Social capital and oral health promotion: Past, present, and future challenges

publishedVersio

Impact of community and individual social capital during early childhood on oral health-related quality of life: a 10-year prospective cohort study

Author's accepted manuscriptAim: To evaluate the impact of community and individual social capital during early childhood on oral healthrelated quality of life (OHRQoL) over a 10-year follow-up period. Methods: A prospective cohort study was conducted in the southern Brazil. Baseline (T1) data collection occurred in 2010 with preschool children aged 1-5 years. Participants were assessed in 2012 (T2), 2017 (T3), and 2020 (T4). OHRQoL was assessed using the B-ECOHIS at T1 and T2 and through CPQ8-10 at T3 and CPQ11-14 at T4. Community social capital was evaluated through the presence of formal institutions in the neighbourhood and individual social capital by social networks, both at T1. Demographic and socioeconomic characteristics were also evaluated. Multilevel Poisson regression analysis was performed to estimate the impact of social capital measures on OHRQoL. Results: Of the 639 children assessed at T1, 469 were followed at T2 (73.3% response rate), 449 at T3 (70.3% response rate), and 429 at T4 (67.1% response rate). Individuals living in neighbourhoods with the presence of social class associations at T1 had higher OHRQoL at T3 and T4. Individuals whose families visit friends and neighbours less than once a month or never at T1 had lower OHRQoL at T1, T3 and T4. Attending religious meetings less than once a month or never at T1 was associated with lower OHRQoL at T2 and T4. Conclusion: Social capital at the community level had a long-term effect on OHRQoL, especially during adolescence, while individual social capital levels impacted OHRQoL across the assessments. Clinical Significance: The findings indicate that psychosocial variables can impact OHRQoL, a fundamental aspect of clinical practice.acceptedVersio

Impact of Early Childhood Caries and Maternal Behaviors on Oral Health-Related Quality of Life of Children

Objective: To evaluate the impact of early childhood caries, maternal behaviors and associated factors on the oral health-related quality of life (OHRQoL) of preschool children. Material and Methods: This cross- sectional study was conducted with 163 preschool children aged 3-4 old from Porto Alegre, Southern Brazil. Mothers completed the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) and answered questions about sociodemographic and maternal behaviors characteristics. The severity of dental caries was assessed by ICDAS criteria for evaluated early childhood caries (ECC). A Poisson regression model was used to investigate the association of ECC and associated factors on OHRQoL. Results: A total of 91.4% of preschooler children was ECC (ICDAS ≥ 1). Mean ECOHIS function domain and parental anxiety domain scores were significantly higher in children with dental caries (p<0.05). The adjusted Poisson regression model showed that household income, maternal education, mother’s job status and breastfeeding time was significantly associated with ECOHIS scores. Regarding oral conditions, child caries experience was associated with worsening child and family quality of life (RR 2.21; 95% IC: 1.43-3.41). Conclusion: Our findings suggest that ECC, socioeconomic and maternal behaviors characteristics influence children’s OHRQoL

Association between malocclusion, tongue position and speech distortion in mixed-dentition schoolchildren: an epidemiological study

Malocclusions are highly prevalent in childhood and adolescence, being considered a public health problem worldwide, in addition to be considered an important predictor in the tongue position and speech disorders. Objective: Evaluate the association of malocclusions with tongue position and speech distortion in mixed-dentition schoolchildren from the south of Brazil. Methodology: This cross-sectional study was performed using a database of an epidemiological survey realized in the southern of Brazil, in 2015, for evaluating the dental and myofunctional condition of the mixed-dentition from 7-13 years’ schoolchildren. The outcome variables were tongue position and speech distortion, evaluated by a trained and calibrated examiner. Characteristics regarding sociodemographic and oral health measures (Angle’s classification of the malocclusion, overjet, overbite, posterior crossbite and respiratory mode) were also assessed. Poisson regression models with adjusted robust variance were used to evaluate the association among predictors variables in the outcomes. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI). Results: A total of 547 children were evaluated. Schoolchildren who presented anterior open bite (PR 2.36 95%CI 1.59-3.49) and having oral/oral-nasal breathing (RP 2.51 95%CI 1.70-3.71) are more likely to have altered position of the tongue. Both deep bite and being male represent protection factors for the abnormal tongue position. Regarding speech distortion, deep overbite presents a protective relationship to speech distortion (PR 0.41; 95%CI 0.24-0.71), whereas schoolchildren with posterior crossbite were more likely to present this problem (PR 1.77; 95%CI 1.09-2.88). Conclusion: Anterior open bite and posterior crossbite were the malocclusions related to speech distortion and/or altered tongue position. Oral/oral-nasal breathing was also related to myofunctional changes. Deep bite malocclusion was a protective factor for both speech problems and altered tongue position when compared to a normal overbite

The Role of Mother’s Knowledge, Attitudes, Practices in Dental Caries on Vulnerably Preschool Children

Objective: To analyze the association between Early Childhood Caries (ECC) and mother´s knowledge, attitudes, and practices (KAP). Material and Methods: This cross-sectional  study  included  a  random sample of 163 preschool children aged 3-4 old in southern Brazil. The severity of dental caries and ECC was assessed by ICDAS criteria, while mothers completed the semi-structured  questionnaire  (KAP-ECC). Maternal behavior characteristics and answered questions about socioeconomic and demographic variables. Logistic regression was performed to evaluate the association of exploratory variables with ECC. For this approach, we calculated the odds ratio (OR) and 95% confidence intervals (95% IC). Results: Dental examinations revealed that 91.4% of children presented ECC (ICDAS = 3, 4, 5 or 6). Among those children, 31.9% presented cavities (ICDAS ≥ 3). Family income was significantly associated with the presence of ECC (OR 2.17; 95% CI: 1.41-3.36). Regarding KAP-ECC, mothers have knowledge related to ECC etiology, reported dental hygiene attitudes and practices that can prevent ECC but reported less healthy attitudes and practices regarding child’s diet, specifically with respect to bottle and breastfeeding habits (OR 0.52; 95% CI: 0.33-0.81). Conclusion: ECC was more frequent in children from low-income families and whose mothers reported the belief that milk with chocolate does not contribute to caries and that disagreed that it is normal that a 2-year-old baby wakes up during the night to suckle. That is, good knowledge toward health habits may impact on lower occurrence of ECC; however, this condition also depends on the socioeconomic level

Addressing climate change with behavioral science: a global intervention tournament in 63 countries

Effectively reducing climate change requires marked, global behavior change. However, it is unclear which strategies are most likely to motivate people to change their climate beliefs and behaviors. Here, we tested 11 expert-crowdsourced interventions on four climate mitigation outcomes: beliefs, policy support, information sharing intention, and an effortful tree-planting behavioral task. Across 59,440 participants from 63 countries, the interventions’ effectiveness was small, largely limited to nonclimate skeptics, and differed across outcomes: Beliefs were strengthened mostly by decreasing psychological distance (by 2.3%), policy support by writing a letter to a future-generation member (2.6%), information sharing by negative emotion induction (12.1%), and no intervention increased the more effortful behavior—several interventions even reduced tree planting. Last, the effects of each intervention differed depending on people’s initial climate beliefs. These findings suggest that the impact of behavioral climate interventions varies across audiences and target behaviors

Design of subtype selective agonists and antagonists of muscarinic receptors

Die Subtypselektivität von Liganden für einzelne Rezeptoren, deren Aktivierung und die anschließende Signalweiterleitung sind bis heute weitestgehend ungeklärt. Die hier synthetisierten Liganden-Gruppen sollen helfen, die verschiedenen Prozesse am muskarinischen Rezeptor und seinen Subtypen zu verstehen. Die Einzelprojekte werden im Folgenden vorgestellt. 1) Um mittels FRET-Mikroskopie den Einfluss von allosteren Modulatoren, die sich von W84 bzw. Naphmethonium ableiten, in Bezug auf die Konformationsänderung aktivierter Rezeptoren untersuchen zu können, wurden die bekannten allosteren Bausteine sowie eine Reihe neuer Derivate synthetisiert. Alle untersuchten Substanzen zeigten einen hemmenden Effekt auf die mit dem Agonisten Iper-oxo vorstimulierten Rezeptoren. Das heißt, die Verbindungen ließen sich als negative allostere Modulatoren charakterisieren. 2) Da Iperoxo aufgrund seiner großen agonistischen Aktivität ein interessantes Werkzeug für die Grundlagenforschung darstellt, war es von großer Bedeutung, eine schnelle und reproduzierbare Synthese zu gewährleisten. Ausgehend von Propargylalkohol wurde in einer Mannich-Reaktion 4-Dimethylamino-but-2-en-1-ol gebildet, was mit dem zuvor hergestellten 3-Nitro-Δ2-isoxazolin zur Iperoxo-Base umgesetzt wurde. Neben einer deutlichen Ausbeutesteigerung ist nun die Reproduzierbarkeit im Gegensatz zu der von Dallanoce et al. publizierten Synthese gewährleistet. 3) Um den Einfluss der Kettenlänge der Hybride Iper-6-Phth und Iper-6-Naph auf die agonistische Aktivität und Subtypselektivität der Substanzen untersuchen zu können, wurde versucht, Hybride verschiedener Kettenlängen herzustellen. Dabei konnte Iper-4-Phth erhalten werden. 4) Weiterhin sollte der Einfluss der Alkylkette am Stickstoff-Atom auf die Wirksamkeit in Bezug auf Affinität und Zellantwort des Iperoxo-Moleküls ohne allosteren Modulator analysiert werden. Hierzu wurden die N-alkylierten Iperoxo-Derivate mit den Kettenlängen C2 bis C10 synthetisiert.. Mithilfe von Radioligand-Bindungsstudien und der dynamischen Massenumverteilung sollte die konformative Änderung des Rezeptors durch Aktivierung und die Signalweiterleitung untersucht werden. Durch Verlängerung der N-Alkylkette zeigte sich ein Wirksamkeitsverlust, d. h. die Dosis-Wirkungs-Kurven der prozentualen Zellantwort wurden im Vergleich zu denen des Iperoxos nach rechts verschoben. In Untersuchungen an der Rezeptor-Mutante CHO-hM2-Y1043.33A zeigte sich zudem, dass für den maximalen Effekt eine deutlich höhere Konzentration der Iperoxo-Derivate benötigt wird, wobei dieser Wirksamkeitsverlust im Vergleich zum Rezeptor-Wildtyp für Iperoxo selbst am stärksten ausgeprägt ist. Allerdings weisen Iperoxo und seine N-alkylierten Derivate an dieser Mutante eine höhere intrinsische Aktivität auf als die Kontrollverbindungen Oxotremorin M, C1-IP-C1 und Acetylcholin. Weiterhin konnte gezeigt werden, dass Iperoxo ebenso wie Oxotremorin, Acetylcholin, aber auch die kurzkettigen Iperoxo-Derivate neben dem Gi-Signalweg auch den Gs-Weg aktivieren können, wohingegen die langkettigen Derivate eine Gi-Signalwegs-Selektivität aufweisen. 5) In Analogie zu den N-alkylierten-Iperoxo-Derivaten sollten Untersuchungen mit den Antagonisten N-Alkyl-Atropin und -Scopolamin durchgeführt werden. In beiden Fällen zeigte das N-Methyl-Derivat eine höhere Affinität zum Rezeptor als der jeweilige Antagonist selbst, was auf die durch Alkylierung generierte positive Ladung zurückzuführen ist. Durch Verlängerung der Alkylketten ist jeweils eine Abnahme der Affinität zu beobachten. Die Affinität findet ebenfalls in beiden Fällen mit dem Butyl-Derivat ihr Minimum. Der anfängliche Affinitätsverlust lässt sich durch die zunehmende sterische Hinderung des Moleküls erklären, der spätere Anstieg bei einer Alkylkette länger als C4 deutet auf eine Wechselwirkung dieser langen Alkylkette mit einer weiteren (allosteren) Bindungsstelle hin. 6) Ausgehend von Iperoxo sollten dualstere Liganden entwickelt werden, die durch geeignete allostere Modulatoren selektiv nur einen Rezeptor-Subtyp adressieren und diesen durch Iperoxo aktivieren sollten. Als allostere Bausteine sollten die M4-selektiven Thienopyridine und die M1-selektiven Chinolone verwendet werden. 7) Zur Fluoreszenzmarkierung sollte Iperoxo-Base zudem mit dem Farbstoff Py-1 umgesetzt werden.The subtype-selectivity of ligands for receptors and the corresponding subtypes, their activation and the subsequent signalling is still largely unknown. The synthesized groups of ligands, described here were designed to understand the various processes at the muscarinic receptor subtypes. The single projects will be discussed below. 1) In order to examine the influence of allosteric modulators derived from W84 and Naphmethonium on the conformation of an activated receptor by means of FRET-microscopy, the allosteric building blocks were synthesized. All substances showed an inhibitory effect on the receptors pre-treated with the agonist iperoxo. That is to say that they behave as negative allosteric modulators. 2) Due to its high potency iperoxo is an important tool for basic research. In the past the availability of this compound was limited because of the elaborate chromatography and low reproducibility of the existing synthesis developed by Dallanoce et al.109 Thus a new synthesis pathway was established. By means of a Mannich reaction and using 2-propyn-1-ol alcohol as a starting material the amino-butinol was obtained. Product was converted to iperoxo-base by the reaction with 3-nitro-Δ2-isoxazolin. Besides reducing the reaction time and increasing the overall yield - compared to the known synthesis of Dallanoce et al. - the reproducibility was now ensured. 3) To investigate the influence of the chain-length in the hybrid compounds iper-6-phth and iper-6-naph on the agonistic activity and the subtype-selectivity, efforts were made to develop derivatives with different N-alkyl-chains. The synthesis of iper-4-phth was successful. 4) Furthermore the influence of the N-alkyl-chain-length on the potency of iperoxo having no allosteric building block was to be examined. Therefore the iperoxo-base was N-alkylated with different bromoalkanes (ethyl-decyl). It was aimed to study the change of the conformation on receptor activation and signalling by means of radioligand binding studies und dynamic mass redistribution. The elongation of the N-alkyl-chain length resulted in a loss of potency compared to iperoxo. All iperoxo derivatives lose potency at the CHO-hM2-Y1043.33A-receptor-mutant compared to the receptor wildtype, which was especially pronounced with iperoxo itself. However, for this receptor-mutant iperoxo and its N-alkylated derivatives had a higher intrinsic activity than the control compounds oxotremorine-M, C1-IP-C1 and acetylcholine. Beyond this, it could be demonstrated that iperoxo, as well as oxotremorine M, acetylcholine and the short-chain derivatives have the ability to activate not only the Gi-, but also the GS-signal-pathway, whereas the long-chain derivatives show selectivity for the Gi-pathway. 5) In analogy to these agonistic derivatives the antagonists atropine and scopolamine were N-alkylated. In both cases radioligand binding studies revealed that the methyl derivatives had a higher affinity to the receptor than both antagonists themselves. This might be caused by the generated positively charged nitrogen atom. The extension of the chain length leads to a loss of affinity, which has a minimum at the butyl-derivatives in both antagonists. The initial loss of affinity is ascribed to the steric hindrance and the subsequent gain of affinity for derivatives with a longer chain length indicates an interaction of this alkyl-chain with a second (allosteric) binding-site. For the special arrangement in the binding pocket it is essential to know the exact configuration of the ligand. The synthesized N-alkylated antagonists were examined via NMR-spectroscopy. By using the NOE-effect, the position of the methyl-groups and the alkyl-chains, respectively, were revealed. Contrary to expectations all derivatives bear their methyl-group in axial position. 6) On the basis of iperoxo, dualsteric ligands should be developed which selectively address only one muscarinic subtype, using a suitable allosteric modulator and simultaneously activate the receptor via iperoxo. As allosteric building blocks the M4-selective thienopyridines and the M1-selective quinolones should be used. 7) Besides radioligand binding studies the introduction of fluorescence markers provides an alternative to investigate the affinity of GPCR ligands. For this reason iperoxo should be coupled with the fluorescence marker py-1

School environment and individual factors influence oral health related quality of life in Brazilian children

Abstract The aim of this study was to verify the influence of school environment and individual factors on oral health related quality of life (OHRQoL) in a representative sample of Brazilian schoolchildren. A cross-sectional study was conducted with 1,134 12-year-old schoolchildren from Santa Maria, Southern Brazil. Clinical variables were obtained from examinations carried out by calibrated individuals. In addition, parents/guardians answered a semi-structured questionnaire about sociodemographic characteristics. Contextual variables were obtained from the city’s official database, including the mean income of the neighborhood in which the school was located and the Basic School’s Development Index (IDEB) of the school. The Brazilian version of the Child Perception Questionnaire (CPQ11–14) was used to access OHRQoL. Data analysis was conducted using multilevel Poisson regression. Children studying in schools with a higher classification on the IDEB presented a lower CPQ11–14 mean score (rate ratio 0.80, 95%CI 0.74–0.88) than those studying in schools with a lower IDEB. Regarding individual variables, children with carious cavities, malocclusion, and gingival bleeding presented higher CPQ11-14 mean values than their counterparts. The same was observed in children from families with low socioeconomic status. School environment, and individual clinical and socioeconomic factors were associated with schoolchildren’s OHRQoL

The Different Roles of Structural and Cognitive Social Capital on Oral Health-Related Quality of Life among Adolescents

This study evaluated the relationship of structural and cognitive dimensions of social capital with oral health-related quality of life (OHRQoL) among adolescents. This was a cross-sectional study nested in a cohort of adolescents from southern Brazil. OHRQoL was evaluated using the short version of the Child Perceptions Questionnaire 11-14 (CPQ11-14). Structural social capital was measured by attendance of religious meetings and social networks from friends and neighbours. Cognitive social capital was evaluated through trust in friends and neighbours, perception of relationships in the neighbourhood, and social support during hard times. Multilevel Poisson regression analysis was performed to estimate the association between social capital dimensions and overall CPQ11-14 scores; higher scores corresponded to worse OHRQoL. The sample comprised 429 adolescents with a mean age of 12 years. Adolescents who attended religious meetings less than once a month or never presented higher overall CPQ11-14 scores. Adolescents who did not trust their friends and neighbours, those who believe that their neighbours did not have good relationships, and those reporting no support during hard times also presented higher overall CPQ11-14 scores. OHRQoL was poorer in individuals who presented lower structural and cognitive social capital, with the greatest impact related to the cognitive dimension