Diabetes, hypertension and mobility among Brazilian older adults: findings from the Brazilian National Household Sample Survey (1998, 2003 and 2008).

BACKGROUND: The rapid population ageing has been accompanied by a growing number of older adults experiencing chronic conditions, especially diabetes and hypertension, which are conditions associated to the decline in physical functioning. The aim of this study was to investigate changes in the strength of the association between mobility and two chronic conditions (hypertension and diabetes) in a large representative sample of Brazilian older adults over a ten year period. METHODS: The data came from the Brazilian National Household Sample Survey (PNAD) of 1998, 2003 and 2008. The sample comprised 28,943 participants aged 60 years and older investigated in 1998, 35,042 in 2003 and 41,269 in 2008, totalling 105,254 older adults. The dependent variable was the physical mobility index (PMI) constructed based on the Item Response Theory (IRT) using five physical mobility indicators. The chronic conditions were self-reported and the confounders included: age, sex, schooling, ethnicity, family income, household composition, other co-morbidities and use of health services. The association between physical mobility (three different groups) and chronic conditions (hypertension and diabetes) was performed using multinomial logistic regression. RESULTS: Over the ten year period the prevalence of hypertension increased from 44 % (1998), 49 % (2003) to 53 % (2008) (p < 0.001). Similar pattern was observed for the prevalence of diabetes: 10 % in 1998, 13 % in 2003 and 16 % in 2008 (p < 0.001). Overall, physical mobility showed a statistical significant association with both chronic diseases studied even after adjusting for potential confounders. The time-disease interaction term was significant (p < 0.05) for the two chronic conditions studied, and the strength of the associations decreased over the first five years, but it was not sustained between 2003 and 2008. CONCLUSIONS: Despite the increases observed in the prevalence of the hypertension and diabetes over the ten year period, the decrease in strength of the association with physical mobility during the first period could be explained by improvements in health services and treatment of older adults. Special attention should be given to the treatment and management of diabetes in order to avoid declines in physical mobility levels.

Socioemotional Factors and Cardiovascular Risk: What Is the Relationship in Brazilian Older Adults?

Background and Objectives: Cardiovascular risk is composed of several modifiable factors that cannot be explained only at the individual level. The aim of this study was to investigate the association between socioemotional factors and cardiovascular risk in older adults. Research Design and Methods: A cross-sectional study with data from The Brazilian Longitudinal Study of Aging (Estudo Longitudinal de Saúde dos Idosos Brasileiros, ELSI-Brazil), population based with data collected between 2015 and 2016. Cardiovascular risk-the study outcome-was assessed using the WHO/ISH Cardiovascular Risk Prediction Charts. The exposure variables were perceived social support from those who would receive help in situations and productive and leisurely social participation carried out in the last 12 months. We used crude and adjusted logistic regression for socioeconomic conditions, health conditions, and lifestyle habits to estimate odds ratio (OR) and 95% confidence intervals (CIs) for the occurrence of the outcome. Results: There were 6,005 participants between 50 and 74 years old with complete data. Of these, 18.7% (95% CI: 16.9-20.6) had high cardiovascular risk. Being in the highest tertile of greater social participation is associated with a lower prevalence of high cardiovascular risk (OR: 0.69; 95% CI: 0.50-0.95), adjusted for all variables, when compared to the lowest tertile. Furthermore, the absence of perceived social support is associated with a higher prevalence in different models. Perceived social support from close family members (son/daughter, son-in-law, and daughter-in-law) for material issues is associated with a higher prevalence, whereas having support from friends for affective resources is associated with a lower prevalence of high cardiovascular risk. Discussion and Implications: Socioemotional factors such as lack of perceived social support and social participation were significantly associated with cardiovascular risk. This suggested that the development of strategies aimed at reducing cardiovascular risk during aging needs to consider socioemotional factors and social relationships.

Condition-specific impacts on quality of life attributed to malocclusion by adolescents with normal occlusion and Class I, II and III malocclusion.

OBJECTIVE: To compare the prevalence, intensity, and extent of condition-specific oral impacts on quality of life attributed to malocclusion by Brazilian adolescents with normal occlusion and those with Angle Class I, II, and III malocclusion. MATERIALS AND METHODS: Four groups of 55 adolescents were configured such that each group represented normal occlusion, as well as Angle Class I, II, and III malocclusion. No radiographs were taken. Adolescents aged 15 to 16 years were selected from those attending all secondary schools in Bauru (Sao Paulo, Brazil). The Oral Impacts on Daily Performances index was used to collect data on condition-specific impacts (CSIs) attributed to malocclusion. The prevalence, as well as the intensity and extent, of CSIs was compared among the four groups with the use of Chi-square and Kruskal-Wallis tests, respectively. RESULTS: Groups were comparable according to sex, age, and socioeconomic status. The prevalence of CSI was significantly different between groups (P = .039). Class II and III malocclusion groups reported a higher prevalence of CSI than those with normal occlusion and Class I malocclusion. However, the intensity and extent of CSI were not significantly different between groups. CONCLUSIONS: The prevalence, but not the intensity and extent, of CSIs attributed to malocclusion differed among groups with different malocclusions. The present findings support the concept that malocclusion has physical, psychological, and social effects on quality of life.

Impacts on daily performances related to wearing orthodontic appliances.

OBJECTIVE: To assess the prevalence, intensity, and extent of the impacts on daily performances related to wearing different types of orthodontic appliances. MATERIALS AND METHODS: A total of 1657 students, 15 to 16 years old, were randomly selected from those attending all secondary schools in Bauru, São Paulo, Brazil. Only those wearing orthodontic appliances at the time of the survey were included. Face-to-face structured interviews were done to collect information about impacts on quality of life related to wearing orthodontic appliances, using the Oral Impact on Daily Performances (OIDP). Adolescents were also clinically examined to assess the type of orthodontic appliance they were wearing. Comparisons, by type of orthodontic appliance and covariables, were performed using nonparametric statistical tests. RESULTS: Three hundred fifty-seven adolescents (36.1% boys and 63.9% girls) undergoing orthodontic treatment participated in the study. The prevalence of condition-specific impacts related to wearing orthodontic appliances was 22.7%. Among adolescents with impacts related to wearing orthodontic appliances, 35.8% reported impacts of severe or very severe intensity and 90.1% reported impacts on only one daily performance, commonly eating or speaking. The prevalence, but not the intensity or the extent, of condition-specific impacts differed by type of orthodontic appliance (P = .001). CONCLUSIONS: One in four Brazilian adolescents undergoing orthodontic treatment reported side effects, specific impacts on daily living, related to wearing orthodontic appliances. Such impacts were higher among adolescents wearing fixed rather than removable or a combination of fixed and removable orthodontic appliances. This information could help to inform patients about the frequency and intensity of sociodental impacts during the course of their treatment.

The relationship between normative orthodontic treatment need and oral health-related quality of life.

OBJECTIVES: The first objective was to assess whether having had orthodontic treatment affected the levels of oral health-related quality of life impacts in Brazilian adolescents. A second objective was to assess the relationship between a normative clinical measure of orthodontic treatment need and two measures of oral health-related quality of life. METHODS: A cross-sectional study was conducted in Bauru, SP, Brazil, on 1675 randomly selected adolescents aged between 15 and 16 years. Adolescents were clinically examined using the Index of Orthodontic Treatment Need (IOTN). Two oral health-related quality of life measures, namely the Oral Impacts on Daily Performance (OIDP) and the shortened version of the Oral Health Impacts Profile (OHIP-14) were used to assess the adolescents' oral health-related impacts. Multiple logistic regression was used in the data analysis. RESULTS: Adolescents who had completed orthodontic treatment reported less oral health impacts on their daily life activities than those currently under treatment or those who never had any treatment. Combining the IOTN index with either of the two oral health-related quality of life measures used in this study provided more information about the adolescents' perceived satisfaction with their appearance than the IOTN on its own. CONCLUSION: Current methods of assessing orthodontic need should be complemented by oral health-related quality of life measures with valid psychometric properties, and measures of perceived need.

Condition-specific sociodental impacts attributed to different anterior occlusal traits in Brazilian adolescents.

The aim of this study was to assess the association between different anterior occlusal traits and the presence of condition-specific sociodental impacts on the quality of life attributed to malocclusion. For that, 1,318 15-16-yr-old adolescents were randomly selected from children attending all secondary schools in Bauru, Brazil. Participants were first interviewed and then dentally examined. Condition-specific impacts (CSI) attributed to malocclusion were calculated using the Oral Impacts on Daily Performances (OIDP index). Nine anterior occlusal traits were evaluated: maxillary and mandibular overjet; openbite and overbite; centreline deviation; dental crowding and spacing; and maxillary and mandibular irregularity. Statistical associations were tested using binary logistic regression analysis. The prevalence of CSI attributed to malocclusions was 21.2%. Of the nine occlusal traits evaluated, maxillary and mandibular overjet, centreline deviation, dental spacing, openbite, and maxillary irregularity were, in that order, directly associated with the presence of CSI attributed to malocclusion. No interaction term was identified. This study, designed to overcome the limitations found in the existing literature, supports the idea that malocclusion can affect social interaction and psychosocial wellbeing. Different anterior occlusal traits affected the quality of life differently.