The global burden of cancer 2013 global burden of disease cancer collaboration

Importance Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies. Objective To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013. Evidence Review The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs. Findings In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries. Conclusions and Relevance Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation

Oral health studies in the 1982 Pelotas (Brazil) birth cohort: methodology and principal results at 15 and 24 years of age Estudo longitudinal de saúde bucal na coorte de nascidos vivos em Pelotas, Rio Grande do Sul, Brasil, 1982: aspectos metodológicos e resultados principais aos 15 e 24 anos de idade

The aim of this study was to describe the methodology and results of oral health studies nested in a birth cohort in Pelotas, Southern Brazil. For the oral health studies a sub-sample (n = 900) was selected from the cohort and dental examinations and interviews were performed at ages 15 (n = 888) and 24 years (n = 720; 81.1%). Data collection included dental outcomes, dental care, oral health behaviors, and use of dental services. Mean DMF-T varied from 5.1 (SD = 3.8) to 5.6 (SD = 4.1) in the study period. The proportion of individuals with at least one filled tooth increased from 51.9% to more than 70%. Individuals who had always been poor used dental services less and had fewer healthy teeth on average than those who had never been poor. Individuals with decreasing or increasing family income trajectories showed intermediate values. An increase was seen in the number of healthy teeth from age 15 to 24 only among those who had never been poor. A history of at least one experience with poverty had a negative impact on oral health in adulthood.<br>Descreveu-se a metodologia e os resultados dos estudos de saúde bucal em uma coorte de nascimentos. Em 1997, uma amostra da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, (n = 900) foi sorteada para o estudo de saúde bucal (15 anos) e os mesmos indivíduos foram novamente investigados aos 24 anos. Agravos bucais, cuidados com a saúde bucal e uso de serviços odontológicos foram avaliados. Participaram do estudo 888 adolescentes aos 15 anos e 720 (81,1%) aos 24. O índice CPO-D médio variou de 5,1 (DP = 3,8) a 5,6 (DP = 4,1) no período. Ter pelo menos um dente restaurado passou de 51,9% aos 15 anos para mais de 70% aos 24. A proporção do uso de serviços e a média de dentes saudáveis foram menores dentre os sempre pobres quando comparados àqueles nunca pobres. Indivíduos com trajetórias econômicas descendente ou ascendente tiveram valores intermediários. Aumento de dentes saudáveis dos 15 aos 24 anos foi observado apenas dentre aqueles nunca pobres. Apresentar pelo menos um episódio de pobreza ao longo da vida impactou na saúde bucal na vida adulta

Verhaltensmedizin, Psychotherapie und Zahnheilkunde

Biological, psychological and social processes are of relevance in the development and treatment of dental disorders. However, knowledge about interactions among these factors has only few implications for clinical practice. Hence, the goal of this article is to provide an overview of the links between behavioral medicine, psychotherapy and dentistry. The biobehavioral implications of different dental illnesses and disorders (caries, gingivitis, periodontitis, burning-mouth syndrome, and halitosis) as well as biobehavioral characteristics of specific patient groups are presented. The existing scientific knowledge in the interdisciplinary field of behavioral medicine, psychotherapy and dentistry provides the basis for a variety of treatment approaches. Its efficacy has, in part, already been confirmed. The integration of knowledge on psychobiological processes underlying psychotherapy and dental illnesses may lead to new interventions, based on the concept of neuropsychotherapy. It can be expected that further studies on the efficacy and effectiveness of specific biobehavioral interventions will significantly contribute to an increase in oral health

Skewed distributions - new outcome measures

The traditional measure of caries, the DMF index, either as prevalence or incidence of disease, has become highly positively skewed among children and young adults. Most discussion of skewed distributions has focused on the properties of statistical analyses using such data or the implications for sample sizes and subject selection in clinical trials. This paper examines the full range of epidemiologic studies, their aims and constitutive interest in order to identify the measurement problems associated with skewed DMF index data. Constitutive interests include: description; documentation; explanation and prediction; evaluation; advocacy; and, experimentation. 'New' outcome measures that would assist in reaching the aims and constitutive interests of the epidemiology of caries include caries severity grading, variants of prevalence, extent and severity and their combination into case definitions, and weighting of the components of the DMF index. Research questions for each area of 'new' outcome measures are identified as steps in the codifying of their use in the epidemiology of caries