Impacto da perda dentária na qualidade de vida relacionada a saúde bucal de adultos

Introdução: a perda dentária parece impor alterações físicas, biológicas e psíquicas que podem impactar negativamente na qualidade de vida dos indivíduos. Objetivo: avaliar a associação entre perda dentária e a percepção do seu impacto negativo na qualidade de vida. Metodologia: estudo transversal, conduzido com 306 adultos, atendidos em serviços públicos de saúde, em Feira de SantanaBa. O impacto na qualidade de vida relacionada à saúde bucal foi mensurado pelo OHIP-14. Foi realizado exame bucal e aplicado questionário estruturado para obter informações relacionadas às características socioeconômicas, demográficas, de estilo de vida e condições de saúde geral e bucal. Foi empregado o Teste qui-quadrado e estimadas as Razões de prevalência e intervalos de confiança a 95% (IC95%). Resultados: dentre as dimensões do OHIP-14, a perda dentária (≥7 dentes) foi estatisticamente associada com a dimensão “incapacidade física” (RP: 1,50; IC95%: 1,18-1,90, p=0,003). Conclusão: houve associação entre alta perda dentária e impacto da saúde bucal na qualidade de vida, expressa pela incapacidade física

SEVERE CHRONIC PERIODONTITIS AND C-REACTIVE PROTEIN LEVELS

This study aims to analyze the relationship between chronic periodontitis and C-reactive protein (CRP), taking certain associated factors into consideration. A cross-sectional study was conducted on a sample of 75 adults of both sexes. After the participants had been interviewed, they underwent physical and dental examinations and blood collection. CRP levels were evaluated by means of nephelometry. A periodontal clinical examination was conducted by trained examiners and the diagnosis of chronic periodontitis was established when at least 30% of the individual’s teeth presented clinical attachment loss ≥ 5 mm. The analysis procedures consisted of descriptive analysis and linear regression. The results showed that there was no statistically significant difference in CRP levels between the groups with and without periodontitis. The median CRP level in the group with periodontitis was 2.3 mg/l (25-75% interquartile range, IQR = 0.74-5.4) and in the group without periodontitis, 1.8 mg/l (25-75% IQR = 0.79-4.54) (p = 0.417). Log CRP was significantly correlated only with the individual’s body mass index (BMI). The main findings from this study indicate that there is no association between severe chronic periodontitis and CRP, and factors like BMI need to be analyzed carefully in studies on this topic

DOENÇA PERIODONTAL MATERNA E PREMATURIDADE/BAIXO PESO AO NASCER: UMA METANÁLISE

OBJETIVO: Avaliar a associação entre doença periodontal (DP) e prematuridade/baixo peso ao nascer (PMBP).MATERIAL E MÉTODOS: Foi realizado um estudo de metanálise no qual foram empregadas as bases de dados PUBMED/Medline, Lilacs e SciELO  para selecionar estudos de caso-controle com ano de publicação no intervalo de tempo de  2001 a 2013.RESULTADOS: Dos 33 estudos de caso-controle elegíveis, 23 tiveram seus achados sumarizados na metanálise. O odds ratio da metanálise foi da ordem de 1,7 (95% IC [1,19 – 2,43],) apontando que gestantes com DP podem ter a chance elevada para terem filhos com PMBP ao serem comparadas àquelas sem DP.CONCLUSÃO: Os achados dessa metanálise sugerem que existe associação entre DP e PMBP

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Trends in mortality from ill-defined causes among the elderly in Brazil, 1979-2013: ecological study

ABSTRACT CONTEXT AND OBJECTIVE: Mortality measurements are traditionally used as health indicators and are useful in describing a population's health situation through reporting injuries that lead to death. The aim here was to analyze the temporal trend of proportional mortality from ill-defined causes (IDCs) among the elderly in Brazil from 1979 to 2013. DESIGN AND SETTING: Ecological study using data from the Mortality Information System of the Brazilian Ministry of Health. METHODS: The proportional mortality from IDCs among the elderly was calculated for each year of the study series (1979 to 2013) in Brazil, and the data were disaggregated according to sex and to the five geographical regions and states. To analyze time trends, simple linear regression coefficients were calculated. RESULTS: During the study period, there were 2,646,194 deaths from IDCs among the elderly, with a decreasing trend (ß -0.545; confidence interval, CI: -0.616 to -0.475; P < 0.000) for both males and females. This reduction was also observed in the macroregions and states, except for Amapá. The states in the northeastern region reported an average reduction of 80%. CONCLUSIONS: Mortality from IDCs among the elderly has decreased continuously since 1985, but at different rates among the different regions and states. Actions aimed at improving data records on death certificates need to be strengthened in order to continue the trend observed

Papel dos medicamentos nas intoxicações causadas por agentes químicos em município da Bahia, no período de 2007 a 2010

A intoxicação medicamentosa é um problema de grande relevância para a saúde pública. No Brasil, os medicamentos são os principais agentes responsáveis por intoxicações humanas. Este artigo objetivou descrever o perfil e a evolução das intoxicações no município de Feira de Santana, Bahia, nos anos 2007 a 2010, e analisar a morbimortalidade causada por medicamentos. Neste estudo transversal, com caráter descritivo, foram analisados 631 casos registrados no SINAN. As variáveis utilizadas foram: sexo; faixa etária; raça; escolaridade; ocupação; evolução do caso notificado; zona de ocorrência da intoxicação; circunstância determinante para a ocorrência da intoxicação; tipo de exposição; frequência deste agravo; e tipo de unidade notificadora. Constatou-se que a intoxicação por medicamentos representou 33% das intoxicações, seguida de “raticidas” (18%), sendo a “tentativa de suicídio”, circunstância responsável, em 2010, por 81% das notificações. O sexo ‘feminino’ apresentou o maior número de casos registrados, bem como as crianças de 1 a 4 anos e os adultos jovens. A letalidade observada em Feira de Santana foi muito maior do que a média regional e nacional, excetuando-se o ano de 2009. A Vigilância em Saúde deve priorizar ações educativas, preventivas e intersetoriais, que assegurem o uso correto de medicamentos e melhorem seu impacto na saúde, bem como investir na sensibilização continuada dos profissionais da Atenção Básica para melhorar a notificação deste importante agravo

Adiponectin Is a Contributing Factor of Low Appendicular Lean Mass in Older Community-Dwelling Women: A Cross-Sectional Study

Inflammation is a chronic, sterile, low-grade inflammation that develops with advanced age in the absence of overt infection and may contribute to the pathophysiology of sarcopenia, a progressive and generalized skeletal muscle disorder. Furthermore, a series of biomarkers linked to sarcopenia occurrence have emerged. To aid diagnostic and treatment strategies for low muscle mass in sarcopenia and other related conditions, the objective of this work was to investigate potential biomarkers associated with appendicular lean mass in community-dwelling older women. This is a cross-sectional study with 71 older women (75 ± 7 years). Dual-energy X-ray absorptiometry was used to assess body composition. Plasmatic blood levels of adipokines (i.e., adiponectin, leptin, and resistin), tumor necrosis factor (TNF) and soluble receptors (sTNFr1 and sTNFr2), interferon (INF), brain-derived neurotrophic factor (BDNF), and interleukins (IL-2, IL-4, IL-5, IL-6, IL-8, and IL-10) were determined by enzyme-linked immunosorbent assay. Older women with low muscle mass showed higher plasma levels of adiponectin, sTNFr1, and IL-8 compared to the regular muscle mass group. In addition, higher adiponectin plasma levels explained 14% of the lower appendicular lean mass. High adiponectin plasmatic blood levels can contribute to lower appendicular lean mass in older, community-dwelling women