Relationship Between Fluoride Levels In The Public Water Supply And Dental Fluorosis

Objective: To assess the prevalence of dental flourosis among schoolchildren subjected to different fluoride concentrations in the public water supply of their cities. Methods: The sample comprised 386 seven-year-old schoolchildren living in two municipalities in the State of São Paulo that practiced external control over the fluoridation of the water from 1998 to 2002: one with homogenous fluoride concentration and the other with oscillating concentration. Dental fluorosis was determined by dry examination of the upper permanent incisors using Dean's index. Scores classified as questionable were considered to represent fluorosis. Sociodemographic variables and questions regarding oral health were assessed using a structured questionnaire sent to the children's parents or the adults responsible for these children. Correlates of fluorosis were assessed using multivariate logistic regression (p<0.05). Results: Both municipalities presented a mild degree of fluorosis. The prevalence of fluorosis in the municipality with oscillating fluoride content in the water was 31.4%, and it was 79.9% in the municipality with homogenous fluoride content. The prevalence of fluorosis was associated with the municipality with homogeneous fluoride levels in the water (OR=8.33, 95% CI: 5.15; 13.45) and with not owning a car (OR=2.10, 95% CI: 1.27;3.49). Conclusions: The prevalence of dental fluorosis was higher in the city with better control of fluoride levels in the water supply, however, this higher prevalence was not related with children's satisfaction with the appearance of their teeth.415732739Aoba, T., Fejerskov, O., Dental fluorosis: Chemistry and biology (2002) Crit Rev Oral Biol Med, 13 (2), pp. 155-170Bårdsen, A., Risk periods associated with the development of dental fluorosis in maxillary permanent central incisors: A meta-analysis (1999) Acta Odontol Scand, 57 (5), pp. 247-256Clark, D.C., Berkowitz, J., The influence of various fluoride exposures on the prevalence of esthetic problems resulting from dental fluorosis (1997) J Public Health Dent, 57 (3), pp. 144-149Clark, D.C., Hann, H.J., Williamson, M.F., Berkowitz, J., Influence of exposure to various fluoride technologies on the prevalence of dental (1994) Community Dent Oral Epidemiol, 22 (6), pp. 461-464Cypriano S, Sousa MLR, Rihs LB, Wada RS. Prevalência e severidade da fluorose dentária em Piracicaba, SP, Brasil. RPG Rev Pos Grad. 2004;11(1):67-73Evans, R.W., Stamm, J.W., An epidemiological estimate of the critical period during which human maxillary central incisors are most susceptible to fluorosis (1991) J Publ Health Dent, 51 (4), pp. 251-259Fejerskov, O., Manji, F., Baelum, V., The nature and mechanisms of dental fluorosis in man (1990) J Dent Res, p. 69. , Spec No:692-700Frazão, P., Peverari, A.C., Forni, T.I., Mota, A.G., Costa, L.R., Fluorose dentária: Comparação de dois estudos de prevalência (2004) Cad Saude Publica, 20 (4), pp. 1050-1058Horowitz, H.S., Grand Rapids: The public health story (1989) J Public Health Dent, 49 (1), pp. 62-63Hosmer, D.W., Lemeshow, S., (1989) Applied logistic regression, , New York: John Wiley & Sons;Mackay, T.D., Thomsom, W.M., Enamel defects and dental caries among Southland children (2005) N Z Dent J, 101 (2), pp. 35-43Maltz, M., Silva, B.B., Relação entre cárie, gengivite e fluorose e nível sócio-econômico em escolares (2001) Rev Saude Publica, 35 (2), pp. 170-176Narvai, P.C., Fluoretação da água: Heterocontrole no município de São Paulo no período de 1990-1999 (2000) Rev Bras Ondontol Saude Coletiva, 1 (2), pp. 50-56Nunn, J.H., Ekanayake, L., Rugg-Gunn, A.J., Saparamadu, K.D., Assessment of enamel opacities in children in Sri Lanka and England using a photographic method (1993) Community Dent Health, 10 (2), pp. 175-188Levantamento Epidemiológico básico de saúde bucal: Manual de instruções (1991) São Paulo: Editora, , Organização Mundial da Saúde, 3 ed, Santos;Tabari, E.D., Ellwood, R., Rugg-Gunn, A.J., Evans, D.J., Davies, R.M., Dental fluorosis in permanent incisor teeth in relation to water fluoridation, social deprivation and toothpaste use in infancy (2000) Br Dent J, 189 (4), pp. 216-220(1962) Public Health Service: Drinking water standards 1962, p. 956. , United States Public Health Service, Washington: Government Printing Office;, Public Health Service PublicationVan Nieuwenhuysen, J.P., Carvalho, J.C., D'Hoore, W., Caries reduction in Belgian 12-year-old children related to socioeconomic status (2002) Acta Odontol Scand, 60 (2), pp. 123-128(1997) Bucal health surveys: Basic methods, , World Health Organization, 4. ed. Geneva;World Health Organization. Fluorides and Oral Health. Geneva1994. (Who Technical Report Series, 846

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2•72 (95% uncertainty interval [UI] 2•66–2•79) in 2000 to 2•31 (2•17–2•46) in 2019. Global annual livebirths increased from 134•5 million (131•5–137•8) in 2000 to a peak of 139•6 million (133•0–146•9) in 2016. Global livebirths then declined to 135•3 million (127•2–144•1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2•1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27•1% (95% UI 26•4–27•8) of global livebirths. Global life expectancy at birth increased from 67•2 years (95% UI 66•8–67•6) in 2000 to 73•5 years (72•8–74•3) in 2019. The total number of deaths increased from 50•7 million (49•5–51•9) in 2000 to 56•5 million (53•7–59•2) in 2019. Under-5 deaths declined from 9•6 million (9•1–10•3) in 2000 to 5•0 million (4•3–6•0) in 2019. Global population increased by 25•7%, from 6•2 billion (6•0–6•3) in 2000 to 7•7 billion (7•5–8•0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58•6 years (56•1–60•8) in 2000 to 63•5 years (60•8–66•1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global burden of 87 risk factors in 204 countries and territories, 1990�2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk�outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk�outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk�outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95 uncertainty interval UI 9·51�12·1) deaths (19·2% 16·9�21·3 of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12�9·31) deaths (15·4% 14·6�16·2 of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253�350) DALYs (11·6% 10·3�13·1 of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0�9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10�24 years, alcohol use for those aged 25�49 years, and high systolic blood pressure for those aged 50�74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

The Impacts Of Oral Health On Quality Of Life In Working Adults.

This study investigated the impacts of oral health-related quality of life (OHRQoL) on daily activities and work productivity in adults. A cross-sectional study was conducted in a supermarket chain in the state of São Paulo, which included 386 workers, age-range 20 - 64 years. Participants were examined for oral disease following WHO recommendations, and the oral health impact profile (OHIP) assessment was used to determine OHRQoL. Demographic, socio-economic, use of dental services, and OHRQoL data were obtained. Answers to the OHIP were dichotomized into no impact and some impact, and the relationship to OHRQoL was determined. Poisson regression with robust variance was performed using SPSS version 17.0. Dimensions with highest OHIP scores were physical pain and psychological discomfort. Sex (male: PR = 0.55, 95% CI 0.38 - 0.80), lower family income (PR = 1.49, 95% CI 1.04 - 2.12), visiting a dentist due to pain (PR = 2.14, 95% CI 1.57 - 3.43), tooth loss (PR = 1.59, 95% CI 1.09 - 2.32), and needing treatment for caries (PR = 1.59, 95% CI 1.09 - 2.32) were most likely to impact OHRQoL. Therefore, socioeconomic and demographic status and use of dental services impacted OHRQoL. These results indicate that oral health promotion strategies should be included in work environments.28

Factors Associated With The Incidence Of Dental Caries Among Schoolchildren Living In A Municipality With Low Prevalence Of Dental Caries [fatores Associados à Experiência De Cárie Em Escolares De Um Município Com Baixa Prevalência De Cárie Dentária]

The literature has shown that poorer levels of oral health are more frequently related to lower socio-economic status, consequently this cross-sectional and exploratory study conducted in 2003 investigated the association between caries and socio-economic factors, access to care, self-perception and habits among 266 12-year-old schoolchildren living in a community with low prevalence of dental caries. World Health Organization dental caries diagnosis methodology was used, in addition to the application of socio-economic and behavioral questionnaires. To identify the factors associated with dental caries, multivariate logistic regression was used and the dependent variable was synthesized into DMFT=0 and DMFT>0. Bearing in mind the limitations of a cross-sectional study, disliking the appearance of teeth, seeking dental care because of pain, studying at a state school and the head of the family being a manual worker were independently associated with dental caries. Even in a municipality with low prevalence of caries, the socio-economic status, dental care and self-perception were important factors in the incidence of dental caries among schoolchildren, and it is recommended that many factors in the bio-psychosocial context of multi-factorial dental caries should be investigated.161040954106Pattussi, M.P., Marcenes, W., Croucher, R., Sheiham, A., Social deprivation, income cohesion and dental caries in Brazilian school children (2001) Soc Sci Med, 53 (7), pp. 915-925Almeida-Filho, N., Kawachi, I., Pellegrini-Filho, A., Dachs, N.W., Research on health inequalities in Latin America and the Caribbean: Bibliometric analysis (1971-2000) and descriptive content analysis (1971-1995) (2003) Am J Public Health, 93 (12), pp. 2037-2043Rihs, L.B., Gushi, L.L., Sousa, M.L.R., Wada, R.S., Cárie Dentária Segundo o nível socioeconômico em Ita-petininga - S P (2005) Rev Odonto Ciênc, 20 (50), pp. 367-371Hoffmann, R.H.S., Cypriano, S., Sousa, M.L.R., Wada, R.S., Experiência de cárie dentária em crianças de esco-las públicas e privadas de um município com água fluoretada (2004) Cad Saude Publica, 20 (2), pp. 522-528Källestål, C., Wall, S., Socio-economic effect on caries. Incidence data among Swedish 12-14-year-old (2002) Community Dent Oral Epidemiol, 30 (2), pp. 108-114van Nieuwenhuysen, J.P., Carvalho, J.C., D'Hoore, W., Caries reduction in Belgian 12-year-old children related to socioeconomic status (2002) Acta Odontol Scand, 60 (2), pp. 123-128Gillcrist, J.A., Brumley, D.E., Blackford, J.U., Community socioeconomic status and children's dental health (2001) J Am Dent Assoc, 132 (2), pp. 216-222Peres, K.G.A., Bastos, J.R.M., Latorre, M.R.D.O., Severida-de de cárie em crianças e relação com aspectos sociais e comportamentais (2000) Rev Saude Publica, 34 (4), pp. 402-408Irygoyen, M.E., Maupomé, G., Mejía, A.M., Caries experience and treatment needs in a 6- to 12-year-old urban population in relation to socio-economic status (1999) Community Dent Health, 16 (4), pp. 245-249Antunes, J.L.F., Narvai, P.C., Nugent, Z.J., Measuring in-equalitities in the distribution of dental caries (2004) Community Dent Oral Epidemiol, 32 (1), pp. 41-48Baldani, M.H., Vasconcelos, A.G.G., Antunes, J.L.F., As-sociação do índice CPO-D com indicadores sócio-econômicos e de provisão de serviços odontológi-cos no Estado do Paraná, Brasil (2004) Cad Saude Publica, 20 (1), pp. 143-152Antunes, J.L.F., Frazão, P., Bispo, C.M., Pegoretti, T., Spatial analysis to identify differentials in dental needs by area-based measures (2002) Community Dent Oral Epidemiol, 30 (2), pp. 133-142Baldani, M.H., Narvai, P.C., Antunes, J.L.F., Cárie Dentá-ria e condições sócio-econômicas no Estado do Paraná, Brasil, 1996 (2002) Cad Saude Publica, 18 (3), pp. 155-163Pattussi, M.P., Marcenes, W., Croucher, R., Sheiham, A., Social deprivation, income inequality, social cohesion and dental caries in Brasilian school children (2001) Soc Sci Med, 53 (7), pp. 915-925Truin, G.J., König, K.G., Bronkhorst, E.M., Frankenmolen, F., Mulder, J., van't Hof, M.A., The trends in caries experience of 6- and 12-year-old children of different socioeconomic status in the Hague (1998) Caries Res, 32 (1), pp. 1-4Laloo, R., Myburgh, N.G., Hodbell, M.H., Oral Health, socio-economic development and national oral health policies (1999) Int Dent J, 49 (4), pp. 196-202Ellwood, R.P., Mullane, D.M., Identification of areas with hight leves of untreated dental caries (1996) Community Dent Oral Epidemiol, 24 (1), pp. 1-6Taani, D.Q., Relationship of socioeconomic background to oral hygiene, gingival status, and dental caries in children (2002) Quintessence Int, 33 (3), pp. 195-198Witt, M.C.R., Pattern of caries experience in a 12-year old Brasilian population related to socioeconomic background (1992) Acta Odontol Scand, 50 (1), pp. 25-30Bastos, J.L.D., Nomura, L.H., Peres, M.A., Tendência de cárie dentária em escolares de 12 e 13 anos de idade de uma mesma escola no período de 1971 a 2002, em Florianópolis, Santa Catarina, Brasil (2004) Cad Saude Publica, 20 (1), pp. 117-122Carvalho, J.C., van Nieuwenhuysen, J.P., D'hoore, W., The decline in dental caries among Belgian children between 1983 and 1998 (2001) Community Dent Oral Epidemiol, 29 (1), pp. 55-61Dini, E.L., Foschini, A.L.R., Brandão, I.M.G., Silva, S.R.C., Changes in caries prevalence in 7-12 year-old children from Araraquara, São Paulo, Brazil: 1989-1995 (1999) Cad Saude Publica, 15 (3), pp. 617-621Cypriano, S., Duran, A.I., Sousa, M.L.R., Wada, R.S., Dental caries experience in 12-year-old schoolchildren in southeastern Brazil (2008) J Appl Oral Sci, 16 (4), pp. 286-292Martins, R.J., Garbin, C.A.S., Garbin, A.J.I., Moimaz, S.A.S., Saliba, O., Declínio da cárie em um município da região noroeste do Estado de São Paulo, Brasil, no período de 1998 a 2004 (2006) Cad Saude Publica, 22 (5), pp. 1035-1041Gomes, P.R., Costa, S.C., Cypriano, S., Sousa, M.L.R., Pau-línia, São Paulo, Brasil: Situação da cárie dentária com relação às metas OMS 2000 e 2010 (2004) Cad Saude Publica, 20 (3), pp. 866-870Birkeland, J.M., Haugejorden, O., von Fehr, F.R., Analyses of the caries decline and incidence among Norwegian adolescents 1985-2000 (2002) Acta Odontol Scand, 60 (5), pp. 281-289(2004), http://www.seade.gov.br/perfil/index.html, Fundação Sistema Estadual de Análise de Dados, SEADE, acessado 2004 maio 23Cypriano, S., Duran, A.I., Sousa, M.L.R., Wada, R.S., Me-tas da Organização Mundial da Saúde para o ano de 2000 e a saúde bucal na região de Campinas, Brasil (2002) Arq Odontol, 38 (2), pp. 151-162Silva, N.N., (1998) Amostragem Probabilística: Um Curso In-trodutório, , São Paulo: Editora da Universidade de São Paulo(2001) Condições De Saúde Bucal Da População Brasileira No Ano 2000, , Brasil. 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