Masticatory function and mortality among older adults living in long-term care facilities in Brazil.

OBJECTIVE: To investigate the association between mortality and masticatory function in older adults living in long-term care facilities (LTCFs), controlling for demographic and health covariates. BACKGROUND: Poor oral health has been associated with mortality; however, no previous study investigated whether objective and self-reported poor masticatory function is a predictor of early mortality in LTCFs. MATERIALS AND METHODS: Baseline characteristics of 295 participants were collected, including age, sex, polypharmacy, mobility, activities of daily living, frailty, nutritional status, and objective (masticatory performance - chewing gum) and self-reported masticatory function. The participants were followed-up with for 4 years to record the mortality data. Cox regression models were run to analyse the data (α = .05). RESULTS: During the 4-year follow-up, 124 (42.0%) participants died. Older adults with poor masticatory performance (hazard ratio [HR] = 1.59, 95% confidence interval [95% CI] = 1.07-2.36) and those who self-reported masticatory dysfunction (HR = 1.48, 95% CI = 1.01-2.16) were at higher risk of early death than those with good mastication. However, in a multivariate model including both objective and self-reported masticatory function, only the objective measurement remained associated with early death (HR = 1.52, 95% CI = 1.02-2.27). CONCLUSION: Poor masticatory performance seems to be associated with early death in older adults living in LTCFs, but they may have shared risk factors accumulated throughout life that were not covered by the study period.

Serum levels of proinflammatory cytokines are high in early childhood caries.

It is unknown whether serum levels of proinflammatory cytokines would be high in children with early childhood caries (ECC). This study investigated the association between serum levels of proinflammatory cytokines and severity of caries in preschoolers younger than 72 months. A case-control study was performed with a random sample of 72 children with ECC and 80 caries-free children. The explanatory variables were serum levels of proinflammatory cytokines (IL-6, TNF-α, and NGAL) and the outcome was severity of ECC (number of decayed teeth). Thecrudeanalyses were used toestimate the association between each cytokine and ECC. Then, the analyses were adjusted for socioeconomic factors, excess weight and sugar sweetened beverages consumption using Poisson regression models. The estimated coefficients were expressed as Means Ratio (MR), with 95% confidence intervals (CI). In the crude analyses, the highest tertiles of IL-6 (MR = 1.47, IC = 1.09-2.00, p = 0.012), TNF-α (MR = 1.33, CI = 1.00-1.78, p = 0.040) and NGAL (MR = 2.20, CI = 1.39-3.49, p = 0.001) were associated to ECC. After adjustment, the highest tertiles of IL-6 levels (MR = 1.54, IC = 1.13-2.10, p = 0.005), and NGAL (MR = 1.71, CI = 1.04-2.80, p = 0.032) remained associated to ECC; while TNF-α was no longer associated to ECC (MR = 1.31, CI = 0.98-1.75, p = 0.066). Higher serum levels of proinflammatory cytokines were associated to severity of caries in preschoolers, suggesting that chronic inflammation underlies ECC.

A conventional microwave oven for denture cleaning: a critical review.

INTRODUCTION: Denture cleaning should be quick and easy to perform, especially in long-term care facilities. The lack of proper oral hygiene can put older adults at higher risk from opportunistic oral infections, particularly fungal. As an alternative to regular brushing, the use of a microwave oven has been suggested for cleaning and disinfecting dentures. OBJECTIVES: To synthesise and discuss the advantages and disadvantages of the use of a conventional microwave oven for cleaning and disinfecting complete dentures. METHODS: A brief literature search focused on papers dealing with microwave therapy for denture cleaning through PubMed Central, Cochrane Database of Systematic Reviews, Google Scholar, Ovid MEDLINE(R) In-Process, and Scifinder Scholar. RESULTS: One hundred and sixty-seven manuscripts published in English with full text were found, and 28 were accepted and discussed in the light of the advantages and disadvantages of the use of conventional microwave oven for cleaning and disinfecting complete dentures. CONCLUSIONS: There was no standardisation for microwave use for denture cleaning. Manual cleaning still seemed to be the optimal method for controlling fungal infection and denture stomatitis. However, such a daily routine appeared to be underused, particularly in long-term care facilities.

Behavioral risk factors for noncommunicable diseases associated with depression and suicide risk in adolescence.

Noncommunicable diseases (NCDs) and mental disorders cooccur in adulthood, which is why their determinants and common risk factors should be addressed at an early age. Therefore, we estimated the association of the major risk factors for NCDs with depression and suicide risk by structural equation modeling considering pathways triggered by social vulnerability or mediated by obesity. This population-based study included 2,515 Brazilian adolescents. The following exposures were the major risk factors for NCDs: substance use behaviors (variable deduced from alcohol, tobacco, and drug use), physical inactivity, and components of unhealthy eating markers (added sugar and saturated fat). Obesity was assessed using the fat mass index. The outcomes were depression and suicide risk. Depression was associated with substance use behaviors (SC = 0.304; p < 0.001), added sugar (SC = 0.094; p = 0.005), and females (SC = 0.310; p < 0.001). Suicide risk was also associated with substance use behaviors (SC = 0.356; p < 0.001), added sugar (SC = 0.100; p = 0.012), and females (SC = 0.207; p < 0.001). In adolescents, these associations may help explain the cluster of NCDs and mental disorders in adulthood.

Café discussions on oral sex, oral cancer, and HPV infection: summative report.

Recent emphasis has been placed on the potential links between oral sex, HPV infection, and oral cancer development. Such links were addressed by researchers, clinicians, and the community during two Café Scientifique discussions in October and November 2008, in Vancouver, Canada. The Cafes gathered panels of experts on oral pathology, dentistry, oncology, social work, and community-based research who interacted with an audience of policy makers, health care administrators, sociologists, sexologists, pharmacists, clinical and social researchers, social workers, technicians, and graduate, undergraduate, and high school students. This commentary summarizes the main points discussed during these two events to encourage a worldwide open dialogue about potential risks for oral cancer beyond tobacco smoking and excessive alcohol consumption as such malignancies have high mortality and morbidity, but are yet preventable diseases.

Behavioral risk factors for noncommunicable diseases associated with depression and suicide risk in adolescence / Fatores de risco comportamentais para doenças não transmissíveis associados à depressão e ao risco de suicídio em adolescentes / Factores de riesgo comportamentales para las enfermedades no comunicables asociadas con la depresión y el riesgo de suicidio en la adolescencia

Noncommunicable diseases (NCDs) and mental disorders cooccur in adulthood, which is why their determinants and common risk factors should be addressed at an early age. Therefore, we estimated the association of the major risk factors for NCDs with depression and suicide risk by structural equation modeling considering pathways triggered by social vulnerability or mediated by obesity. This population-based study included 2,515 Brazilian adolescents. The following exposures were the major risk factors for NCDs: substance use behaviors (variable deduced from alcohol, tobacco, and drug use), physical inactivity, and components of unhealthy eating markers (added sugar and saturated fat). Obesity was assessed using the fat mass index. The outcomes were depression and suicide risk. Depression was associated with substance use behaviors (SC = 0.304; p < 0.001), added sugar (SC = 0.094; p = 0.005), and females (SC = 0.310; p < 0.001). Suicide risk was also associated with substance use behaviors (SC = 0.356; p < 0.001), added sugar (SC = 0.100; p = 0.012), and females (SC = 0.207; p < 0.001). In adolescents, these associations may help explain the cluster of NCDs and mental disorders in adulthood.

As doenças não transmissíveis (DNT) e transtornos mentais podem ocorrer simultaneamente na vida adulta, razão pela qual seus determinantes e fatores de risco comuns devem ser abordados em idade precoce. Portanto, estimamos a associação entre os principais fatores de risco para DNT e a depressão e risco de suicídio através da modelagem de equações estruturais, considerando os caminhos desencadeados pela vulnerabilidade social ou mediados pela obesidade. Este estudo de base populacional incluiu 2.515 adolescentes brasileiros. As exposições foram os principais fatores de risco para DNT: comportamento de risco viciante (variável latente deduzida a partir do uso de álcool, tabaco e drogas), inatividade física e componentes da dieta não saudável (açúcar de adição e gordura saturada). A obesidade foi avaliada pelo índice de massa gorda. Os desfechos foram depressão e risco de suicídio. Comportamento de risco viciante (CP = 0,304; p < 0,001), açúcar de adição (CP = 0,094; p = 0,005) e sexo feminino (CP = 0,310; p < 0,001) estiveram associados à depressão. Comportamento de risco viciante (CP = 0,356; p < 0,001), açúcar de adição (CP = 0,100; p = 0,012) e sexo feminino (CP = 0,207; p < 0,001) também estiveram associados ao risco de suicídio. Comportamento de risco viciante e açúcar de adição estiveram associados à depressão e ao risco de suicídio em adolescentes, fato este que pode ajudar a explicar o agrupamento de DNT e transtornos mentais na vida adulta.

Las enfermedades no comunicables (ENTs) y los desórdenes mentales ocurren en la etapa adulta, un hecho que da impulso para dirigirse a sus determinantes y factores de riesgo comunes a una edad temprana. Por ello estimamos la asociación de los mayores factores de riesgo para ENTs con la depresión y riesgo de suicidio mediante un modelo de ecuación estructural, considerando trayectorias derivadas de la vulnerabilidad social o mediadas por la obesidad. Este estudio basado en población incluyó a 2.515 adolescentes brasileños. Las exposiciones fueron los mayores factores de riesgo para las ENTs: comportamiento en el uso de sustancias (variable latente deducida del alcohol, tabaco y consumo de drogas), inactividad física y componentes de marcadores de consumo de comida insana (azúcar añadido y grasas saturadas). La obesidad fue evaluada usando el índice de masa grasa. Los resultados fueron depresión y riesgo de suicidio. Los comportamientos en el uso de sustancias (CE = 0,304; p < 0,001), azúcar añadido (CE = 0,094; p = 0,005), y sexo femenino (CE = 0,310; p < 0,001) estuvieron asociados con depresión. Comportamientos en el consumo de sustancias (CE = 0,356; p < 0,001) y azúcar añadido (CE = 0,100; p = 0,012) y el sexo femenino (CE = 0,207; p < 0,001) estuvieron también asociados con el riesgo de suicidio. Los comportamientos en el consumo de sustancias y de azúcar añadido, estuvieron asociados con la depresión y el riesgo de suicidio en adolescentes, un hecho que puede ayudar a explicar la concentración de ENTs y desórdenes mentales en la etapa adulta.

Aging, diversity, and health: the Brazilian and the Canadian context

Aging is a universal and yet diverse phenomenon. This paper presents a review on the topic of diversity in the context of the aging populations in Brazil and Canada. The diversity of the aging population in both countries is discussed in terms of gender, ethnicity, age groups and living conditions while considering the impact on the health care systems. Understanding and reflecting on the Brazilian and Canadian realities reinforces the need for respecting these diversities when developing and implementing local health policies and interventions. There are some similarities regarding gender, but marked differences in immigration patterns, education and living arrangements. The heterogeneity in the aging process within each country and between them carries different expectations and generates social consequences that manifest themselves in differences in health situations, resulting in new challenges to health services and the formulation of public policies for this age group in both countries.

O envelhecimento é um fenômeno universal e ainda diverso. Este estudo apresenta uma revisão sobre a diversidade no contexto do envelhecimento populacional no Brasil e Canadá. Esta diversidade em ambos os países é discutida em termos de gênero, etnia, faixa etária e condições de vida ao considerar o impacto aos sistemas de saúde. Entender e refletir sobre as realidades brasileira e canadense reforça a necessidade de respeitar essas diversidades no desenvolvimento e implementação de políticas locais de saúde e de intervenções em saúde. Existem algumas semelhanças em relação ao gênero, mas destacam-se diferenças nos padrões de imigração, educação e arranjos domiciliares. A heterogeneidade no processo de envelhecimento de cada país e, entre eles, envolve diferentes expectativas e gera consequências sociais que se manifestam em distintas situações de saúde, resultando em novos desafios aos serviços de saúde e na formulação de políticas públicas para esse grupo etário em ambos os países.

El envejecimiento es un fenómeno universal y aun diverso. En este estudio se presenta una revisión sobre la diversidad en el contexto del envejecimiento poblacional en el Brasil y Canadá. Esta diversidad en ambos países es discutida en términos de género, etnia, grupo etáreo y condiciones de vida al considerar el impacto para los sistemas de salud. Entender y reflexionar sobre las realidades brasileña y canadiense refuerza la necesidad de respetar esas diversidades en el desarrollo e implementación de políticas locales de salud y de intervenciones en salud. Existen algunas semejanzas en relación al género, sin embargo se destacan diferencias en los patrones de inmigración, educación y arreglos domiciliarios. La heterogeneidad en el proceso de envejecimiento de cada país y, entre ellos, involucra diferentes expectativas y genera consecuencias sociales que se manifiestan en distintas situaciones de salud, resultando en nuevos desafíos para los servicios de salud y en la formulación de políticas públicas para ese grupo etáreo, en ambos países.

Educaçäo preventiva em odontogeriatria - mais do que uma necessidade, uma realidade / Odontogeriatric preventive education - More than a necessity, it's a reality

As atividades educacionais em saúde bucal desempenham um papel fundamental na melhora da qualidade de vida para qualquer pessoa, em qualquer idade. Como conseqüencia de um grande número de idosos envelhecer cada vez mais com dentes naturais em boca (mesmo quando substituídos por implantes ou prótese fixas), a higiene oral torna-se muito mais exigente. No intuito de melhorar a qualidade de vida desses idosos, uma maior atençäo deverá ser dada na prevençäo das doenças bucais. Como visto na literatura odontológica, atividades preventivas, a exemplo dos programas educacionais, reduzem o risco destas enfermidades. Este artigo objetiva comparar e analisar cinco diferentes atividades preventivas educacionais no campo da odontogeriatria

Diabetes e periodontite: a hora e a vez da Medicina periodontal / Diabetes and periodontal disease: the hour and the time of the periodontal Medicine

Este estudo trata-se de uma revisão da literatura sobre as inter-relações entre doença periodontal e medicina, em especial em relação ao diabetes. Ambas as doenças tratam-se de patologias constantes no processo de envelhecimento, mostrando uma alta incidência no idoso. Como resultado, a baixa na qualidade de vida nesses pacientes é observada, sem falar dos problemas que, indiretamente, passam a ocorrer. A literatura científica tem sugerido uma relação mais do que próxima entre essas duas doenças. Não apenas o diabetes influencia o desenrolar da doença periodontal, a exemplo da dificuldade cicatricial, mas também sofre influência da mesma. Estuda-se a possibilidade de que tal ligação ocorra no que diz respeito ao metabolismo da glicose e, conseqüentemente, no qual essa correlação pode estar ocorrendo é apenas sugestivo e pesquisas são necessárias de maneira a entender melhor tal processo. Mais do que nunca a Medicina encontra-se relacionada à Odontologia, ambas direcionando esforços na busca de um envelhecimento bem sucedido, com melhor qualidade de vida