Selenium intake is not associated with the metabolic syndrome in Brazilian adolescents: an analysis of the Study of Cardiovascular Risk Factors in Adolescents.

Se reduces cellular inflammation and lipid peroxides; therefore, its association with CVD and the metabolic syndrome (MetS) has been studied. We aimed to investigate the association between Se intake and the MetS and its parameters (high waist circumference, hyperglycaemia, high blood pressure, high TAG and low HDL-cholesterol) in Brazilian adolescents between 12 and 17 years old. This research is part of the Study of Cardiovascular Risks in Adolescents (ERICA), a Brazilian nationwide school-based study with regional and national relevance. We assessed: (1) socio-demographic data (sex, age, type of school and maternal education) using a self-administered questionnaire; (2) dietary intake using a 24-h recall applied for the whole sample and a second one applied to a subsample to allow within-person variability adjustment; (3) anthropometric data (weight, height, waist circumference) and blood pressure using standardised procedures; and (4) biochemical analyses (fasting glucose, TAG and HDL-cholesterol). Logistic regression was applied, basing the analysis on a theoretical model. Median Se intake was 98·3 µg/d. Hypertension and hyperglycaemia were more prevalent among boys, while a high waist circumference was more frequent in girls, and low HDL-cholesterol levels were higher among private school students. The prevalence of the MetS was 2·6 %. No association between the MetS and its parameters and Se intake was found. This lack of association could be due to an adequate Se intake in the studied population.

Relationship between oral health literacy of caregivers and the oral health-related quality of life of children: a cross-sectional study.

BACKGROUND: Oral health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions. However, scientific evidence about the oral health literacy of caregivers and the children's oral health-related quality of life. The purpose of this study was to verify the relationship between the level of oral health literacy of caregivers and the children's oral health-related quality of life (OHRQOL). METHODS: This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred thirty children were examined to assess the prevalence of dental caries (dmft index). Parents were interviewed to obtain sociodemographic status, oral conditions, and oral health literacy (OHL). The variable outcome was the children's OHRQOL as assessed by the Early Childhood Oral Health Impact Scale (ECOHIS). We fitted zero-inflated negative binomial regression (ZINB) models to evaluate associations between the study outcome and covariates in terms of PR (Prevalence Ratios), RR (Rate Ratios), and their respective Confidence Intervals (95% CI). RESULTS: Children's OHRQOL was not associated with OHL. Dental caries had a negative impact on the children's quality of life (p < 0.05). A reduced impact on OHRQOL is also associated with having siblings (PR = 0.70, 95% CI 0.52-0.95). A higher age of the mother reduced OHRQOL impacts (PR = 0.72, 95% CI 0.52-0.98). CONCLUSIONS: The factors associated with children's OHRQOL were the number of siblings, the mothers' age, and dental caries. This study observed no association between parental OHL and children's OHRQOL.

Oral and oropharyngeal cancer mortality in Brazil, 1983-2017: Age-period-cohort analysis.

AIM: To estimate the effect of age, period, and birth cohort on mortality from oral and oropharyngeal cancer in Brazil. METHODS: Deaths due to oral and oropharyngeal cancer from 1983 to 2017 were analyzed. The effect of age, period, and cohort was calculated using the Poisson regression model. RESULTS: Between 1983 and 2017, 142,634 deaths were recorded from oral and oropharyngeal cancer in Brazil, 54% from oropharyngeal cancer. The male sex contributed to 81% of the deaths. The average mortality rate for men was 4.5 deaths per 100,000 inhabitants, and for women, it was 0.9 deaths per 100,000 inhabitants. There was a strong effect of age on mortality rates from oral and oropharyngeal cancer. The risk increases from 40 years of age in men and 55 years of age in women. An overall period effect was observed. The 2000 period showed the greatest risk when compared to the 1985 period in men. In women, the period of highest risk was 2010. The cohorts born between 1958 and 1962 had a higher risk of death. CONCLUSIONS: The period effect is mainly attributed to mortality from oropharyngeal cancer. Most significant values regarding the effect on the cohort groups were observed in female mortality from oral cancer.

Sociodemographic, health and pro-breast-feeding policies and programmes associated with breast-feeding duration in Latin American countries.

OBJECTIVE: To describe the duration of breast-feeding between 1990 and 2013 and to estimate the association between breast-feeding duration and sociodemographic, health and pro-breast-feeding policies and programmes in Latin American countries. DESIGN: This is a cross-sectional study with data from Demographic and Health Surveys programme conducted in Bolivia, Brazil, Colombia, Peru and the Dominican Republic between 1990 and 2013. The median duration of breast-feeding was estimated by survival analysis. Information on pro-breast-feeding policies and programmes was extracted from the World on Breastfeeding Trends Initiative (WBTi) tool. The association between the duration of breast-feeding and WBTi tool score was analysed by multilevel survival regression. SETTING: Nationally representative cross-sectional survey from Bolivia, Brazil, Colombia, Peru and Dominican Republic. PARTICIPANTS: We included children under 24 months of age, totalling 17 318 children. RESULTS: Breast-feeding duration showed a significant increase in all countries, except the Dominican Republic. Mothers with higher schooling level (HR = 1·66; 95 % CI 1·35, 2·04), higher income (HR = 1·58; 95 % CI 1·40, 1·77) and overweight (HR = 1·14; 95 % CI 1·05, 1·23) breastfed for a shorter time. Breast-feeding in the first hour of life (HR = 0·79; 95 % CI 0·74, 0·83) was associated with increase in the duration of breast-feeding. Regarding WBTi, Peru presented the lowest score and the Dominican Republic presented the highest score. WBTi score was inversely related to the duration of breast-feeding for this set of countries (HR = 1·07; 95 % CI 1·02, 1·12). CONCLUSIONS: Mothers with better socio-economic conditions and overweight breastfed for a shorter time. Breast-feeding in the first hour was associated with longer duration of breast-feeding. In this set of countries, higher scores from WBTi tool did not result in longer duration of breast-feeding.

Tuning of bending and torsional modes of bars used in mallet percussion instruments.

The present paper proposes a generic design-optimization procedure for the concomitant tuning of bending and torsional modes of bars used in mallet percussion instruments. The undercut model uses a series of discontinuous cuts aimed to facilitate the manufacturing process. Compared to one-dimensional beam models, the use of three-dimensional (3-D) finite element modeling not only allows for the calculation of torsional modes but also provides an increased accuracy in the prediction of modal frequencies, an important aspect when dealing with the demanding tuning tolerances required in a musical context. A global optimization problem is formulated and solved using a surrogate function algorithm, which enables fast computations even with the expensive function evaluations associated with 3-D finite element models. Modal identification of experimental bars demonstrates the potential of the proposed procedure, leading to bars with demanding tuning ratios (six target frequencies) at absolute tuning deviations typically below 15 cents. Measurements of the radiated sound from the experimental bars illustrate the benefits of the improved designs compared to those without torsional tuning. The proposed framework, aside from dealing with the comprehensive tuning of percussive musical bars, also accounts for important practical considerations regarding efficient optimization, modeling accuracy, and manufacturing complexity.

Toward a physical model of the clavichord.

String excitation by the tangent in the clavichord is a unique mechanism. The tangent, keeping in contact with the string after the initial strike, continuously controls the string tension. Four main flexible subsystems are considered in the clavichord: the tangent/key subsystem, the string subsystem, the bridge-soundboard subsystem, and the string damper subsystem. A modal description of the dynamics of these subsystems is proposed. Parameters of the subsystems are estimated on a copy of a historical instrument by Hubert (1784). The different subsystems and their couplings are modeled using a modal Udwadia-Kalaba formulation. The string-tangent interaction is modeled via the intermittent contact dynamics, using the Kirchoff-Carrier string model. Realistic string, soundboard, and tangent motions are obtained using a time-domain synthesis scheme that computes the dynamics of the uncoupled subsystems and the constraints resulting from coupling between them. Simulated motions of the model in response to a driving force on the key are analyzed. The results are consistent with experimental measurements and published data on the dynamics of the clavichord. The model is able to reproduce the main acoustic features of the instrument: force on the key for intonation control, key velocity for dynamic nuances control, and constant spectral slope for varying dynamic nuances.

The association of dietary glycaemic index and glycaemic load with gestational weight gain and newborn birth weight.

Diet during pregnancy is related to several maternal and infant health outcomes; however, the relationship between maternal dietary glycaemic index (GI) and glycaemic load (GL) and gestational weight gain (GWG) or newborn birth weight is controversial. The purpose of the present study was to investigate the relationship between maternal dietary GI and GL and GWG and birth weight. A cohort of adult pregnant women with usual obstetric risk was followed in Botucatu, SP, Brazil. Two 24-h dietary recalls were collected in each gestational trimester (<14, 24-27, 31-34 weeks), one in person and the other by telephone. GI and GL were determined using the software Nutrition Data System for Research. GWG was obtained from medical records and evaluated as the weekly GWG between the second and third gestational trimesters. Newborn birth weight z-score in relation to gestational age was evaluated according to Intergrowth-21st Project recommendations. A multiple linear regression model, adjusted for potential confounders, showed a one-point increase in the GI resulted in a mean decrease of 12·9 (95 % CI -21·48, -4·24) g in weekly GWG; GL was not associated with this outcome. The birth weight z-score was not associated with GI (P = 0·763) or GL (P = 0·317). In conclusion, in a cohort of pregnant women considered at usual risk for obstetric complications, maternal dietary GI was negatively associated with weekly GWG in the second and third gestational trimesters. No association was observed between GL and GWG, and neither GI nor GL was associated with birth weight z-score.

Analysis of the combined risk of oral problems in the oral health-related quality of life of Brazilian adolescents: multilevel approach.

OBJECTIVES: The objective of this study was to evaluate the combined risk of oral problems in the oral health-related quality of life (OHRQoL) of adolescents aged 15 to 19 years in São Paulo state (Brazil) in the year of 2015. MATERIALS AND METHODS: Data from the São Paulo State Oral Health Survey (SBSP-15) and the contextual characteristics of the cities of São Paulo state, evaluated in the year 2015 were accessed. Correlations were made between contextual factors (i.e., coverage of the family health team, average supervised tooth brushing, number of first dental appointments, and average income), individual sociodemographic variables (i.e., ethnicity, gender, and schooling) and dental problems (dental pain, caries, overjet, open bite, indication for endodontic and exodontic treatment, gingival bleeding, and dental trauma). These variables were correlated with the quality of life of the adolescents using the Oral Impacts on Daily Performance (OIDP) index. Multilevel Poisson regressions were performed to calculate the rate ratio (RR) with 95% confidence interval (CI). RESULTS: According to the bivariate analysis, the presence of low (RR, 1.62; 95% CI 1.07-2.46) and very intense (RR, 2.53, 95% CI 1.92-3.34) dental pain, indication for endodontic (RR, 1.31; 95% CI 1.05-1.63) or for exodontic (RR, 1.31; 95% CI 1.06-1.63) treatment, and gingival bleeding (RR, 1.41; 95% CI 1.11-1.80) reduced the quality of life of adolescents. All domains of OIDP scores were associated between healthy and unhealthy individuals (p < 0.001) increasing mean scores with combined oral health problems. Higher impact on quality of life was associated with simultaneous presence of dental pain, gingival bleeding, and indication for exodontic treatment (RR, 6.03; 95% CI, 4.02-9.04) in the adolescents. CONCLUSION: Individual and contextual factors and the various dental problems are independently associated with the quality of life of Brazilian adolescents aged 15 to 19 years, especially when they are associated with the perception of intense dental pain, gingival bleeding, and indication for exodontic treatment, with up to six times greater impact on OIDP. CLINICAL RELEVANCE: The study highlighted the importance for an integral treatment in adolescents, considering that the associated risk of several dental diseases can progressively affect the quality of life of this population.

Describing mortality trends for major cancer sites in 133 intermediate regions of Brazil and an ecological study of its causes.

BACKGROUND: In Brazil, 211 thousand (16.14%) of all death certificates in 2016 identified cancer as the underlying cause of death, and it is expected that around 320 thousand will receive a cancer diagnosis in 2019. We aimed to describe trends of cancer mortality from 1996 to 2016, in 133 intermediate regions of Brazil, and to discuss macro-regional differences of trends by human development and healthcare provision. METHODS: This ecological study assessed georeferenced official data on population and mortality, health spending, and healthcare provision from Brazilian governmental agencies. The regional office of the United Nations Development Program provided data on the Human Development Index in Brazil. Deaths by misclassified or unspecified causes (garbage codes) were redistributed proportionally to known causes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed calculating trends for each region, sex and cancer type. RESULTS: Trends were predominantly on the increase in the North and Northeast, whereas they were mainly decreasing or stationary in the South, Southeast, and Center-West. Also, the variation of trends within intermediate regions was more pronounced in the North and Northeast. Intermediate regions with higher human development, government health spending, and hospital beds had more favorable trends for all cancers and many specific cancer types. CONCLUSIONS: Patterns of cancer trends in the country reflect differences in human development and the provision of health resources across the regions. Increasing trends of cancer mortality in low-income Brazilian regions can overburden their already fragile health infrastructure. Improving the healthcare provision and reducing socioeconomic disparities can prevent increasing trends of mortality by all cancers and specific cancer types in Brazilian more impoverished regions.

Is reduced dentition with and without dental prosthesis associate with oral health-related quality of life? A cross-sectional study.

BACKGROUND: Oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research and should contribute to professional judgment about restorative treatments and prosthetic replacement in patients who had reduced dentitions. The aim was to compare the OHRQoL among adults (35-44 years) categorized according to different definitions of reduced dentition and considering the use (or non-use) of dental prosthesis. METHODS: This study used data from a probabilistic sample of adults in Sao Paulo, Brazil, 2015. OHRQoL was based on none items of Oral Impacts on Daily Performance (OIDP) index, as prevalence (at least one impact) and extent (the number of items with non-zero score). We used different criteria to assess dentition status: (1) Shortened Dental Arch (SDA): having 3-5 natural occlusal units (OUs) in posterior teeth and intact anterior region; (2) hierarchical functional classification system: a five-level stepwise classification of dentition; and (3) presence of ≥21 teeth. The use or nonuse of dental prosthesis was recorded. Negative binomial regression models involved the adjustment for social determinants of health. RESULTS: Nearly half (53.1%) of the 5753 participating adults had at least one oral health issue impacting OHRQoL. OIDP prevalence in adults with SDA did not differ from those with more OUs (PR = 1.02; 95%CI 0.91-1.13). Individuals with non-functional dentition had worse OHRQoL regardless of their use of a dental prosthesis. Adults with fewer than 21 remaining teeth, ranked significantly higher in OIDP extent, regardless of dental prosthesis use (PR = 1.38; 95%CI 1.16-1.63 with prosthesis; PR = 1.62; 95%CI 1.19-2.20 without dental prosthesis). CONCLUSIONS: Individuals with more missing teeth reported worse OHRQoL regardless of using a dental prosthesis. Preserving a functional dentition, even with missing teeth, is compatible with OHRQoL.

Individual and contextual factors associated with traumatic dental injuries in a population of Brazilian adolescents.

BACKGROUND/AIMS: Traumatic dental injuries (TDIs) stand out as one of the major public health problems worldwide, characterized by a high prevalence in children and adolescents. However, their association with the 15-19 years age group has not been fully described. The aim of this study was to evaluate TDIs in a population of Brazilian adolescents. METHODS: An association study was performed with 5558 adolescents attending the São Paulo State Oral Health Survey (SBSP-15). Individual predisposing variables (gender, age, schooling, ethnic, overjet, and molar relationship); contextual predisposing (city size and Municipal Human Development Index); individual enabling (per capita income and type of service used); contextual enabling (number of dentists, family health team coverage, and family median income); individual need (satisfaction and perception regarding treatment) and contextual needs (average supervised brushing, number of visits, and dental extractions per city), as well as health behaviors were analyzed. Andersen's behavioral model was used for the data analysis. A multilevel logistic regression with fixed effects was performed to calculate the odds ratio (OR), with 95% confidence interval (CI). RESULTS: The prevalence of TDIs in adolescents was 1.42% (95% CI: 0.94-2.13). Individual and contextual factors of need, predisposing factors, facilitators, and health behaviors were associated with TDIs. In the adjusted analysis, gender (OR = 0.32, 95% CI: 0.18-0.53), mean family income (OR = 2.52, 95% CI: 1.35-4.69), number of dental visits (OR = 0.40, 95% CI: 0.19-0.84), and time of last visit (OR = 2.64, 95% CI: 1.46-4.77) remained significant concerning trauma. CONCLUSION: At least one variable of the individual and contextual predisposing, enabling, and need factors (except for individual enabling variables) were associated with dental trauma in Brazilian adolescents aged 15-19 years. This information may help with the planning of preventive actions and dental treatment, especially in mid-sized and large cities.

Case 6: amputation site on an ulcerated diabetic foot.

A patient presented with diabetic gangrene on four toes and a moderately infected ulcer on the dorsum of the foot. Following amputation of the gangrenous toes, it was possible to salvage the remaining foot using a combination of antibiotics, octenilin Wound Irrigation Solution and Octiset.

Prolonged pacifier use during infancy and smoking initiation in adolescence: evidence from a historical cohort study.

AIM: To investigate the association between prolonged pacifier use during childhood and smoking in adolescence and early adulthood. METHODS: A historical cohort study including patients from a dental private office was designed. Dental records were used, which contained complete data about sucking habits from 314 children (2-10 years of age) who had attended a private dental office from 1988 to 1994 in Ibiá, Brazil. Then, we collected data about the smoking habits from 261 subjects who were successfully contacted again from 2004 to 2006. Our outcome variable was smoking, and subjects who had smoked more than 100 cigarettes during their lifetime were classified as smokers. Poisson regression analysis matched the association between oral habits and smoking. Incidence rate ratios (IRR) and 95% confidence intervals (95% CI) were calculated. The level of significance was set at 5%. RESULTS: We observed a statistically significant association between prolonged pacifier use (more than 24 months) and smoking (IRR = 4.48; 95% CI 2.32-8.65). Breastfeeding, in contrast, was a protective factor (IRR = 0.64; 95% CI 0.42-0.96). CONCLUSIONS: Prolonged pacifier use during childhood is positively associated with smoking initiation in adolescence and early adulthood.

The influence of normative and subjective oral health status on schoolchildren's happiness.

BACKGROUND: Traditional methods to measure oral health based on clinical standards are limited because they do not consider psychosocial and functional aspects of oral health. It has been recommended that these measures need to be supplemented by data obtained from patients regarding their individual perceptions on oral health-related quality of life (OHRQoL). Happiness is a multidimensional construct comprising both emotional and cognitive domains, and has been defined as "the degree to which an individual judges the overall quality of his or her life as a whole favorably". It has been associated with several health outcomes, including oral health. The aim of this study was to assess the impact of oral health conditions, oral health-related quality of life (OHRQoL), and socioeconomic factors on the subjective happiness of Brazilian adolescents. METHODS: A cross-sectional study was conducted in 2012 on a representative sample of 12-year-old schoolchildren in Santa Maria-RS, Brazil. The data were collected through dental examinations and structured interviews. The participants underwent an evaluation aimed at detecting dental caries, traumatic dental injuries, malocclusion, and gingival bleeding. They also completed the Brazilian versions of the Child Perceptions Questionnaire-short form (CPQ11-14-ISF: 16) and the Subjective Happiness Scale (SHS), which was our outcome variable. Socioeconomic conditions were evaluated through a questionnaire that was completed by the participants' parents. Poisson regression analysis was used to determine the association between the explanatory variables and the outcome. Moreover, a correlation analysis was performed to determine the relationship between the SHS scores and the overall and domain scores of the CPQ11-14-ISF: 16. RESULTS: A total of 1,134 children were evaluated. Unadjusted analyses showed that happiness was associated with socioeconomic indicators, the use of dental services, clinical status, and scores on the OHRQoL measure. After adjustment, household overcrowding (RR: 0.96; 95% CI: 0.93-0.98), dental caries (RR: 0.98; 95% CI: 0.97-0.99), malocclusion (RR: 0.98; 95% CI: 0.96-0.99), and the severity associated with the CPQ11-14 (RR: 0.95; 95% CI: 0.93-0.97) still showed a significant association with lower levels of the mean SHS score. CONCLUSIONS: Happiness is influenced by oral conditions, socioeconomic status, and OHRQoL.

Assessing individual and neighborhood social factors in child oral health-related quality of life: a multilevel analysis.

PURPOSE: It has been suggested that subjective measures of oral health are influenced by both individual and contextual characteristics. This study assessed the relationship between neighborhood and individual social networks and child oral health-related quality of life (COHRQoL). METHODS: This study followed a cross-sectional design using a multistage sample of 478 children aged 1-5 years old. Caregivers completed the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) and answered questions related to socioeconomic status and social network. The dental examination provided information on the prevalence of dental caries, dental trauma, and occlusion. Contextual social determinants included the presence of cultural community centers and of workers' association in the neighborhood. Data analysis considered the total ECOHIS scores as the outcome and neighborhood/individual social networks as the independent variables. A multilevel Poisson regression model was used to investigate the association among individual and contextual characteristics and COHRQoL. RESULTS: Total ECOHIS scores ranged from 0 to 41 (possible range 0-52). The mean ECOHIS score was low (mean = 1.8, SD = 3.9), and the functional domain presented the highest mean impact on COHRQoL (mean = 0.5, SD = 1.4). Following adjusted analysis, low household income, visiting a neighbor less than once a month, the presence of anterior open bite, dental trauma, and dental caries were identified as individual determinants of negative impact on a child's quality of life. These variables remained associated with the outcome even after adding the contextual-level variables in the model. At the contextual level, the presence of community cultural centers was associated with overall mean ECOHIS score; higher impacts on COHRQoL were observed in those living in neighborhoods without cultural community centers. CONCLUSION: There is a significant association between individual and contextual social determinants and COHRQoL; unfavorable social conditions and poor socioeconomic status have a negative impact on caregiver reports of children's oral health-related quality of life.

Cancer mortality in childhood and adolescence: analysis of trends and spatial distribution in the 133 intermediate Brazilian regions grouped by macroregions.

OBJECTIVE: To assess the magnitude, trend, and spatial patterns of childhood and adolescent cancer mortality between 1996 and 2017 in 133 Brazilian intermediate regions by using socioeconomic and healthcare services indicators. METHODS: This is an ecological study for analyzing the trend of mortality from cancer in childhood and adolescence through time series. Data on deaths were extracted from the Brazilian Mortality Information System. Data on population were extracted from the 1991, 2000, and 2010 demographic censuses of the Brazilian Institute of Geography and Statistics, with interpolation for intercensal years. Time series were delineated for mortality by type of cancer in each intermediate region. Such regions were grouped by macroregions to present the results. The calculation and interpretation of mortality trends use the Prais-Winsten autoregression procedure. RESULTS: Mortality rates for all neoplasms were higher in the Northern region (7.79 deaths per 100 thousand population), while for leukemias, they were higher in the Southern region (1.61 deaths per 100 thousand population). In both regions, mortality was higher in boys and in the 0-4 age group. The trend was decreasing (annual percent change [APC] - -2.11 [95%CI: -3.14; - 1.30]) for all neoplasms in the Brazilian regions and stationary (APC - -0.43 [95%CI: -1.61; 2.12]) for leukemias in the analyzed period. CONCLUSION: The mortality rate for all neoplasms showed higher values in regions with smaller numbers of ICU beds in the public healthcare system.

Sex Differences in Diagnosis and Treatment Timing of Comorbid Depression/Anxiety and Disease Subtypes in Patients With ADHD: A Database Study.

OBJECTIVE: Our study examined the impact of sex, ADHD subtype, and comorbid illnesses (depression/anxiety) on the timing of diagnosis and treatment for ADHD. METHOD: To analyze ADHD patients, four health databases were used to assess subtype, comorbid mood, and antidepressant or anxiolytic drug exposure. Analyses were stratified by sex and age. Standardized mean differences measured intergroup differences. RESULTS: Females with ADHD were identified at older ages and had higher rates of depression and anxiety diagnoses and treatments before and after their initial ADHD diagnosis. Predominantly inattentive ADHD patients were diagnosed later and more likely to receive mood disorder diagnosis and treatment than hyperactive impulsive ADHD patients. CONCLUSIONS: Results suggest a more complex ADHD presentation in females, potentially causing late diagnosis and delayed treatment.