CIRURGIA PERIODONTAL PARA AUMENTO DE COROA CLÍNICA: REVISÃO INTEGRATIVA

RESUMO: Objetivo: O presente trabalho objetivou realizar uma revisão de literatura sobre aumento de coroa clinica com fins estéticos e/ou funcionais Metodologia: Para tal, realizou-se uma revisão narrativa de literatura. Como estratégia de busca, foram utilizados os portais de periódicos MEDLINE via pubmed e Google Acadêmico. A busca foi realizada em setembro de 2022, a partir das palavras chaves em português: “aumento da coroa clinica”, “gengivectomia”, e em inglês: “estética”; “Gingivectomy”, e “esthetics”. Resultado e Conclusão: Após a leitura dos títulos, resumos e textos na integra foram selecionados 21 artigos. Concluiu-se que a indicação para o aumento cirúrgico de coroa clínica dental depende das exigências protéticas e estéticas. O ideal é que se mantenha o espaço biológico com uma média de 3,0mm de altura. Sendo que a cirurgia pode ser realizada por meio de técnicas mais invasivas (deslocamento de retalho para apical associado a osteotomia) ou técnicas mais conservadoras que usam micro cinzéis via sulco gengival (Flapless), ultrassom piezoelétrico ou lasers de alta potência

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Sedentary behavior, obesity and disabilities in community-dwelling older adults: analysis of the Brazilian National Health Survey 2019

TCC (graduação) - Universidade Federal de Santa Catarina, Campus Araranguá, Medicina.Comportamento sedentário (CS) e obesidade são descritos como problemas de saúde pública. Todavia, carecem estudos nacionais que analisem a associação simultânea dessas condições com a incapacidade funcional. O conhecimento dessas associações poderá contribuir para a proposição de ações e políticas de promoção de autonomia para pessoas idosas. Assim, o objetivo deste estudo foi investigar a associação de obesidade e CS, assistindo televisão (CS TV) e no lazer (CS lazer), com a presença de incapacidade nas atividades básicas (ABVD) e instrumentais da vida diária (AIVD) em idosos comunitários. Tratou-se de um estudo transversal, com dados de 22.728 idosos participantes da Pesquisa Nacional de Saúde de 2019. Os desfechos foram às incapacidades nas ABVD e AIVD e as variáveis de exposição foram diferentes categorias, que englobaram obesidade, CS TV e CS lazer, analisadas separada e conjuntamente. Observou-se que CS TV (OR: 1,26; IC95%: 1,14; 1,39), obesidade (OR: 1,21; IC95%: 1,07; 1,36) e CS TV + obesidade (OR: 1,55; IC95%: 1,37; 1,75) tiveram associações positivas com a incapacidade nas ABVD. Já CS TV (OR: 1,38; IC95%: 1,24; 1,54) e CS TV+ obesidade (OR: 1,25; IC95%: 1,12; 1,40) foram associados positivamente à incapacidade nas AIVD. Ainda, CS lazer foi associado positivamente com a presença de incapacidade nas ABVD (OR: 1,28; IC95%: 1,18; 1,39) e negativamente com a incapacidade nas AIVD (OR: 0,56; IC95%: 0,41; 0,76). Concluiu-se que o CS TV aumentou as chances de incapacidades nas ABVD e nas AIVD, enquanto a obesidade isolada aumentou as chances de incapacidade somente nas ABVD. Por outro lado, o CS lazer diminuiu as chances de incapacidade somente nas AIVD

Comportamento sedentário, obesidade e incapacidade funcional em idosos comunitários: análise da Pesquisa Nacional de Saúde (PNS) de 2019

Comportamento sedentário (CS) e obesidade são descritos como problemas de saúde pública. Todavia, carecem estudos nacionais que analisem a associação simultânea dessas condições com a incapacidade funcional. O conhecimento dessas associações poderá contribuir para a proposição de ações e políticas de promoção de autonomia para pessoas idosas. Assim, o objetivo deste estudo foi investigar a associação de obesidade e CS, assistindo televisão (CS TV) e no lazer (CS lazer), com a presença de incapacidade nas atividades básicas (ABVD) e instrumentais da vida diária (AIVD) em idosos comunitários. Tratou-se de um estudo transversal, com dados de 22.728 idosos participantes da Pesquisa Nacional de Saúde de 2019. Os desfechos foram às incapacidades nas ABVD e AIVD e as variáveis de exposição foram diferentes categorias, que englobaram obesidade, CS TV e CS lazer, analisadas separada e conjuntamente. Observou-se que CS TV (OR: 1,26; IC95%: 1,14; 1,39), obesidade (OR: 1,21; IC95%: 1,07; 1,36) e CS TV + obesidade (OR: 1,55; IC95%: 1,37; 1,75) tiveram associações positivas com a incapacidade nas ABVD. Já CS TV (OR: 1,38; IC95%: 1,24; 1,54) e CS TV + obesidade (OR: 1,25; IC95%: 1,12; 1,40) foram associados positivamente à incapacidade nas AIVD. Ainda, CS lazer foi associado positivamente com a presença de incapacidade nas ABVD (OR: 1,28; IC95%: 1,18; 1,39) e negativamente com a incapacidade nas AIVD (OR: 0,56; IC95%: 0,41; 0,76). Concluiu-se que o CS TV aumentou as chances de incapacidades nas ABVD e nas AIVD, enquanto a obesidade isolada aumentou as chances de incapacidade somente nas ABVD. Por outro lado, o CS lazer diminuiu as chances de incapacidade somente nas AIVD

Sedentary behavior, obesity and disabilities in community-dwelling older adults: analysis of the Brazilian National Health Survey 2019

Sedentary behavior (SB) and obesity are relevant public health concerns, although there are few researches analyzing the association of these conditions with disabilities in activities of daily living. Thus, this study investigated the association between obesity and SB typologies with disabilities in basic activities (BADL) and instrumental activities of daily living (IADL) in community-dwelling Brazilian older adults. A cross-sectional study was conducted with data from 22,728 elderly participants of the 2019 Brazilian National Health Survey. The outcomes were disabilities in BADL and IADL and the independent variables were different categories, including obesity, daily time of sedentary behavior watching television (SB TV), and daily time of sedentary behavior in leisure activities (SB leisure), which were analyzed separately and jointly. The SB TV (OR: 1.26; 95% CI: 1.14; 1.39), obesity (OR: 1.21; 95% CI: 1.07; 1.36), and SB TV + obesity (OR: 1.55; 95%CI: 1.37; 1.75) were positively associated with disability in BALD, whereas SB TV (OR: 1.38; 95% CI: 1.24; 1.54) and SB TV + obesity (OR: 1.25; 95% CI: 1.12; 1.40) were positively associated with disability in IADL. Nevertheless, isolated SB leisure was positively associated with the disability in BADL (OR: 1.28; 95% CI: 1.18; 1.39) and negatively with disability in IADL (OR: 0.56; 95% CI: 0.41; 0.76). In conclusion, SB TV alone or associated with obesity increased the odds of disabilities in both types (i.e., BADL and IADL). In contrast, isolated obesity only increased the odds of disability in BADL, and SB leisure alone only reduced the odds of disability in IADL