Epidemiology of dental caries in 12-year-old schoolchildren in Piracicaba: estimates and risk indicators

Orientador: Antonio Carlos PereiraDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O presente estudo, composto por 3 artigos teve como objetivos: a) analisar as desigualdades na distribuição da cárie e os indicadores de risco associados a este fato; b) descrever a experiência de cárie em escolares de 12 anos e sua relação com variáveis socioeconômicas, comportamentais e de acesso aos serviços; c) verificar a representatividade de cada dente permanente no índice CPOD. A amostra probabilística foi composta por 824 escolares provenientes de escolas públicas e privadas de Piracicaba em 2001 e 939 escolares em 2005. Os exames foram realizados por dois examinadores previamente calibrados, no pátio das escolas, sob luz natural, com os escolares sentados nas cadeiras e com escovação supervisionada realizada por THD, utilizando-se sonda periodontal (CPI) e espelho bucal plano, seguindo as recomendações da OMS. Os índices CPOD, Índice de Cuidados (Care Index) e o índice SiC (Significant Caries Index ¿grupo polarizado) foram utilizados. Um questionário semi-estruturado foi enviado aos pais para a obtenção das informações socioeconômicas e comportamentais. a) O CPOD foi de 1,7 (dp = 2,07), o índice SiC foi de 4,15 (dp=1,65) e o índice de cuidados 57,0%, em 2001. b) Para o levantamento de 2005 o CPOD e o Índice SiC foram 1,32 (dp=1,96) e 3,52 (1,86), respectivamente, e o Índice de Cuidados foi de 75,0%. Variáveis socioeconômicas e comportamentais foram indicadores de risco para a cárie não apenas para toda a amostra como também para o grupo polarizado. c) A distribuição do índice CPOD (freqüências relativa e absoluta) foi calculada em função de cada dente permanente. A média e o desvio padrão foram calculados considerando todos os dentes (CPOD¿real) e os dentes mais afetados (CPOD¿parcial). Por meio de análise de regressão, os dados do levantamento de 2005 foram utilizados para estimar modelos de regressão, em função dos dentes mais afetados. Para a validação dos modelos foi utilizado o levantamento realizado em 2001. Por meio apenas do status dos primeiros molares foi possível estimar em 82% e 81,5% o CPOD-real em 2001 e 2005, respectivamente. Por meio das equações de regressão (utilizando os dentes mais afetados) foi possível estimar o CPOD em 98,2%. As superfícies oclusais foram as mais atacadas (60,4%), seguidas pelas superfícies vestibulares e depois pelas distais. Estes dados refletem que o status dos primeiros molares é determinante para a estimativa do índice CPOD, demonstrando a suscetibilidade destes dentes à cárie na idade de 12 anosAbstract: The present study was composed by 3 articles which aims were: a) to evaluate the inequalities of caries distribution in schoolchildren and the risk indicators related to them; b) to describe the caries experience of 12-year-old schoolchildren from public and private schools and to verify the relationship between the disease and socioeconomic, behavioral and oral health variables; c) to determine the representativeness of each permanent teeth in the DMFT. The sample was randomized and composed by 1763 individuals from public and private schools in Piracicaba - SP/Brazil, in 2005 (n=939) and in 2001 (n=824). The examinations were carried out by two calibrated dentists in outdoor settings, under natural light, using mirror and ball point probe. The examinations were executed after tooth-brushing and followed the recommendations of WHO. A semi-structured questionnaire was sent to the parents to collect information on socioeconomic level and behavior variables related to dental health. a) In 2001, the DMFT and SiC (Significant Caries Index ¿ polarized group) were 1.7 (SD=2.07) and 4.15 (SD=1.65), and the Care Index was 57.0%. b) The DMFT and the SiC Index were 1.32 (SD=1.92) and 3.50 (SD=1.86), respectively, and the Care Index was 75.0% in 2005. The socioeconomic and the behavioral variables related to dental health were considered risk indicators for caries in permanent dentition not only for the entire sample, but also for the polarization group. c) The DMFT distribution (absolute and relative frequencies) was calculated in function of each permanent tooth. The mean and standard deviation were determined for all teeth (DMFT¿real) as well as for the most affected teeth (DMFT¿partial). Regression models were estimated in function of the most affected teeth using the data collected in 2005 and they were validated using the data collected in 2001. By the status of the first molars, the DMFT ¿ partial could be estimated in 82% and 81.5% in 2001 and 2005, respectively. The regression equations estimated 98.2% of the DMFT-real. The occlusal surfaces were the most attacked (60.4%) followed by the buccal and distal surfaces. In conclusion, the status of first molars was determinant to the estimation of DMFT index, demonstrating their susceptibility to caries in 12 year-old individualsMestradoCariologiaMestre em Odontologi

The use of Geographic Information Systems (GIS) in dentistry : application in the municipality of Piracicaba, SP, Brazil

Orientadores: Antonio Carlos Pereira, Glaucia Maria Bovi Ambrosano, Carlos Alberto VettorazziTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O presente estudo é composto por 2 artigos, tendo como principal objetivo avaliar o perfil de distribuição dos principais problemas bucais e suas associações com áreas de privação social em dois níveis, individual e contextual (territorial), por meio de um Sistema de Informação Geográfica (SIG) e análises Multiníveis. A amostra probabilística por conglomerados foi composta por 1002 escolares de 12 anos provenientes de 25 escolas públicas e privadas de Piracicaba, SP, em 2005-2006. Os exames foram realizados por um único examinador previamente calibrado, no pátio das escolas, sob luz natural, com os escolares sentados nas cadeiras e com escovação supervisionada realizada por THD, utilizando-se sonda periodontal (CPI) e espelho bucal plano, seguindo as recomendações da OMS. Um questionário semi-estruturado foi enviado aos pais para a obtenção das informações socioeconômicas e comportamentais individuais (primeiro nível). As variáveis contextuais "porcentagem de chefes de família sem renda e porcentagem de chefes de família analfabetos" foram usadas no nível contextual (segundo nível). Um SIG foi elaborado para a construção de mapas de distribuição das condições bucais, utilizando-se o software ArcView. Artigo 1: Os índices CPOD e o Índice de Cuidados (IC) foram considerados como desfechos. No nível individual, escolares com menor renda familiar mensal (OR=1,8;IC=1,0-3,6), maior número de pessoas morando na mesma casa (OR=1,4;IC=1,0-1,8), menos visitas ao dentista (OR=1,8;IC=1,3-2,4), menor nível educacional do pai (OR= 1,67;IC=1-3,33) e da mãe (OR=1,67;IC=1.1-1,25) tiveram mais chance de apresentar um CPOD maior. Indivíduos com maior renda familiar (OR=3.9,IC=0,84-17,9) e com mais visitas ao dentista (OR=4,7;IC=2,9-7,7) apresentaram um melhor IC. No nível contextual, áreas com maior privação social não foram associadas aos índices CPOD e IC, entretanto, é possível visualizar por meio dos mapas que os bairros centrais possuem melhores condições sociais e bucais que os bairros periféricos. No nível individual, as variáveis sociais foram relacionadas a uma maior prevalência da doença, contudo, esta relação não pôde ser observada em nível territorial. Artigo 2: Foram avaliadas as lesões iniciais não cavitadas (manchas brancas) e o Índice Periodontal Comunitário foi incluído. Foi possível observar por meio dos dados obtidos nas diferentes análises que as variáveis sociais, econômicas e comportamentais foram associadas aos níveis dos problemas bucais no primeiro nível, podendo ser visualmente distinguidas nos mapas, apresentando uma melhor tendência de saúde bucal (menores escores de machas brancas e sangramento gengival) nas regiões centrais, consideradas como privilegiadas. Entretanto, no segundo nível (contextual) da análise multinível, somente a porcentagem de chefes de família analfabetos foi significante em ambos desfechos, enquanto a variável renda não foi significativa em relação a estes problemas bucais. O presente estudo confirma um melhor status de saúde bucal para escolares provenientes de famílias privilegiadas, mas não confirma os dados em relação à variável dos bairros renda (chefes de família sem renda). Os indivíduos vindos de áreas de chefes de família sem renda não são associados a uma maior prevalência de problemas bucais, sugerindo que estes estão relativamente protegidos do impacto da privação social, devido às ações de saúde bucal dos serviços públicos do município.Abstract: The present study was composed by 2 articles which aims were evaluate the distribution profile of oral health problems and its associations with areas of social deprivation at two levels, individual and contextual, by means of Geographic Information Systems (GIS) and multilevel analysis. The cluster sample consisted of 1002 12-year-old schoolchildren attending 25 public and private schools in Piracicaba, SP, Brazil in 2005-06. The examinations were carried out by a single calibrated examiner in outdoor settings, under natural light, using mirror and ball point probe. The examinations were executed after tooth-brushing and followed the recommendations of WHO. A semi-structured questionnaire was sent to the parents to collect information on socioeconomic level and behavior variables related to dental health (first level). The contexts variables "the percentage of heads of families without income" and "the percentage of illiterate heads of families" were used in the contextual level (second level). A GIS was elaborated for mapping the distribution of the oral health condition, using the ArcView software Article 1: The DMFT and Care Index (CI) were considered as dependent variables. At individual level, students with lower income (OR=1.8; CI=1.0-3.6), more people living in the household (OR=1.4;CI=1.0-1.8), lower visits to the dentist (OR=1.8;CI=1.3-2.4), lower father's (OR=1.7;CI=1.0-3.3) and mother's (OR=1.7;CI=1.0-3.3) educational level were more likely to present a higher DMFT. The individuals with higher income (OR=3.9; CI=0.8-17.9) and more visits to the dentist (OR=4.7;CI=2.9-7.7) showed best Care Index. At conglomerate level, areas with social deprivation were not associated with the DMFT and the CI indexes, however, by means of the maps, it is possible to visualize that the central districts have the best social and oral conditions than the outlying deprived districts. At individual level, social and economic variables were associated with a higher prevalence of the disease, however, this relationship was not observed at territorial level. Article 2 Initials lesions and Community Periodontal Index were included. Variables can be visually distinguished in the maps, which show a upward tendency of oral health (less scores of initials lesions and gingival bleeding) in the central regions of the city, that are recognized as a privileged area. However, in the second level (contextual level) of the multilevel analysis, only the percentage of illiterate heads of families was statistically significant associated to both outcomes, while the variable "income" was not associated to these oral health problems. The individuals from areas where the heads of family do not have income were not associated to a higher prevalence of oral health problems. This fact suggests that these individuals are reasonably protected of the impact of the social deprivation due to the actions of the health public services of the municipality regarding prevention and treatment of the oral health problems.DoutoradoSaude ColetivaDoutor em Odontologi

I Diretrizes do Grupo de Estudos em Cardiogeriatria da Sociedade Brasileira de Cardiologia

O idoso apresenta características próprias na manifestação das doenças, na resposta à terapêutica e no efeito colateral dos medicamentos. Constitui um grupo de maior risco para o aparecimento das doenças degenerativas, em geral, e cardiovasculares, em particular, além de apresentar maior número de comorbidades

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO