Exposure variability and behaviour of indoor and outdoor air pollutants in primary schools in the United Kingdom

Copyright @ 2011 ISEEBackground and Aims: Current evidence suggests that exposure to common indoor air pollutants is associated with adverse health effects in children. This study was conducted to examine air quality in four primary schools in southern England, in order to establish daily, weekly and seasonal variability of pollutant concentrations within and between the schools, and to understand the behaviour of common indoor and outdoor air pollutants. Methods: Four primary schools were selected for the study, in urban, suburban and rural environments with diverse size and socioeconomic backgrounds. Air quality monitoring was conducted in three rounds (autumn, winter, summer) during the academic year 2009-2010. Each round involved monitoring continuously for one week in four locations of typical children’s exposure: generally three indoors and one outdoors. Measurements were carried out for particulate matter count for size range 0.5-5.0μm (PM0.5-5.0), carbon dioxide (CO2), carbon monoxide (CO), and nitrogen dioxide (NO2). Results: Findings revealed great variability in PM0.5-5.0 concentrations during the week and between rounds of measurements within each school, and between schools. CO concentrations were greatly variable for the suburban and rural schools. Little variability was seen for NO2 concentrations. CO2 levels differed during the day and between days and rounds in each school, and between schools, depending on the daily activity patterns of children and practice of ventilation. Linear regression models predicted indoor levels for PM0.5-5.0, CO and NO2, based on contribution of outdoor concentrations to the same pollutant, ventilation measured by CO2 concentrations and weather variables. Conclusions: Study findings showed variability in pollutant exposure levels between locations, days and seasons in each school, and between all four schools. These differences related to school building design and location, ventilation practices and children’s daily activities. These findings support the need for developing methodology for personal exposure assessment to air pollutants among school children

Comparison of the caries-protective effect of fluoride varnish with treatment as usual in nursery school attendees receiving preventive oral health support through the Childsmile oral health improvement programme - the Protecting Teeth@3 Study:a randomised controlled trial

Background: The Scottish Government set out its policy on addressing the poor oral health of Scottish children in 2005. This led to the establishment of Childsmile, a national programme designed to improve the oral health of children in Scotland. One element of the programme promotes daily tooth brushing in all nurseries in Scotland (Childsmile Core). A second targeted component (Childsmile Nursery) offers twice-yearly application of fluoride varnish to children attending nurseries in deprived areas. Studies suggest that fluoride varnish application can reduce caries in both adult and child populations. This trial aims to explore the effectiveness and cost-effectiveness of additional preventive value fluoride varnish application compared to Childsmile Core. Methods/Design: The Protecting Teeth@3 Study is an ongoing 2 year parallel group randomised treatment as usual controlled trial. Three-year-old children attending the ante pre-school year are randomised (1:1) to the intervention arm (fluoride varnish & treatment as usual) or the control arm (treatment as usual). Children in the intervention arm will have Duraphat® fluoride varnish painted on the primary tooth surfaces and will continue to receive treatment as usual: the core Childsmile Nursery intervention. Children in the treatment as usual arm will receive the same series of contacts, without the application of varnish and will also continue with the Childsmile Core intervention. Interventions are undertaken by Childsmile trained extended duty dental nurses at six-monthly intervals. Participants receive a baseline dental inspection in nursery and an endpoint inspection in Primary 1 at the age of 5 years old. We will use primary and secondary outcome measures to compare the effectiveness of Duraphat® fluoride varnish plus treatment as usual with treatment as usual only in preventing any further dental decay. We will also undertake a full economic evaluation of the trial

National supervised toothbrushing program and dental decay in Scotland

We aimed to assess the association between the roll-out of the national nursery toothbrushing program and a reduction in dental decay in five-year-old children in a Scotland-wide population study. The intervention was supervised toothbrushing in nurseries and distribution of fluoride toothpaste and toothbrushes for home use, measured as the percentage of nurseries participating in each health service administrative board area. The endpoint was mean d3mft in 99,071 five-year-old children, covering 7% to 25% of the relevant population (in various years), who participated in multiple cross-sectional dental epidemiology surveys in 1987 to 2009. The slope of the uptake in toothbrushing was correlated with the slope in the reduction of d3mft. The mean d3mft in Years -2 to 0 (relative to that in start-up Year 0) was 3.06, reducing to 2.07 in Years 10 to 12 (difference = -0.99; 95% CI -1.08, -0.90; p < 0.001). The uptake of toothbrushing correlated with the decline in d3mft (correlation = -0.64; -0.86, -0.16; p = 0.011). The result improved when one outlying Health Board was excluded (correlation = -0.90; -0.97, -0.70; p < 0.0001). An improvement in the dental health of five-year-olds was detected and is associated with the uptake of nursery toothbrushing

Economic evaluation of the protecting teeth @ 3 randomised controlled trial

Introduction: An economic evaluation (EE) was conducted alongside a randomised controlled trial (the Protecting Teeth @ 3 Study; PT@3), exploring the additional preventive value of fluoride varnish (FV) application at six-monthly intervals in nursery schools compared to treatment as usual (TAU) in the same nurseries. TAU represented a multi- component national child oral health improvement intervention – the Childsmile programme, apart from nursery FV. Methods: The EE was a within-trial cost-utility analysis (CUA) comparing the FV and TAU groups. The CUA was conducted from a National Health Service perspective and followed relevant methods guidance. Within-trial costs included intervention costs and health care resource use costs. Health outcomes were expressed in quality-adjusted life years (QALYs) accrued over the two-year follow-up period. The CHU9D questionnaire was used to obtain utility scores. National reference costs were used, a discount rate of 1.5% for public health interventions was adopted, multiple imputation methods for missing data were employed, sensitivity analyses were conducted, and incremental cost-utility ratios calculated. Results: Data from 534 participants from the 2014/15 PT@3 intake were used in the EE analyses, n=265 (50%) in the FV and n=269 (50%) in the TAU arm. Mean incremental cost per child in the FV was £68.37 (p=0.382; 95% confidence interval: -£18.04, £143.82). Mean incremental QALY was -0.004 (p=0.636; 95% confidence interval: -0.016, 0.007). The probability that the FV intervention was cost-effective at the UK’s £20,000 threshold was 11.3%. Conclusion: The results indicate that applying FV in nurseries in addition to TAU (all other components of Childsmile, apart from nursery FV) would not be deemed cost-effective given current UK thresholds. In view of previously proven clinical effectiveness and economic worthiness of the universal nursery toothbrushing component of Childsmile, continuation of the additional, targeted nursery FV component in its pre-COVID-19 form, should be reviewed given its low probability of cost-effectiveness