43 research outputs found

    Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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    Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030


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    Objective: Investigate the association between obesity (measured using the body mass index and abdominal circumference) and periodontal disease in adults.Methods: A cross-sectional study was conducted with 280 adults (102 men and 178 women) who sought dental care at the clinic of the dentistry course of the Lutheran University of Brazil (Cachoeira do Sul campus). The participants answered a questionnaire addressing socioeconomic, demographic, behavioral and health-related characteristics. Height, body weight and waist measurements were determined in a standardized way for the calculation of the variables used to define obesity: body mass index (BMI) and abdominal circumference (AC). Oral clinical examinations were performed by two examiners who had undergone training and calibration exercises. Periodontal disease was recorded when clinical attachment loss was ≥ 5 mm in ≥ 30% of the teeth. Statistical analysis involved simple and multivariate Poisson regression with robust variance.Results: The prevalence of periodontal disease was 49.6% (139/280). The multivariate models indicated a lower likelihood of periodontal disease in individuals considered obese based on BMI (PR=0.64; 95% CI: 0.47-0.88) and AC (PR=0.72; 95% CI: 0.55-0.93). Moreover, the prevalence of the outcome was significantly higher in older individuals, those with less schooling, smokers and individuals with diabetes.Conclusion: An inverse association was found between obesity measured using both criteria and periodontal disease. The present data suggest that care and counseling for the prevention and control of periodontal disease should be equally directed at individuals in the ideal weight range as well as those with overweight or obesity

    Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective

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    Background: This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018. Aim: The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy. Design: This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC. Results: Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care. Conclusions: This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC

    Distribuição espacial de cárie dentária em crianças pré-escolares de Canoas, sul do Brasil

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    The aims of this study were to analyze the spatial distribution of dental caries among preschool children and create equiprobable scenarios of its occurrence in the city of Canoas, Southern Brazil. Trained, calibrated dentists examined 1,100 children enrolled at public preschools to determine dental caries experience following World Health Organization criteria. The ArcGis 10.0 Geographic Information System was used to analyze spatial and non-spatial data. Geostatistical Modeling Software was used in geostatistical analyses to detect spatial continuity and create maps using stochastic simulation. Overall prevalence of dental caries was 25% with intraurban differentials in distribution. The findings enabled the generation of 100 equiprobable scenarios and maps with the best and worst scenarios. The highest concentration of dental caries occurrence was found in the western portion of the city, while the lowest probability of occurrence was found in the northern and southern portions. Identifying spatial inequalities in health conditions and visualizing them through the creation of maps can help to qualify and organize public health interventions and provide information to gain better understanding of the influence of the surrounding environment on adverse health conditions.O objetivo do estudo foi analisar a distribuição espacial de cárie dentária entre crianças préescolares e criar cenários equiprováveis da ocorrência deste agravo na cidade de Canoas, sul do Brasil. Exame clínico para detecção da experiência de cárie dentária de acordo com o critério da Organização Mundial da Saúde foi realizado por cirurgiõesdentistas treinados e calibrados em uma amostra de 1.100 crianças matriculadas em escolas de educação infantil. Utilizouse o Sistema de Informação Geográfica ArcGis 10.0 para a inserção de dados espaciais e não espaciais. O programa GeoMS foi utilizado nas análises geoestatísticas para a detecção da continuidade espacial e construção de mapas através da simulação estocástica. A prevalência de cárie dentária foi 25%, com diferenciais intraurbanos na sua distribuição. Os resultados permitiram a construção de 100 cenários equiprováveis e de mapas com os melhores e piores cenários no município. Uma maior concentração de ocorrên cias foi encontrada na região oeste da cidade, enquanto que as regiões norte e sul tiveram a menor probabilidade de ocorrência de cárie dentária. A identificação de desigualdades espaciais em condições de saúde e a sua visualização por meio de mapas pode auxiliar na qualificação e organização de intervenções de saúde pública, assim como fornecer subsídios que ajudem no entendimento da influência do meio ambiente sobre as condições adversas de saúde

    Feeding frequency in infancy and dental caries in childhood: a prospective cohort study

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    ObjectivesFeeding patterns in infancy are plausible contributors to dental caries later in childhood, yet relatively few cohort studies have examined potential dietary risk factors at this age. This study aimed to investigate the associations between feeding frequency at age 12 months and caries prevalence at age 3 years.MethodsIn this prospective birth cohort of 345 Brazilian children, all foods and drinks consumed at age 12 months, including bottle-use and breastfeeding, were recorded using two 24-hour infant dietary recalls with mothers. The prevalence of early childhood caries (ECC) and severe ECC (S-ECC) at age 38 months were compared in groups defined according to 12-month feeding frequency, using regression models to adjust for sociodemographic characteristics and total carbohydrate intake.ResultsIndependent of other variables, compared with children with infrequent bottle-use and breastfeeding at 12 months, at 38 months the ECC prevalence was 1.8-times higher in children breastfed more than three times/day (P = 0.001), 1.4-times higher in children bottle-fed more than three times/day (P = 0.07) and 1.5-times higher with combined high frequency of bottle and breastfeeding together (P = 0.04), but the association with consumption of other foods or drinks more than five times/day [risk ratio (RR) = 1.2; P = 0.10] was not statistically significant. Prevalence of S-ECC was significantly associated with frequent breastfeeding (RR = 2.4; P &lt; 0.001) and with greater frequency of consumption of other foods or drinks (RR = 1.7, P = 0.001).ConclusionsHigh-frequency feeding in late infancy, including both bottle use and breastfeeding, were positively associated with dental caries in early childhood, suggesting possible early-life targets for caries prevention