Sex prediction based on mesiodistalwidth data in the Portuguese population

UIDB/04038/2020 UIDP/04038/2020Accurate sex prediction is a key step in creating a postmortem forensic profile as it excludes approximately half the population. It is our goal to develop a predictive model to establish sex through teeth mesiodistal widths in a Portuguese population. The pretreatment dental casts of 168 of Portuguese orthodontics subjects (59 males and 109 females) were included. Mesiodistal widths from right first molar to left first molar were measured on each pretreatment cast to the nearest 0.01 mm using a digital caliper. Overall, the mesiodistal widths of the upper and lower canines, premolars, and molars were found to be significantly different between females and males. Conversely, no significant differences between sexes were identified for incisors. A multivariate logistic regression model for sex prediction was developed and the teeth included in the final reduced model being the upper left canine (2.3), the lower right lateral incisor (4.2) and the lower right canine (4.3). There is a prevalence of sexual dimorphism in all teeth except the incisors. The canines present the most noticeable difference between sexes. The presented sex determination predictive model exhibits an overall correct classification of 75%, outperforming all available models for this purpose and therefore is a potential tool for forensic analysis in this population.publishersversionpublishe

Validation of the Third Molar Maturation Index (I-3M) to assess the legal adult age in the Portuguese population

UIDB/04038/2020 UIDP/04038/2020Age estimation is a major step in forensic and legal procedures. Its relevance has been increasing due to growing society issues, such as identification of missing people, crimes against minors or lack of valid identification papers from locals or foreigners. Evaluation of the cut-off value of the Third Molar Maturation Index (I3M) = 0.08 for discriminating minors from adults in the Portuguese population. The left lower third molars were analysed by applying a specific cut-off value of 0.08 determined by Cameriere et al. in 2008. A sample of 778 digital panoramic radiographs of a representative Portuguese sample (442 females and 336 males), in the age range of 12–24 years (mean age 17.7 ± 2.98 years in females and 18.1 ± 3.0 years in males), was retrospectively evaluated. I3M decreased as the real age gradually increased in both sexes. The 0.08 cut-off score was valuable in discriminating adults from minors. According to the pooled results, the accuracy, by means of area under the curve, was 92.8% (95% confidence interval (CI) 91.0–94.6%). The proportion of correctly classified subjects (sensitivity) was 90.7% (95% CI 88.7–92.8%) and the specificity was 94.9% (95% CI 93.3–96.4%). The results show that I3M is a valuable method to differentiate minors from adults in the Portuguese population.publishersversionpublishe

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95$7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95$43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and$37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained

Cross-Cultural Adaptation and Validation of the Portuguese Version of the Psychosocial Impact of Dental Aesthetics Questionnaire

The aim of this study was to cross-culturally adapt and validate the psychosocial impact of dental esthetics questionnaire (PIDAQ) to the Portuguese language. The PIDAQ was culturally translated and adapted according to international guidelines. In this cross-sectional study, we enrolled 501 subjects in a population-based epidemiological survey conducted at the Egas Moniz Dental Clinic (Almada, Portugal) in June 2022. The participants answered the Portuguese version of the PIDAQ (PIDAQ-PT), which was a 23-item scale with four conceptual domains (self-confidence, social impact, psychological impact and esthetic concern factor). Psychometric properties were estimated using content validity, construct validity, internal consistency and test–retest reliability. The PIDAQ-PT presented an intraclass correlation coefficient (ICC) of 0.84, and a 95% confidence interval (0.73–0.90, p < 0.001), with values for the Cronbach’s alpha coefficient of the subconstructs ranging from 0.93 to 0.98. In the confirmatory factor analysis (CFA), the final models presented a good fit, with the comparative fit indices (CFIs) ranging from 0.905 to 0.921 and the root mean squared error of approximation (RMSEA) ranging between 0.088 and 0.090. The PIDAQ-PT was shown to be a valid and reliable tool to assess oral health values in a Portuguese population. Further studies should evaluate the psychometric properties of the oral personal representation on dental specialties and its impact on dental appointments and procedures

Geographical Distribution of Periodontitis Risk and Prevalence in Portugal Using Multivariable Data Mining and Modeling

We aimed to estimate the geographical distribution of periodontitis prevalence and risk based on sociodemographic and economic data. This study used sociodemographic, economic, and health services data obtained from a regional survey and governmental open data sources. Information was gathered for all 308 Portuguese municipalities and compiled in a large set of 52 variables. We employed principal component analysis (PCA), factor analysis (FA) and clustering techniques to model the Portuguese nationwide geographical distribution of the disease. Estimation of periodontitis risk for each municipality was achieved by calculation of a normalized score, obtained as an adjusted linear combination of six independent factors that were extracted through PCA/FA. The municipalities were also classified according to a quartile-based risk grade in each cluster. Additionally, linear regression was used to estimate the periodontitis prevalence within the peri-urban municipality clusters, accounting for 30.5% of the Portuguese population. A total of nine municipality clusters were obtained with the following characteristics: mainly rural/low populated, including small villages (one), partly rural, including small cities (two), mainly urban/peri-urban, including medium-sized to large cities (4), and urban/large cities (2). Within the clusters, a higher periodontitis risk was identified for municipalities with lower income, older populations. The estimated periodontitis prevalence for the 18 municipalities included in the four peri-urban clusters ranged from 41.2% to 69.0%. Periodontitis prevalence estimates range from 41.2% to 69.0% for the municipalities characterized as peri-urban and mainly urban, most of them located in the Lisbon Metropolitan Area, the tenth largest in Europe

Cross-Cultural Adaptation and Validation of the Oral Health Values Scale for the Portuguese Population

Background: To adapt and validate cross-culturally the Oral Health Values (OHVS) questionnaire to Portuguese language. Methods: The OHVS questionnaire was culturally translated and adapted according to international guidelines. We enrolled 280 patients in a population-based epidemiological survey conducted at the Egas Moniz Dental Clinic (Almada, Portugal). The participants answered the Portuguese version of the OHVS (OHVS-PT), which is a 12-item scale with four-factor structure (Professional Dental Care, Appearance and Health, Flossing and Retaining Natural Teeth factor). Psychometric properties were tested using content validity, construct validity, internal consistency, and test–retest reliability. Results: The OHVS-PT presented adequate reliability (ICC = 0.93, 95% confidence interval (CI): 0.86; 0.97, p < 0.001) with values for the Cronbach’s alpha coefficient of the sub-constructs ranging from 0.92 to 0.98. In the Confirmatory Factor Analysis, the final models presented good fit, with the Comparative Fit Indices ranging from 0.882 to 0.891 and the root-mean-squared error of Approximation between 0.065 and 0.069. Conclusions: The OHVS-PT was shown to be a valid and reliable tool to assess oral health values in a Portuguese population. Further studies should evaluate the psychometric properties of the oral personal representation on dental specialties and its impact on dental appointments and procedures

Association between Dietary Inflammatory Index and Periodontitis: A Cross-Sectional and Mediation Analysis

Inflammation-modulating elements are recognized periodontitis (PD) risk factors, nevertheless, the association between dietary inflammatory index (DII) and PD has never been appraised. We aimed to assess the association between DII and PD and the mediation effect of DII in the association of PD with systemic inflammation. Using the National Health and Nutrition Examination Survey 2009–2010, 2011–2012 and 2013–2014, participants who received periodontal exam and provided dietary recall data were included. The inflammatory potential of diet was calculated via DII. PD was defined according to the 2012 case definition. White blood cells (WBC), segmented neutrophils and C-reactive protein (CRP) were used as proxies for systemic inflammation. The periodontal measures were regressed across DII values using adjusted multivariate linear regression and adjusted mediation analysis. Overall, 10,178 participants were included. DII was significantly correlated with mean periodontal probing depth (PPD), mean clinical attachment loss (CAL), thresholds of PPD and CAL, WBC, segmented neutrophils and DII (p < 0.01). A linear regression logistic adjusted for multiple confounding variables confirmed the association between DII and mean PPD (B = 0.02, Standard Error [SE]: 0.02, p < 0.001) and CAL (B = −0.02, SE: 0.01, p < 0.001). The association of mean PPD and mean CAL with both WBC and segmented neutrophils were mediated by DII (from 2.1 to 3.5%, p < 0.001). In the 2009–2010 subset, the association of mean CAL with serum CRP was mediated by DII (52.0%, p < 0.01). Inflammatory diet and PD may be associated. Also, the inflammatory diet significantly mediated the association of leukocyte counts and systemic inflammation with PD

Miniscrew-Assisted Rapid Palatal Expansion (MARPE): An Umbrella Review

In postpubertal patients, maxillary transverse discrepancy is a common condition often requiring surgical approaches. To overcome the excess morbidity and discomfort, maxillary expansion through miniscrew-assisted rapid palatal expansion (MARPE) was proposed and studied in the last few years. This umbrella review aims to critically appraise the quality of evidence and the main clinical outcomes of available systematic reviews (SRs) on MARPE. An extensive search was carried out in five electronic databases (PubMed-Medline, Cochrane Database of SRs, Scielo, Web of Science, and LILACS) until December 2021. The methodological quality was appraised using the A Measurement Tool to Assess SRs criteria 2 (AMSTAR2). The primary outcome was the methodological quality of SRs. Overall, four SRs were included and analyzed, one of high methodological quality, one of low and two of critically low. Despite the verified methodological constraints, MARPE seems to present significant clinical changes when compared to conventional RPE, SARPE or controls and less adverse clinical outcomes. The quality of evidence produced by the available SRs was not favorable. Future high standard SRs and well-designed clinical trials are warranted to better clarify the clinical protocols and outcomes success of MARPE

Prevalence and extent of chronic periodontitis and its risk factors in a Portuguese subpopulation: a retrospective cross-sectional study and analysis of Clinical Attachment Loss

Objectives To assess the prevalence and extent of chronic periodontitis, and its risk factors in a Portuguese subpopulation referred to periodontal examination. Methods This retrospective cross-sectional study used a subset of data from patients who sought dental treatment in a university dental clinic in the Lisbon metropolitan area. The sample consisted of 405 individuals (225 females/180 males), aged 20–90 years. All patients underwent a full-mouth periodontal examination and chronic periodontitis was defined as Clinical Attachment Loss (CAL) ≥ 3 mm affecting two or more teeth. Aggressive periodontitis cases were excluded from the analysis. Results Prevalence of chronic periodontitis was 83.5% (95% CI [80.4–86.6%]). For these subjects, CAL ≥ 3 mm affected 86.0% (95% CI [84.7–87.2]) of sites and 83.7% (95% CI [81.7–85.6]) of teeth, respectively. Mean CAL ranged from 3.6 to 4.3 mm, according to age. In the multivariate logistic regression model, smoking (OR = 3.55, 95% CI [1.80–7.02]) and older age (OR = 8.70, 95% CI [3.66–20.69] and OR = 4.85, 95% CI [2.57–9.16]), for 65+ and 45–64 years old, respectively, were identified as risk indicators for CAL ≥ 3 mm. Conclusions This particular Portuguese adult subpopulation had a high prevalence of chronic periodontitis, with severe and generalized clinical attachment loss, and its presence was significantly associated with age and smoking. This data should serve to prepare future detailed epidemiological studies and appropriate public health programs

Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019Research in context

Summary: Background: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding: The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38)