Prevalência da doença periodontal de uma população de utentes em cuidados de saúde primários inscritos na Unidade Saúde Familiar (USF) Espinho

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina DentáriaA doença periodontal (DP), de acordo com a Academia Americana de Periodontia (AAP), é uma doença inflamatória crónica, que afeta os tecidos da gengiva e do osso encarregados de sustentar as peças dentárias; em meados do século XX, acreditava-se que todas as espécies de bactérias no biofilme bacteriano tinham igual capacidade de causar doença, mas a proporção de espécies de bactérias específicas responsáveis DP só foi estabelecida entre 1960 e 1970; segundo aos dados da Organização Mundial da Saúde (OMS), o 90% da população mundial sofre de esta doença; e a periodontite é o estágio mais avançado tendo muitos fatores que produzem a destruição progressiva do ligamento periodontal e o osso alveolar. Em Portugal, este problema assume particular gravidade dado que durante muitas décadas, a saúde oral não esteve acessível a toda a população, mas atualmente, é inquestionável a necessidade de programas nacionais que contemplem a promoção da Saúde Oral (SO), e a prevenção e tratamento das Doenças Orais (DO), que contribuam significativamente na melhora da Saúde Geral das populações. Estudos epidemiológicos utilizados na atualidade, encontram-se na procura de detectar placa, cálculo e hemorragia gengival, como indicadores da doença e, admite-se que os dois primeiros fatores são essenciais para promover a iniciação e a progressão da DP, com todas as tentativas para tomar referências e poder medir e repetir medições para avaliar a evolução da DP, criaram-se os índices periodontais para ter uma forma de detectar a prevalência da DP em populações. Em 1982 a OMS preconizou o CPITN (Communite Periodontal Index of Treatment Needs), o qual foi desenvolvido com propósito de ser o índice que avaliasse de forma rápida e simples a condição periodontal, mas tempo posteriormente para IPC (Índice Periodontal Comunitário); hoje amplamente aceite. Devido à necesidade da procura de novas medições com fim de observar os valores de incidência da DP em diferentes populações; o presente trabalho foi desenhado para determinar a “Prevalência da doença periodontal em uma população de utentes em cuidados de saúde primários inscritos na Unidade Saúde Familiar Espinho (USF) ”. Foi desenvolvido um estudo observacional, transversal e analítico no período entre Abril e Junho de 2014. A população foi constituída por 100 utentes inscritos na USF de Espinho, seleccionados aleatoriamente de entre os utentes que recorriam a consulta de Medicina Geral e Familiar. Objectivos Determinar a Prevalência da Doença Periodontal nos utentes vigiados na USF de Espinho. Determinar a associação entre a doença periodontal com outros factores individuais (sexo, higiene oral, hábitos tabágicos, utilização de prótese dentária). Resultados Observou-se que 80% da população possui doença periodontal, e em relação ao género, a doença encontra-se distribuida em 57% no género feminino, e 23% no género masculino. A profundidade à sondagem em 88% dos indivíduos examinados indicou que o 41% possui medidas de sondagem entre 4-5 mm, e 16% de ≥6 mm. Por outro lado, o 42% possuia uma perda de inserção a partir da junção esmalte-cimento entre 0-3mm, o 35% entre 4-5mm e por último o 23% apresentou uma perda de inserção entre 6-8 mm. O hábito de higiene oral foi representado com o 90% da população que realiza a higiene oral diária, e a distribuição observada do edentulismo, foi representada pelo 69% de indivíduos com edentulismo parcial, e o 12% com edentulismo total. Conclusão Apesar da alta prevalência de DP (80%) para este grupo de estudo, onde>50% da população possuem bolsas periodontais estabelecidas com perda de inserção de mais de 4 mm, um nível considerado da população realiza a higiene oral diária. Além disso, sendo a taixa de edentulismo parcial que lidera com o 69%, podemos concluir que com uma percentagem tão elevada de DP e classificando a maioria dos pacientes com algum tipo de edentulismo; para haver pouca quantidade de dentes examinados existe uma grande quantidade de dentes com DP. The periodontal disease (PD), with agreement with the American Academy of Periodontology, is a chronic inflammatory disease that affects the tissues of the gums and the bones in charge of sustaining dental parts; in the mid-twentieth century it was accepted that all the species of bacteria in dental plaque had the same capacity to cause disease; however, the proportion of bacterial species that was specifically responsible for PD was establish between 1960 and 1970. According to data from the World Health Organization (WHO), 90% percent of the world population suffers from this disease. The periodontitis is the most advanced stage, having many factors that produce progressive damage to periodontal ligaments and alveolar bones. In Portugal, this problem has reached a particular level of severity as the general population did not have accessibility to dental care for many decades. Although, recently there is no doubt that there have been national programs that promote oral health, as well as the prevention and the treatment of oral diseases (OD); these programs have contributed significantly to the improvement to the overall health of the population. Epidemiological studies currently used demand the detection of plaque, tartar, and hemorraging in the gums as indicators of disease and it is assumed that the first two factors are essential in the development and progress of a PD. With all the attempts to take references to be able to measure and evaluate the evolution of a PD, an index has been created to have a method to detect the prevalency of PD among the population. In 1982 the WHO recommended the CPITN (Community Peridontal Index of Treatment Needs), which was created with the purpose of being the index to rapidly evaluate the simple periodontal conditions. After time the organization would change into the now widely accepted ICP (Communal Periodontal Index). Due to the new medical necessities to provide observation of the impact levels of PDs in different populations; the current work is designed to determine the “Prevalence of periodontal disease among the population of health care clients subscribed to USF de Espinho. Materials and Methods An observational study was held transversely and analytically in USF Espinho between April and June of 2014. The population was made up of 100 clients subscribed to USF Espinho, and were randomly selected. Objectives Determine the prevalence of periodontal disease among the observed population in USF Espinho Determine the association of periodontal disease and other individual factors (gender, oral hygiene, smoking habits, etc.) Results It was observed that 80% of the population has periodontal disease, and in relation to gender, the disease is found distributed in 57% in females and 23% in males. The probing depth in 88% of pacients surveyed indicated that 41% of survey measures has between 4-5 mm, and 16% for ≥ 6 mm. On the other hand, 42% possessed an insertion loss from the cement-enamel junction between 0-3mm, 35% between 4-5mm and finally 23% exhibited an insertion loss between 6-8 mm. The habit of oral hygiene was represented with 90% of the population that performs daily oral hygiene, and the observed distribution of edentulism was represented by 69% of individuals with partial edentulism, and 12% with complete edentulism. Conclusion Despite the high prevalence of PD (80%) for this study group, where >50% of the population have established periodontal pockets with insertion loss of more than 4 mm, a level considered of the population performs daily oral hygiene. Furthermore, with a percentage of partial edentulous leading with 69%, we can conclude that with such a high percentage of DP and classifying the majority of patients with any type of tooth loss; to be little amount of teeth examined, there is a lot of teeth with PD

Prevalência da doença periodontal de uma população de utentes em cuidados de saúde primários inscritos na Unidade Saúde Familiar (USF) Espinho

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina DentáriaA doença periodontal (DP), de acordo com a Academia Americana de Periodontia (AAP), é uma doença inflamatória crónica, que afeta os tecidos da gengiva e do osso encarregados de sustentar as peças dentárias; em meados do século XX, acreditava-se que todas as espécies de bactérias no biofilme bacteriano tinham igual capacidade de causar doença, mas a proporção de espécies de bactérias específicas responsáveis DP só foi estabelecida entre 1960 e 1970; segundo aos dados da Organização Mundial da Saúde (OMS), o 90% da população mundial sofre de esta doença; e a periodontite é o estágio mais avançado tendo muitos fatores que produzem a destruição progressiva do ligamento periodontal e o osso alveolar. Em Portugal, este problema assume particular gravidade dado que durante muitas décadas, a saúde oral não esteve acessível a toda a população, mas atualmente, é inquestionável a necessidade de programas nacionais que contemplem a promoção da Saúde Oral (SO), e a prevenção e tratamento das Doenças Orais (DO), que contribuam significativamente na melhora da Saúde Geral das populações. Estudos epidemiológicos utilizados na atualidade, encontram-se na procura de detectar placa, cálculo e hemorragia gengival, como indicadores da doença e, admite-se que os dois primeiros fatores são essenciais para promover a iniciação e a progressão da DP, com todas as tentativas para tomar referências e poder medir e repetir medições para avaliar a evolução da DP, criaram-se os índices periodontais para ter uma forma de detectar a prevalência da DP em populações. Em 1982 a OMS preconizou o CPITN (Communite Periodontal Index of Treatment Needs), o qual foi desenvolvido com propósito de ser o índice que avaliasse de forma rápida e simples a condição periodontal, mas tempo posteriormente para IPC (Índice Periodontal Comunitário); hoje amplamente aceite. Devido à necesidade da procura de novas medições com fim de observar os valores de incidência da DP em diferentes populações; o presente trabalho foi desenhado para determinar a “Prevalência da doença periodontal em uma população de utentes em cuidados de saúde primários inscritos na Unidade Saúde Familiar Espinho (USF) ”. Foi desenvolvido um estudo observacional, transversal e analítico no período entre Abril e Junho de 2014. A população foi constituída por 100 utentes inscritos na USF de Espinho, seleccionados aleatoriamente de entre os utentes que recorriam a consulta de Medicina Geral e Familiar. Objectivos Determinar a Prevalência da Doença Periodontal nos utentes vigiados na USF de Espinho. Determinar a associação entre a doença periodontal com outros factores individuais (sexo, higiene oral, hábitos tabágicos, utilização de prótese dentária). Resultados Observou-se que 80% da população possui doença periodontal, e em relação ao género, a doença encontra-se distribuida em 57% no género feminino, e 23% no género masculino. A profundidade à sondagem em 88% dos indivíduos examinados indicou que o 41% possui medidas de sondagem entre 4-5 mm, e 16% de ≥6 mm. Por outro lado, o 42% possuia uma perda de inserção a partir da junção esmalte-cimento entre 0-3mm, o 35% entre 4-5mm e por último o 23% apresentou uma perda de inserção entre 6-8 mm. O hábito de higiene oral foi representado com o 90% da população que realiza a higiene oral diária, e a distribuição observada do edentulismo, foi representada pelo 69% de indivíduos com edentulismo parcial, e o 12% com edentulismo total. Conclusão Apesar da alta prevalência de DP (80%) para este grupo de estudo, onde>50% da população possuem bolsas periodontais estabelecidas com perda de inserção de mais de 4 mm, um nível considerado da população realiza a higiene oral diária. Além disso, sendo a taixa de edentulismo parcial que lidera com o 69%, podemos concluir que com uma percentagem tão elevada de DP e classificando a maioria dos pacientes com algum tipo de edentulismo; para haver pouca quantidade de dentes examinados existe uma grande quantidade de dentes com DP. The periodontal disease (PD), with agreement with the American Academy of Periodontology, is a chronic inflammatory disease that affects the tissues of the gums and the bones in charge of sustaining dental parts; in the mid-twentieth century it was accepted that all the species of bacteria in dental plaque had the same capacity to cause disease; however, the proportion of bacterial species that was specifically responsible for PD was establish between 1960 and 1970. According to data from the World Health Organization (WHO), 90% percent of the world population suffers from this disease. The periodontitis is the most advanced stage, having many factors that produce progressive damage to periodontal ligaments and alveolar bones. In Portugal, this problem has reached a particular level of severity as the general population did not have accessibility to dental care for many decades. Although, recently there is no doubt that there have been national programs that promote oral health, as well as the prevention and the treatment of oral diseases (OD); these programs have contributed significantly to the improvement to the overall health of the population. Epidemiological studies currently used demand the detection of plaque, tartar, and hemorraging in the gums as indicators of disease and it is assumed that the first two factors are essential in the development and progress of a PD. With all the attempts to take references to be able to measure and evaluate the evolution of a PD, an index has been created to have a method to detect the prevalency of PD among the population. In 1982 the WHO recommended the CPITN (Community Peridontal Index of Treatment Needs), which was created with the purpose of being the index to rapidly evaluate the simple periodontal conditions. After time the organization would change into the now widely accepted ICP (Communal Periodontal Index). Due to the new medical necessities to provide observation of the impact levels of PDs in different populations; the current work is designed to determine the “Prevalence of periodontal disease among the population of health care clients subscribed to USF de Espinho. Materials and Methods An observational study was held transversely and analytically in USF Espinho between April and June of 2014. The population was made up of 100 clients subscribed to USF Espinho, and were randomly selected. Objectives Determine the prevalence of periodontal disease among the observed population in USF Espinho Determine the association of periodontal disease and other individual factors (gender, oral hygiene, smoking habits, etc.) Results It was observed that 80% of the population has periodontal disease, and in relation to gender, the disease is found distributed in 57% in females and 23% in males. The probing depth in 88% of pacients surveyed indicated that 41% of survey measures has between 4-5 mm, and 16% for ≥ 6 mm. On the other hand, 42% possessed an insertion loss from the cement-enamel junction between 0-3mm, 35% between 4-5mm and finally 23% exhibited an insertion loss between 6-8 mm. The habit of oral hygiene was represented with 90% of the population that performs daily oral hygiene, and the observed distribution of edentulism was represented by 69% of individuals with partial edentulism, and 12% with complete edentulism. Conclusion Despite the high prevalence of PD (80%) for this study group, where >50% of the population have established periodontal pockets with insertion loss of more than 4 mm, a level considered of the population performs daily oral hygiene. Furthermore, with a percentage of partial edentulous leading with 69%, we can conclude that with such a high percentage of DP and classifying the majority of patients with any type of tooth loss; to be little amount of teeth examined, there is a lot of teeth with PD

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research