays, in order to assist in the clinical interpretation of certain copy number variants (CNVs), particularly those that are rare, and guide array design for optimal clinical utility. To address these issues, the International Standards for Cytogenomic Arrays Consortium has established an EBR Work Group charged with building a framework to systematically assess the potential clinical relevance of CNVs throughout the genome. This group has developed a rating system enumerating the evidence supporting or refuting dosage sensitivity for individual genes and regions that considers the following criteria: number of causative mutations reported; patterns of inheritance; consistency of phenotype; evidence from large-scale case-control studies; mutational mechanisms; data from public genome variation databases; and expert consensus opinion. The system is designed to be dynamic in nature, with regions being reevaluated periodically to incorporate emerging evidence. The evidence collected will be displayed within a publically available database, and can be used in part to inform clinical laboratory CNV interpretations as well as to guide array design.

Getting ahead of the oral health game: it starts before we're born?

Dental caries is one of the most common chronic diseases affecting individuals of all ages. Caries in the primary dentition is one of the main risk factors for caries in the permanent dentition. Preventing the development of the first carious lesion is fundamental not only to long term health and wellbeing but to reducing the burden of this disease on individuals, families and the community. Described as the developmental origins of health and disease, events from the prenatal period are increasingly recognised as having a significant impact on later health outcomes. While social and behavioural factors from this period have long been linked with oral health, emerging evidence of the influence of epigenetics and early life programming of microbiome and host response suggests that the prenatal period provides a timely opportunity for preventive interventions. Pregnancy is an ideal time to focus on health promoting activities as most women have regular interaction with health care professionals who can target risk factors before the onset of disease. This paper summarizes contemporary understanding of the role of pre- and perinatal factors on child oral health and describes how this evidence might be used by all health professionals to ensure infants start life ahead in the oral health game.

Parental knowledge, beliefs and behaviours for oral health of toddlers residing in rural Victoria.

BACKGROUND: Little is known about the oral health of children under the age of four years. The determinants of early childhood caries (ECC) in this young age group are also not well understood despite a growing recognition that early interventions may deliver the greatest benefits. The aim of this study was to examine the oral health-related knowledge, attitudes and reported behaviours of parents of children aged 12-24 months living in rural areas of Victoria, Australia. METHODS: A robust theoretical model was utilized to identify oral health-related behaviours and their antecedent and reinforcing conditions within the context of this specific population group. Two hundred and ninety-four parent/child dyads were recruited through their maternal and child health nurses as part of a larger intervention trial. Parents completed a self-report questionnaire. RESULTS: Knowledge regarding risk and protective factors amongst parents was variable and sometimes at odds with contemporary evidence. Knowledge of the role of early infection with S. mutans was very low, with high levels of behaviours that may promote early transmission reported. Tooth cleaning was reported by most parents at least sometimes, however a large proportion lacked confidence and this was significantly related to the frequency of the cleaning. Parents were confused about the fluoride status of their water supplies. Most parents believed fluoride toothpaste reduced the risk of ECC but did not know whether it should be used with toddlers. CONCLUSIONS: The results of this study have implications for efforts to prevent dental decay in this very young age group. Health care professionals other than dentists need support to provide information and promote confidence with regard to optimal fluoride exposure. Attention should also be given to the contribution of early contact with particular bacteria in oral health education and promotion programmes.

Midwives' and women's views on accessing dental care during pregnancy: an Australian qualitative study.

BACKGROUND: Maternal behaviours during pregnancy are likely to play a significant role in the development of dental caries in children. Although midwives are well placed to discuss oral health and provide information to women, dental attendance by women during pregnancy is minimal. This study aimed to explore midwives' experience of facilitating pregnant women's access to dental care and to document women's experience of receiving dental information and care during pregnancy. METHODS: Focus groups with midwives and telephone interviews with women who were referred to Monash Health Dental Services were conducted to explore their perspectives and experiences. The qualitative data was thematically analysed. RESULTS: Three focus groups with 13 midwives and telephone interviews with eight women who recently gave birth were conducted. Three key themes were identified: maternal oral health knowledge; barriers to accessing dental information and care during pregnancy; and suggested recommendations. CONCLUSIONS: This study highlighted the barriers that exist for midwives to discuss oral health with women and refer women to dental care, and women's experiences of accessing dental care during pregnancy. Ongoing collaboration between the maternity and dental services is required to strengthen midwives' knowledge, confidence and practise in supporting women to access dental care during pregnancy.

Exploring child dental service use among migrant families in metropolitan Melbourne, Australia.

BACKGROUND: This study describes and explores factors related to dental service use among migrant children. METHODS: A cross-sectional analysis of baseline data from Teeth Tales, an exploratory trial implementing a community based child oral health promotion intervention. The sample size and target population was 600 families with 1-4 year old children from Iraqi, Lebanese and Pakistani backgrounds residing in metropolitan Melbourne. Participants were recruited into the study using purposive and snowball sampling techniques. RESULTS: Most (88%; 550/625) children had never visited the dentist (mean (SD) age 3.06 years (1.11)). In the fully adjusted model the variable most significantly associated with child dental visiting was parent reported 'no reason for child to visit the dentist' (OR = 0.07, p < 0.001). Of those children whose parents reported their child had no reason to visit the dentist, 22% (37/165) experienced dental caries with 8% (13/165) at the level of cavitation. CONCLUSIONS: Dental service use by migrant preschool children was very low. The relationship between perceived dental need and dental service use is currently not aligned. One in 10 children of select migrant background had visited a dentist, which is in the context of 1 in 3 with dental caries. To improve utilization, health services should consider organizational cultural competence, outreach and increased engagement with the migrant community.

Hard to reach communities or hard to access services? Migrant mothers' experiences of dental services.

BACKGROUND: Good oral health is an important component of overall health which can help migrants settle in a new country. Infant oral health is intimately associated with maternal oral health knowledge and behaviours and therefore, encounters with dental services. This study aimed to explore the experiences of dental service use from the perspective of migrant mothers living in Melbourne, Australia. METHODS: A participatory research approach utilizing qualitative methods was adopted. Women from Iraq, Lebanon and Pakistan participated. Semi-structured focus groups and interviews were conducted and thematic analysis of the data was completed. RESULTS: Focus groups (n = 11) and interviews (n = 7) were conducted with 115 women. Despite an understanding that visiting the dentist was important for promoting oral health, the first dental contact for both the women and their children was typically for emergency care. Accessibility, cost and waiting lists were identified as significant barriers to attendance. Problematic interpreter encounters often led to negative experiences which were compounded by a perception that public services provided poorer quality of care. CONCLUSIONS: Despite evidence of poorer oral health, migrant women face significant barriers in accessing mainstream dental services. Reorientation of such services, to address the accessibility and experience for migrant communities may help reduce oral health inequalities.

Over and undernutrition in the children of Australian immigrants: Assessing the influence of birthplace of primary carer and English language use at home on the nutritional status of 4-5-year-olds.

OBJECTIVE: To document the relationship between childhood nutrition status and ethnicity (defined as the birthplace of primary carer and English language use at home) using a nationally representative sample of 4- to 5-year-old children. DESIGN AND PARTICIPANTS: Cross-sectional population survey of 4 983 4- to 5-year-old children (2 537 boys and 2 446 girls) as part of Wave 1 (2004) of the Longitudinal Study of Australian Children. MAIN OUTCOME MEASURES: Overweight/obesity and thinness using the newly published body mass index cut-off points of Cole (2007). RESULTS: In total, 20.6% (95%CI 19.5, 21.7) of children aged 4 to 5 years were estimated to be overweight or obese, while 1.0% (95%CI 0.8, 1.3) was thin. Unadjusted analyses showed a significant relationship between childhood overweight/obesity and primary carer's country of birth (chi2=15.9, p<0.01), but the significance became minimal after adjusting for socio-economic and demographic factors. The adjusted model suggests that boys of primary carer's born in Europe (excluding UK and Ireland) were less likely to be overweight/obese than boys whose primary carers were born in Australia, but the overall effect size was negligible. No difference was found for girls. In addition, boys who mainly spoke English at home were less likely to be overweight/obese (OR=0.49; 95%CI 0.27, 0.88; p=0.017) and thin (OR=0.27; 95%CI 0.12, 0.62; p=0.002) than boys who spoke a language other than English at home. No difference was found for girls. CONCLUSIONS: There is a relationship between main language spoken at home and nutritional status in 4-5-year-old boys but not girls. The use of English language at home may be a protective factor for normal weight in young boys. After adjustment for socio-economic and demographics characteristics, there was a negligible relationship between overweight/obesity in children and their primary carer's country of birth.

Characterization of rat liver oligonucleosomes enriched in transcriptionally active genes: evidence for altered base composition and a shortened nucleosome repeat.

A transcriptionally active chromatin fraction of oligonucleosome size has been separated and isolated by a modified micrococcal nuclease fractionation procedure. After mild enzymatic digestion, rat liver nuclei were lysed, and the chromatin was separated by centrifugation on linear sucrose gradients. Fractions from four regions of the gradient were pooled and labeled, from the top to the bottom, A, B, C, and D, respectively. Fraction A, which contained 20% or less of the total DNA, was determined to have a mean size of a hexanucleosome. By hybridization with [3H]cDNA transcribed from total cytoplasmic poly(A) mRNA, DNA from fraction A was shown to be 10-15-fold enriched in transcribing genes when compared with total DNA. This fraction also has a somewhat higher concentration of AT base sequences. Significant differences were observed in nucleosome phasing. Fraction A has the shortest repeat length, fractions B and C are intermediate, and fraction D, which is depleted in transcribing DNA sequences, has the longest. Thus, we have isolated a chromatin fraction of oligonucleosome size enriched in transcribing genes and organized with reduced nucleosome spacing.

[Descriptive anatomy of the posterior root of the trigeminal nerve (preliminary study)]. / Anatomie descriptive de la racine postérieure du trijumeau (étude préliminaire)

By 25 dissections, an angulation of 40 degrees at the emergency of the trigeminal nerve was observed. To the three types of fibers described by SICARD, a fourth type is added of V2 fibers wrapped by cranio-median and caudo-lateral fibres. Two groups form the motor root, a postero-superior group and an antero-inferior group. Anastomoses exist between the motor and sensitive roots as well as a few unusual sensitive rootlets.

Determination of an epitope of the diffuse systemic sclerosis marker antigen DNA topoisomerase I: sequence similarity with retroviral p30gag protein suggests a possible cause for autoimmunity in systemic sclerosis.

The possibility that viruses play a role in the etiology of various autoimmune diseases has been proposed. One approach to the search for these agents involves identifying potential crossreactive epitopes in viruses that infect cells of the immune system or of the target tissues. Antibodies to DNA topoisomerase I are the marker autoantibodies for diffuse systemic sclerosis. The major epitope of the antigen was therefore sought through cloning and sequencing of the cDNA for human topoisomerase I and eventually by the synthesis of the smallest possible peptide recognized by sera from patients with the diffuse form of systemic sclerosis. The antigenic 11-amino acid sequence contains 6 sequential amino acids that are identical to a sequence present in the group-specific antigen (p30gag) of some mammalian retroviruses. This sequence is separated by only 1 amino acid from the retroviral epitope sequence that crossreacts with autoantibodies against the marker antigen for mixed connective-tissue disease and systemic lupus erythematosus, the 70-kDa polypeptide of U1 ribonucleoprotein particles. These findings suggest that a retroviral agent may be involved in the pathogenesis of systemic sclerosis and other connective tissue diseases and that antibodies to intracellular antigens are not involved in the pathogenesis of autoimmune disease but may be useful as footprints for tracking the potential etiological agent of autoimmune disease.

Mapping of homologous, amino-terminal neutralizing regions of human T-cell lymphotropic virus type I and II gp46 envelope glycoproteins.

Twelve synthetic peptides containing hydrophilic amino acid sequences of human T-cell lymphotropic virus type I (HTLV-I) envelope glycoprotein were coupled to tetanus toxoid and used to raise epitope-specific antisera in goats and rabbits. Low neutralizing antibody titers (1:10 to 1:20) raised in rabbits to peptides SP-2 (envelope amino acids [aa] 86 to 107), SP-3 (aa 176 to 189), and SP-4A (aa 190 to 209) as well as to combined peptide SP-3/4A (aa 176 to 209) were detected in the vesicular stomatitis virus-HTLV-I pseudotype assay. Higher-titered neutralizing antibody responses to HTLV-I (1:10 to 1:640) were detected with pseudotype and syncytium inhibition assays in four goats immunized with a combined inoculum containing peptides SP-2, SP-3, and SP-4A linked to tetanus toxoid. These neutralizing anti-HTLV-I antibodies were type specific in that they did not inhibit HTLV-II syncytium formation. Neutralizing antibodies in sera from three goats could be absorbed with peptide SP-2 (aa 86 to 107) as well as truncated peptides containing envelope aa 90 to 98, but not with equimolar amounts of peptides lacking envelope aa 90 to 98. To map critical amino acids that contributed to HTLV-I neutralization within aa 88 to 98, peptides in which each amino acid was sequentially replaced by alanine were synthesized. The resulting 11 synthetic peptides with single alanine substitutions were then used to absorb three neutralizing goat antipeptide antisera. Both asparagines at positions 93 and 95 were required for adsorption of neutralizing anti-HTLV-I antibodies from all three sera. Peptide DP-90, containing the homologous region of HTLV-II envelope glycoprotein (aa 82 to 97), elicited antipeptide neutralizing antibodies to HTLV-II in goats that were type specific. In further adsorption experiments, it was determined that amino acid differences between homologous HTLV-I and HTLV-II envelope sequences at HTLV-I aa 95 (N to Q) and 97 (G to L) determined the type specificity of these neutralizing sites. Thus, the amino-terminal regions of HTLV-I and -II gp46 contain homologous, linear, neutralizing determinants that are type specific.