Confirmation of symmetrical distributions of clinical attachment loss and tooth loss in a homogeneous Mexican adult male population

Background/purpose To ascertain whether or not clinical attachment loss and tooth loss are present with similar severity and prevalence across the two sides of the mouth in a homogeneous sample of urban male adults. Materials and methods A cross-sectional study was carried out on 161 policemen (a largely homogeneous group in terms of ethnic background, socioeconomic status, sex, occupation, and medical/dental insurance) in Campeche, Mexico. Periodontal examinations were undertaken using the Florida Probe System in a dental chair by one trained and standardized examiner (kappa ≥ 0.60) to determine clinical attachment loss and tooth loss. We examined six sites in all teeth present in the mouth (a maximum of 168 sites, no third molars). Because of correlated data between observations, McNemar (for tooth loss) and Wilcoxon (for attachment loss) signed-rank tests were used to compare right and left sites within the same patient. Results The mean age was 38.4 ± 11.0 years. The mean number of teeth present was 24.4 ± 4.6; the mean number of periodontal sites/person was 146.7 ± 27.8. All P values were ≥ 0.05 (except for attachment loss in the upper first premolars), suggesting that there were no statistically significant differences between the right and left sides for the frequency of presentation of these two conditions. Conclusion Tooth loss and attachment loss measurements largely resemble each other on both sides of the mouth

Dental caries’ experience, prevalence and severity in mexican adolescents

Objective Determining dental caries’ experience, prevalence and severity in students applying for degree courses at San Luis Potosi University (UASLP). Material and Methods A cross-sectional study was carried out involving adolescents and young adults (16 to 25 years old) applying for undergraduate courses at UASLP (~10 %, n=1 027). Two standardized examiners undertook dental examinations; DMFT index, prevalence (DMFT and gt;0), severity (DMFT and gt;3 and DMFT and gt;6) and significant caries index (SiC) were calculated. STATA 9.0 non-parametric tests were used for statistical analysis.Results Mean age was 18.20±1.65; 48.0% were female. The DMFT index was 4.04±3.90 and caries prevalence was 74.4%. Regarding caries’ severity, 48.8% had MDFT and gt;3 and 24% DMFT and gt;6. The SiC index was 8.64. Females had higher caries experience than males (4.32±4.01 cf 3.78±3.78; p0.05). Age was associated with both experience (

Pérdida de dientes en adolescentes y adultos jóvenes universitarios mexicanos

una población universitaria de adolescentes y adultos jóvenes, así como conocer su distribución por edad y sexo. Se realizó un estudio transversal en una muestra de 1027 adolescentes y adultos jóvenes de 16 a 25 años de edad seleccionados aleatoriamente del total de aspirantes a las licenciaturas de la Universidad Autónoma de San Luis Potosí, México. La variable dependiente fue la prevalencia de PD, codificándose como 0=sujetos sin PD y 1=sujetos que tuvieron almenos un diente perdido. Otras variables incluidas fueron edad y sexo del sujeto. El análisis se llevó a cabo en STATA v9,0 con regresión logística. El promedio de edad de los sujetos incluidos fue de 18,20±1,65 y 52,0% fueron hombres. La prevalencia de sujetos con PD fue de 18,0% (n=185) y el promedio de 0,46±1,13, mientras que en quienes tuvieron al menos uno perdido fue de 2,54±1,32. El número máximo de PD fue de 5. En el modelo ajustado obtuvimos significancia estadística en la edad (RM=1,11; p<0,05). Las mujeres tuvieron 41% mayor riesgo de presentar al menos un diente perdido que los hombres. Los sujetos que presentaron más de 6 obturacionestuvieron mayor posibilidad de tener dientes perdidos (RM=1,60; p<0,05). Los hallazgos indican que la experiencia de tener PD alcanza casi el 20%, además se mostró una asociación entre la PD con la edad, el sexo y el número de obturaciones. Este estudio demuestra la existencia de desigualdades de género

Lesiones cariosas reversibles e irreversibles en escolares mexicanos de 11 y 12 años de edad: un análisis de regresión binomial negativa

Introduction: Dental caries is one of the most common chronic childhood diseases worldwide. In Mexico it is a public health problem. Objective: To identify variables associated with caries occurrence (non-reversible and reversible lesions) in a sample of Mexican schoolchildren. Material and methods: We performed a cross-sectional study in 640 schoolchildren of 11 and 12 years of age. The dependent variable was the D1+2MFT index, comprising reversible and irreversible carious lesions (dental caries) according to the Pitts D1/D2 classification. Clinical examinations were performed by trained and standardized examiners. Using structured questionnaires we collected socio-demographic, socio-economic and health-related oral behaviors. Negative binomial regression was used for the analysis. Results: The D1+2MFT index was 5.68±3.47. The schoolchildren characteristics associated with an increase in the expected average rate of dental caries were: being female (27.1%), having 12 years of age (23.2%), consuming larger amounts of sugar (13.9%), having mediocre (31.3%) and poor/very poor oral hygiene (62.3%). Conversely, when the family owned a car the expected mean D1+2MFT decreased 13.5%. Conclusions: When dental caries occurrence (about 6 decayed teeth) is estimated taking into consideration not only cavities (lesions in need of restorative dental treatment) but also incipient carious lesions, the character of this disease as a common clinical problem and as a public health problem are further emphasized. Results revealed the need to establish preventive and curative strategies in the sample. http://dx.doi.org/10.7705/biomedica.v33i1.841 Introducción. La caries dental es una de las enfermedades crónicas infantiles más frecuentes. En México es un problema de salud pública bucal. Objetivo. Identificar las variables asociadas a la presencia de caries (lesiones reversibles e irreversibles) en una muestra de escolares mexicanos. Materiales y métodos. Se hizo un estudio transversal en 640 escolares de 11 y 12 años de edad. La variable dependiente fue el índice C1+2POD, contemplando las lesiones cariosas (caries dental) reversibles e irreversibles según la clasificación C1/C2/ de Pitts. Se practicaron exámenes clínicos por examinadores capacitados y estandarizados. Utilizando cuestionarios estructurados, se recogieron variables sociodemográficas, socioeconómicas y sobre conductas relacionadas con la salud bucal. En el análisis se empleó el modelo de regresión binomial negativa. Resultados. El índice C1+2POD fue 5,68±3,47. Las características de los escolares que estuvieron asociadas a un incremento en la media esperada del índice de caries dental fueron: ser del sexo femenino (27,1 %), tener 12 años de edad (23,2 %), consumir mayores cantidades de azúcar (13,9 %), tener higiene bucal regular (31,3 %), o tener mala o muy mala higiene bucal (62,3 %). Contrariamente, el que la familia poseyera un automóvil disminuyó 13,5 % la media esperada del C1+2POD. Conclusiones. Cuando se toman en consideración las caries que presentan cavidades y aquellas que se encuentran en un estado incipiente de desarrollo, se acentúa aún más el carácter de esta enfermedad (promedio de casi seis dientes con caries) como un problema clínico común y un problema de salud pública bucal. Los resultados revelan la necesidad de establecer estrategias preventivas y curativas en la muestra. doi: http://dx.doi.org/10.7705/biomedica.v33i1.841

Factores de riesgo hereditarios y socioeconómicos para labio o paladar hendido no asociados a un síndrome en México: estudio de casos y controles pareado

Introduction. From an epidemiological point of view, non-syndromic orofacial clefts are the most common oral congenital deformities worldwide.Objective. Family histories were traced and socioeconomic risk factors were identified for non-syndromic cleft lip with or without cleft palate.Material and methods. A case-control study was carried out with 208 cases of non-syndromic cleft lip with or without cleft palate, and matched by age and sex with 416 controls. Cases were patients attending a referral clinic from 2002 through 2004 in Campeche, Mexico. A questionnaire was administered to collect sociodemographic and socioeconomic variables as well as familial background relevant to non-syndromic cleft lip with or without cleft palate. Conditional logistic regression models were used; adjusted odds ratios and 95% confidence intervals were calculated.Results. In the multivariate model, the following risk factors were identified: 1) low socioeconomic status; 2) birth in the southern region of Campeche state; 3) home delivery or delivery in a publicly funded hospital; 4) occurrence of prior non-syndromic cleft lip with or without cleft palate cases in the father's or mother's family: 5) having a sibling with non-syndromic cleft lip with or without cleft palate; 6) the proband having another malformation, and 7) a history of infections during pregnancy. Prenatal care consisting of vitamin supplementation was a protective factor for non-syndromic cleft lip with or without cleft palate (odds ratio=0.29).Conclusions. A "social gradient in health" was seen to link oral malformation with diet components, and several socioeconomic and socio-demographic factors broadly encompassed in low socioeconomic status. Further characterization of risk factors will guide the assemblage of a pro-active counseling and prevention program for families at risk for non-syndromic cleft lip and cleft palate.Introducción. Desde el punto de vista epidemiológico, las hendiduras faciales son las deformidades orales más comunes alrededor del mundo.Objetivo. Identificar los factores de riesgo hereditarios y socioeconómicos relacionados con la presencia de labio o paladar hendido no asociados a un síndrome.Materiales y métodos. Se hizo un estudio de casos y controles en el que se incluyeron 208 casos con diagnóstico de labio, paladar hendido o ambos no asociados a un síndrome, los cuales fueron pareados por edad y sexo con 416 controles. Se incluyeron todos los pacientes quirúrgicos atendidos durante el periodo 2002-2004 en el programa estatal de labio o paladar hendido de Campeche, México. Se aplicó un cuestionario en el que se recogió información sobre variables sociodemográficas y socioeconómicas, así como sobre antecedentes hereditarios de labio o paladar hendido no asociados a un síndrome en la familia. Debido a que el diseño fue pareado, el análisis se hizo con regresión logística condicionada.Resultados. En el modelo multivariado para labio o paladar hendido no asociado a un síndrome se identificaron de forma significativa (p<0,05) los siguientes factores de riesgo: nivel socioeconómico bajo (razón de momios, RM=2,02), nacimiento en el sur del estado (RM=3,96), nacimiento en casa (RM=2,51) o nacimiento en hospital público (RM=4,08), antecedentes heredofamiliares paternos (RM=5,38), antecedentes heredofamiliares maternos (RM=4,11), tener otro hijo con labio o paladar hendido en la familia (RM=46,02), presentar algún otro defecto congénito asociado (RM=8,20) e infección en el embarazo (RM=2,90), y como factor protector, el cuidado prenatal y el uso de vitaminas (RM=0,29).Conclusiones. El mayor riesgo en nuestra muestra para labio, paladar hendido o ambos, no asociados a un síndrome, radica en las variables relacionadas con los antecedentes familiares y hereditarios, y las indicadoras de la posición socioeconómica. Se observó un efecto protector del manejo prenatal con vitamina

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe