Chronic Encapsulated Sclerosing Peritonitis: A Case Report.

Chronic encapsulated sclerosing peritonitis (CESP) is a very rare cause of intestinal obstruction that has been associated with certain chronic conditions. It is characterized by the thickening of the peritoneum, generating a membrane that covers the intestinal loops and prevents their adequate mobilization. Most cases present as a surgical emergency, leading to a diagnosis during surgery; however, imaging studies can support the pre-surgical diagnosis. Treatment is based on the clinical context of the patient, based on medical management with corticosteroids in a stable patient, or surgical management when it presents as an acute complication. The morbidity and mortality associated with this condition are high and epidemiological data are scarce. There is still a lack of studies to describe the associated demographic data, diagnosis, and treatment.

Distribution of Edentulism by the Macro Determinants of Health in 204 Countries and Territories: An Analysis of the Global Burden of Disease Study.

OBJECTIVE: To carry out a comprehensive description of edentulism estimates by the macro determinants of health in 2000, 2010 and 2019 worldwide. METHODS: This ecological study analyzed data from the Global Burden of Disease Study (GBD) to describe the incidence rate, prevalence rate and years lived with disability (YLDs) rate due to edentulism by macro determinants of health (governance, macroeconomic policy, social policy, public policies, societal values), for 204 countries and territories. The estimates were reported as rates (cases/100,000 people), for people of both sexes aged 55 years or older. RESULTS: Countries belonging to the least privileged categories of the macro determinants showed the lowest prevalence rate, incidence rate, and YLD rate due to edentulism for all exposures. Countries with low government expenditure on health showed the lowest prevalence rate of edentulism in 2000 (18,972.1; 95 %CI 15,960.0 - 21,984.3) and 2010 (16,646.8; 95 %CI: 14,218.3-19,075.4) than those with high government expenditure on health in 2000 (25,196.6; 95 %CI: 23,226.9 - 27,166.2) and 2010 (21,014.7; 95 %CI: 19,317.9 - 22,711.5). Countries with low SDI showed the lowest YLDs in 2000 (321.0, 95 %CI: 260.1- 381.9), 2010 (332.0; 95 %CI: 267.7-396.3), and 2019 (331.6; 95 %CI: 266.6-396.5). CONCLUSION: The findings point to persistent inequalities in the distribution of edentulism between countries worldwide. The most privileged countries, with higher economic development, better governance, and better social and public policies, have shown higher rates of edentulism. CLINICAL SIGNIFICANCE: This model must be reconsidered by advancing toward upstream and midstream strategies, beyond its conventional downstream clinical interventions.

Neutrophil- and Platelet-Lymphocyte Ratio as Biomarkers of Severity in Complicated Diverticular Disease.

INTRODUCTION: Diverticulitis is a prevalent gastrointestinal disease that may require surgical intervention. The aim of the study was to investigate the involvement of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as biomarkers of severity in complicated diverticular disease (CDD) in Mexican patients and their correlation with the need for surgical intervention, the length of hospital stay, and mortality. MATERIAL AND METHODS: An observational, longitudinal, and retrospective study performed from 2017 to 2021 was considered in patients over 18 years of age, with a diagnosis of CDD by using computed tomography and with a hemogram taken in the first 24 hours upon admission to the emergency department to describe the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of NLR and PLR in the CDD.  Results: A total of 102 Mexican patients suffering from CDD, 54% women and 46% men with a mean of 59 years, were analyzed. According to Hinchey's classification, 79 (77.5%) patients showed type I, 12 (12.8%) type II, 5 (4.9%) type III, and 6 (5.9%) type IV. The mean hospital stay was 8.8 days, with a mortality rate of 3.9%. The cut-off value was established at 5.1 for NLR according to the results of the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.633, a sensitivity of 90%, a specificity of 43%, PPV of 21.8%, and NPV of 96% for the prediction of CDD. A cut-off value for PLR at 72 was established according to the results of the ROC curve with an AUC of 0.482, a sensitivity of 78%, a specificity of 40%, PPV of 96%, and NPV of 9% for the prediction of CDD. CONCLUSION: The NLR and PLR are easily calculable and accessible biomarkers that can be part of the decision-making for the diagnosis and treatment of CDD in Mexican people as has been observed in other populations. However, more prospective, multicenter comparative studies are needed to assess the efficacy and safety of these biomarkers in relation to those already described.

Associations between psychological stress, discrimination, and oral health-related quality of life: the buffering effects of social support networks.

Stress and discrimination negatively affect quality of life, but social support may buffer their effects. This study aims: (1) to examine the associations between psychological stress, discrimination, and oral health-related quality of life (OHRQoL); and (2) to assess whether social support, stress and discrimination interact to modify their associations with OHRQoL. We used cross-sectional household-based data from a study including 396 individuals aged 14 years and over from families registered for government social benefits in a city in Southern Brazil. OHRQoL was measured with the Oral Impacts on Daily Performance (OIDP) scale; psychological stress was assessed with the Perceived Stress Scale (PSS); social support was assessed based on the number of close relatives or friends of the participant, and discrimination was assessed with a short version of the Everyday Discrimination Scale. Interactions were estimated using the relative excess of risk due to interaction (RERI). Adjusted effects were calculated with logistic regression. The prevalence of oral impacts among people with higher and lower PSS scores was 81.6% and 65.5%, respectively (p < 0.01). Social support was found to have no interactions with stress levels and discrimination. The association between social discrimination and OHRQoL (OIDP score > 0) was OR = 2.03 (95%CI: 1.23; 3.34) among people with a low level of stress, but was OR = 12.6 (95%CI: 1.31; 120.9) among those with higher levels (p = 0.09, for interaction). Individuals who reported experiencing higher levels of psychological stress and discrimination had worse OHRQoL; a synergistic effect with social support was not clear.

Towards the integration of prevention and control of oral diseases within child primary healthcare: The case of Peru.

OBJECTIVES: The Peruvian public health norm of primary healthcare (PHC) for growth and development medical check-ups (CRED, Spanish acronym) of children under 5 years of age was updated in 2017 with the inclusion of interdisciplinary prevention and control actions for oral diseases, such as dentist referral. The aim of this study was to explore the association between CRED and oral health services utilization (OHSU), throughout the heterogeneous Peruvian territory. METHODS: A population-based cross sectional study was conducted using the 2021 Demographic and Family Health Survey of Peru and included data from 15 836 children aged 12-59 months. Poisson generalized linear models were used to evaluate the association between any CRED and OHSU, in the 6 months prior to the survey, including sociodemographic characteristics of the children and their mothers as confounding variables. A possible effect modification by natural region of residence (Metropolitan Lima/rest of the Coast/Highlands/Jungle) was evaluated. To examine the robustness of the regression model, a sensitivity analysis was performed using the cumulative number of CRED. RESULTS: Children who had at least one CRED were almost twice as likely to report OHSU (aPR: 1.95; 95% CI: 1.73-2.21), which was greater in the regions of rest of the Coast (aPR: 2.56; 95% CI: 2.00-3.17) and Jungle (aPR: 2.03; 95% CI: 1.64-2.56). The sensitivity analysis showed consistent results for the association CRED-OHSU. Nevertheless, within the last 6 months, attendance at CRED and OHSU were only achieved by 43.7% and 13.7% of the children respectively. CONCLUSIONS: Integrating oral health into Peruvian Child PHC seems to be a promising public health intervention to increase children's OHSU. For a greater scope, it is crucial to drive greater attendance at CRED and continuous monitoring and strengthening of CRED-based oral health promotion in all Peruvian natural regions with an equity-focused approach.

Preventive dental service use and oral health-related quality of life in Brazilian older adults.

BACKGROUND: Information on the use of preventive dental services and associated variables is needed to guide policy for the old adult population and consequently promote better oral health-related quality of life (OHRQoL). OBJECTIVE: To investigate the association between preventive dental service use and OHRQoL by older Brazilians. MATERIALS AND METHODS: This cross-sectional study was carried out using the baseline data of participants of the Brazilian Longitudinal Stud of Aging (ELSEI-Brazil) who were aged 60 years or more. Associations with the use of preventive dental services were carried out using Poisson regression models with robust variance, adjusting for confounders. RESULTS: The final sample consisted of 5432 older adults. Almost all (90.7%) participants reported not having sought preventive dental services in the last year. Individuals who used dental services for prevention had fewer impacts on their OHRQoL (RR: 0.74; [95% CI: 0.57-0.97]). CONCLUSION: Preventive dental service use is associated with a better OHRQoL in older Brazilians. Policies to improve access to preventive dental services may result in improved OHRQoL in this age group.

Composite indexes of anthropometric failure in children under 5 years of age in Argentina: Comparative analysis among regions: 2019-2020.

OBJECTIVES: Composite Index of Anthropometric Failure (CIAF) and Extended CIAF (ECIAF) allow for the identification of simultaneous presence of two or more types of malnutrition. The objective of this study was to analyze anthropometric failure in Argentinean children under 5 years old, taking into consideration regional and socioeconomic perspectives. MATERIALS AND METHODS: Data from the National Survey of Children and Adolescents MICS 2019-2020 were used, which included 5473 children under 5 years old of both sexes residing in the six regions of Argentina. CIAF and ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting, and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess. The data were analyzed according to region and wealth quintile. RESULTS: In children aged 0-2.99 years, CIAF was 12.5% and ECIAF was 27.7%, with boys being more affected. In children aged 3-4.99 years, the rates were 9.7% and 22.3%, respectively, with girls showing a higher prevalence. The highest ECIAF was recorded in the Patagonia region (31.3%), while the highest ECIAF was observed in the poorest quintile. DISCUSSION: The presence of double burden of malnutrition has been observed across all regions and household income levels. Additionally, overweight has shown a higher intensity in economically prosperous regions and households, while stunting has been more prevalent in economically disadvantaged areas.

Associations between psychological stress, discrimination, and oral health-related quality of life: the buffering effects of social support networks / Associações entre estresse psicológico, discriminação e qualidade de vida relacionada à saúde bucal: os efeitos amortecedores das redes de apoio social / Asociaciones entre estrés psicológico, discriminación y calidad de vida relacionada con la salud bucal: los efectos atenuantes de las redes de apoyo social

Stress and discrimination negatively affect quality of life, but social support may buffer their effects. This study aims: (1) to examine the associations between psychological stress, discrimination, and oral health-related quality of life (OHRQoL); and (2) to assess whether social support, stress and discrimination interact to modify their associations with OHRQoL. We used cross-sectional household-based data from a study including 396 individuals aged 14 years and over from families registered for government social benefits in a city in Southern Brazil. OHRQoL was measured with the Oral Impacts on Daily Performance (OIDP) scale; psychological stress was assessed with the Perceived Stress Scale (PSS); social support was assessed based on the number of close relatives or friends of the participant, and discrimination was assessed with a short version of the Everyday Discrimination Scale. Interactions were estimated using the relative excess of risk due to interaction (RERI). Adjusted effects were calculated with logistic regression. The prevalence of oral impacts among people with higher and lower PSS scores was 81.6% and 65.5%, respectively (p < 0.01). Social support was found to have no interactions with stress levels and discrimination. The association between social discrimination and OHRQoL (OIDP score > 0) was OR = 2.03 (95%CI: 1.23; 3.34) among people with a low level of stress, but was OR = 12.6 (95%CI: 1.31; 120.9) among those with higher levels (p = 0.09, for interaction). Individuals who reported experiencing higher levels of psychological stress and discrimination had worse OHRQoL; a synergistic effect with social support was not clear.

O estresse e a discriminação afetam negativamente a qualidade de vida, mas o apoio social pode amortecer seus efeitos. Os objetivos deste estudo são: (1) examinar as associações entre estresse psicológico, discriminação e qualidade de vida relacionada à saúde bucal (QVRSB); e (2) avaliar se apoio social, estresse e discriminação interagem para modificar suas associações com QVRSB. Os dados são de uma pesquisa transversal de base domiciliar de um estudo que incluiu 396 indivíduos com 14 anos ou mais de famílias registradas para benefícios federais em uma cidade no sul do Brasil. A QVRSB foi mensurada pelo Impactos Orais no Desempenho Diário (OIDP), enquanto o estresse psicológico foi avaliado pela Escala de Estresse Percebido (PSS). Além disso, o apoio social foi avaliado pelo número de parentes ou amigos próximos e a discriminação por meio da Escala de Discriminação Diária (EDS). As interações foram estimadas por meio do excesso relativo de risco devido à interação (RERI). Os efeitos ajustados foram calculados por meio de regressão logística. A prevalência de impactos bucais entre as pessoas com maior e menor escores de PSS foi de 81,6% e 65,5%, respectivamente (p < 0,01). O apoio social mostra interações inclusivas com níveis de estresse e discriminação. A associação entre discriminação social e QVRSB (escore OIDP > 0) foi OR = 2,03 (IC95%: 1,23; 3,34) dentre pessoas com baixo nível de estresse, mas foi de OR = 12,6 (IC95%: 1,31; 120,9) dentre aqueles com níveis mais altos (p = 0,09, para interação). Indivíduos que relataram níveis mais elevados de estresse psicológico e discriminação apresentaram pior QVRSB; o efeito sinérgico com o apoio social não foi evidente.

El estrés y la discriminación afectan negativamente a la calidad de vida, pero el apoyo social puede mitigar sus efectos. Los objetivos de este estudio son: (1) examinar las asociaciones entre el estrés psicológico, la discriminación y la calidad de vida relacionada con la salud bucal (CVRSB); y (2) evaluar si el apoyo social, el estrés y la discriminación interactúan para modificar sus asociaciones con la CVRSB. Los datos provienen de una encuesta transversal de hogares cuyo estudio incluyó a 396 individuos de 14 años o más de familias registradas en beneficios del gobierno en una ciudad del Sur de Brasil. La CVRSB se midió mediante el Impactos Orales en el Rendimiento Diario (OIDP), mientras que el estrés psicológico se evaluó mediante la Escala de Estrés Percibido (PSS). El apoyo social se basó en el número de familiares o amigos cercanos, y la discriminación en la Escala de Discriminación Cotidiana (EDS). Las interacciones se estimaron mediante el excesivo de riesgo relativo debido a la interacción (RERI). Los efectos ajustados se calcularon mediante regresión logística. La prevalencia de impactos orales entre las personas con puntajes de PSS más altas y más bajas fue del 81,6% y del 65,5%, respectivamente (p < 0,01). El apoyo social presenta interacciones inclusivas con niveles de estrés y discriminación. La asociación entre discriminación social y OHRQoL (puntuación OIDP > 0) fue OR = 2,03 (IC95%: 1,23; 3,34) entre personas con un nivel bajo de estrés, pero fue OR = 12,6 (IC95%: 1,31; 120,9) entre aquellos con niveles más altos (p = 0,09, para interacción). Las personas que informaron tener niveles más elevados de estrés psicológico y discriminación tuvieron una peor CVRSB; el efecto sinérgico con el apoyo social no estaba claro.

Core Cariology Curriculum Framework in Spanish for Latin American dental schools: development and consensus.

The aim of this study was to develop and achieve consensus on a cariology teaching framework for dental schools in Latin American Spanish-speaking countries. The Delphi process, with a ≥8 0% pre-defined participants' agreement, included three phases and a Coordinating Group. During the Preparation phase three panels of experts were selected and invited to participate: a) Regional academic/professional Dental Associations (Associations-Panel): n = 12; b) Regional Dental Schools (Dental-Schools-Panel): existing dental schools (n = 263) from the 19 Spanish-speaking regional countries; c) International academic/professional associations Peer Experts (Peer-Panel): n = 4. Based on consensus documents from Europe, Colombia, the Caribbean, USA, Chile and Spain, and updated scientific evidence, the Coordinating Group developed a baseline framework proposal of domains, main competencies (MC) and specific competencies (SC). The Consultation-Agreement and Consensus phases included three rounds of questionnaires with a step-wise sharing of the MC updated version of the consensus framework with the Dental-Schools-Panel and including SC with the Associations-Panel. Diverse communication strategies were used ( e.g ., independent google-form questionnaires and workshops). Consensus was reached after an on-site Associations-Panel workshop and secret voting, followed by an online meeting with the Peers-Panel. A total of 127 academic/professional institutions participated (Associations-Panel: 11, 91.6%; Dental-Schools-Panel: 112, 42.6%, all countries; Peers-Panel: 4, 100%). The baseline Cariology teaching framework of 5 domains, 10 MC and 92 SC underwent modifications after agreements for a final consensus framework consisting of 5 domains, 10 MC and 85 SC. A Core Cariology curriculum framework in Spanish for Latin American Dental Schools was successfully developed and agreed upon with regional dental academic and professional institutions.

Virtual learning object about oral ulcerative lesions: controlled educational intervention study.

The aim of this study was to develop a virtual learning object (VLO) to teach undergraduate dental students about the diagnostic and therapeutic approaches to oral ulcerative lesions. The VLO was developed with information on the diagnostic process, lesion classification, and clinical-surgical management of oral ulcerative lesions. The VLO content was initially validated by a group of specialists. Learning was evaluated in a sample of 58 undergraduate dental students, divided into control group (conventional theoretical class, n = 29) and intervention group (interaction with VLO, n = 29). All students answered a pre-test and post-test questionnaire. The VLO group also answered a specific questionnaire on the evaluation of the VLO. Both quantitative and qualitative descriptive analyses were performed. The validation showed that professors and students considered the VLO adequate. The use of the VLO was recommended by 100% of professors and 86.6% of students. In the intervention group, the results showed a significantly higher number of correct answers in the post-test (p < 0.01). In conclusion, the VLO proved to be a useful tool for teaching oral medicine, contributing significantly to the knowledge of ulcerated lesions in the mouth.

Current status of geriatric dentistry education in selected dental schools in Latin America and the Caribbean.

OBJECTIVE: Latin American and Carribean (LAC) are currently experiencing a rapid aging of their population, coupled with a significant burden of oral diseases. Despites this, there is a scarcity of evidence regarding the manner in wich geriatric dentistry is being taught in dental schools across LAC. So, the objective of this study is to investigate the current status of geriatric dentistry education at undergraduate and postgraduate levels in selected LAC dental schools. METHODS: An electronic questionnaire was developed and emailed to all 539 dental schools in 19 LAC countries. The questionnaire recorded activity levels, contents and methodology of geriatric dentistry education as part of dental degree programmes. Reminders by email and telephone calls were used to encourage non-responders to complete the questionnaire. RESULTS: In total, 317 schools from 17 countries responded to the questionnaire (response rate: 58.8%). Geriatric dentistry was taught in 54.6% of the schools at the undergraduate level and in 6.9% at the postgraduate level. Thirty two percent of the schools had a programme director trained in geriatric dentistry. Geriatric dentistry was taught as an independent course in 14.5% of the schools. Dry mouth, periodontal disease, denture-related conditions and prosthodontic management, oral mucosal disease and age-related changes of the orofacial complex were the most frequently covered topics. Clinical teaching of geriatric dentistry was reported by 26.5% of the schools, with 38.0% providing clinical training in outreach facilities. CONCLUSIONS: Geriatric dentistry education remains incipient in LAC, with only one in every four dental school offering it as a standalone course. There is an urgent need to further develop geriatric dentistry education in the continent, including further research to develop a minimum geriatric dentistry curriculum.

Effects of lipodystrophy and physical exercise on bioimpedance parameters in people living with HIV: A cross-sectional study.

OBJECTIVE: The aim of this study was to evaluate the effects of lipodystrophy and physical exercise on the parameters of bioimpedance spectroscopy (BIS) and bioimpedance vector analysis (BIVA) of people living with HIV (PLWHIV). METHODS: Seventy patients were divided into two groups: PLWHIV with lipodystrophy (PLWHIV-L) and PLWHIV without lipodystrophy (PLWHIV-NL). The phase angle (PhA) and the BIVA were determined from the values of resistance and reactance collected by the BIS. The percentage of fat mass and lean soft tissue (LST) were determined by dual-energy x-ray absorptiometry. For comparisons between the PLWHIV-L and PLWHIV-NL groups, the t test for independent samples or the Mann-Whitney test was used. From the BIVA, the average of the impedance vectors of the two groups was calculated with the 95% confidence ellipse, and the individual vectors of the patients divided by sex were also compared with the tolerance ellipses of 50%, 75%, and 95% of the healthy reference population. The relationships between the variables of interest were determined by the Pearson or Spearman correlation coefficient and the coefficient of determination. Analysis of covariance was used for comparisons between groups, adjusted for possible confounding variables. RESULTS: PLWIV-L showed better hydration conditions (P <0.01), higher LST (P <0.01), and lower percent of fat mass (P <0.01). No differences in PhA were observed between PLWHIV who practiced or did not practice physical exercise. There was a significant difference between the impedance vectors of the groups with and without lipodystrophy (T = 42.4 and P <0.01). Additionally, most of the patients who were positioned beyond the ellipse limits of 50% of tolerance fell into the areas of edema and cachexia. The extracellular to intracellular water ratio explained 81% of the PhA variations. When PhA was adjusted for height2, fat mass/height2 and LST, it was significantly different between groups of the female sex (PhA: P <0.01). CONCLUSION: Lipodystrophy and the practice of physical exercise do not present direct involvement in the PhA values, with sex, body composition, and hydration variables being the main influences on this variable. BIVA was able to show differences in the body composition of the groups even when the PhA values were similar.

Characterization of the equine placental microbial population in healthy pregnancies.

In spite of controversy, recent studies present evidence that a microbiome is present in the human placenta. However, there is limited information about a potential equine placental microbiome. In the present study, we characterized the microbial population in the equine placenta (chorioallantois) of healthy prepartum (280 days of gestation, n = 6) and postpartum (immediately after foaling, 351 days of gestation, n = 11) mares, using 16S rDNA sequencing (rDNA-seq). In both groups, the majority of bacteria belonged to the phyla Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidota. The five most abundant genera were Bradyrhizobium, an unclassified Pseudonocardiaceae, Acinetobacter, Pantoea, and an unclassified Microbacteriaceae. Alpha diversity (p < 0.05) and beta diversity (p < 0.01) were significantly different between pre- and postpartum samples. Additionally, the abundance of 7 phyla and 55 genera was significantly different between pre- and postpartum samples. These differences suggest an effect of the caudal reproductive tract microbiome on the postpartum placental microbial DNA composition, since the passage of the placenta through the cervix and vagina during normal parturition had a significant influence on the composition of the bacteria found in the placenta when using 16S rDNA-seq. These data support the hypothesis that bacterial DNA is present in healthy equine placentas and opens the possibility for further exploration of the impact of the placental microbiome on fetal development and pregnancy outcome.

Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic.

OBJECTIVE: To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS). METHODS: We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change. RESULTS: Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods. CONCLUSION: After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

Pathways that explain racial differences on edentulism among older adults: 2019 Brazil National Health Survey.

This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3-52.6), and 36.8% (95%CI: 35.7-37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.

[The use of dental services in the past year in the brazilian population: a systematic review with meta-analysis]. / O uso dos serviços odontológicos no último ano na população brasileira: revisão sistemática com metanálise.

The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.

O objetivo foi analisar os fatores associados ao uso dos serviços odontológicos no Brasil. A estratégia de revisão incluiu as bases PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS e Google Scholar, além de repositórios e bancos de dissertações e teses. Os estudos foram selecionados ​​usando a estratégia PEO (população/exposição/desfechos). O desfecho deste estudo foi o uso dos serviços odontológicos no último ano pela população brasileira, tratado como variáveis dicotômicas para as análises: ≤ 1 ano e > 1 ano. Foi realizada uma metanálise de efeito randômico de Mantel-Haenszel, estimando-se razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Foram selecionados 94 estudos. A maioria (98%) tinha delineamento transversal, sendo 63% oriundos de dados primários. Para a metanálise, 25 estudos foram incluídos. O uso dos serviços odontológicos no último ano esteve associado com maior escolaridade (≥ 8 anos de estudo) (RP = 0,49, (IC95%: 0,39-0,60)); maior renda familiar (≥ 2 salários-mínimos) (RP = 0,79, (IC95%: 0,74-0,84)); e residir na zona urbana (RP = 0,79, (IC95%: 0,64-0,97)). A oferta de serviços odontológicos no Sistema Único de Saúde precisa ser ampliada entre pessoas com menor renda, menor escolaridade e moradores da zona rural.

O uso dos serviços odontológicos no último ano na população brasileira: revisão sistemática com metanálise / The use of dental services in the past year in the brazilian population: a systematic review with meta-analysis

Resumo O objetivo foi analisar os fatores associados ao uso dos serviços odontológicos no Brasil. A estratégia de revisão incluiu as bases PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS e Google Scholar, além de repositórios e bancos de dissertações e teses. Os estudos foram selecionados ​​usando a estratégia PEO (população/exposição/desfechos). O desfecho deste estudo foi o uso dos serviços odontológicos no último ano pela população brasileira, tratado como variáveis dicotômicas para as análises: ≤ 1 ano e > 1 ano. Foi realizada uma metanálise de efeito randômico de Mantel-Haenszel, estimando-se razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Foram selecionados 94 estudos. A maioria (98%) tinha delineamento transversal, sendo 63% oriundos de dados primários. Para a metanálise, 25 estudos foram incluídos. O uso dos serviços odontológicos no último ano esteve associado com maior escolaridade (≥ 8 anos de estudo) (RP = 0,49, (IC95%: 0,39-0,60)); maior renda familiar (≥ 2 salários-mínimos) (RP = 0,79, (IC95%: 0,74-0,84)); e residir na zona urbana (RP = 0,79, (IC95%: 0,64-0,97)). A oferta de serviços odontológicos no Sistema Único de Saúde precisa ser ampliada entre pessoas com menor renda, menor escolaridade e moradores da zona rural.

Abstract The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.

Untreated caries and serum vitamin D levels in children and youth of the United States: NHANES 2013-2014.

This study aimed to investigate the association between serum vitamin D levels and untreated caries and determining factors in children and youth. METHODOLOGY: This cross-sectional study used data from the National Health and Nutrition Examination Survey (2013-2014). In total, 3,072 participants with ages ranging from 1 to 19 years were included in our sample. The main dependent variable, untreated caries, was defined as having at least one untreated carious surface in any tooth. Serum concentration of 25-hydroxyvitamin D [25(OH)D] was categorized into four groups: ≥75 nmol/ml, 50-74.9 nmol/ml, 25-49.9 nmol/ml, and <25 nmol/ml. Data were analyzed using a binary logistic regression. RESULTS: For children aged 1-5 years, age (OR = 1.68, 95% confidence intervals (95% CI) 1.38-2.04) and low levels of vitamin D (25-49.9 nmol/ml, and <25 nmol/ml: OR = 2.55, 95% CI 1.06-6.13) were associated with untreated caries. For children aged 6-11 years, low levels of vitamin D (50-74.9 nmol/ml: OR=1.45, 95% CI 1.16-1.82) remained associated with untreated caries. No associations were found in those between 12 and 19 years of age. CONCLUSION: Our findings show an association between low levels of 25(OH)D and untreated caries in children between 1 and 11 years of age, suggesting that this nutrient might interfere in the caries process.

Untreated caries and serum vitamin D levels in children and youth of the United States: NHANES 2013-2014

Abstract This study aimed to investigate the association between serum vitamin D levels and untreated caries and determining factors in children and youth. Methodology: This cross-sectional study used data from the National Health and Nutrition Examination Survey (2013-2014). In total, 3,072 participants with ages ranging from 1 to 19 years were included in our sample. The main dependent variable, untreated caries, was defined as having at least one untreated carious surface in any tooth. Serum concentration of 25-hydroxyvitamin D [25(OH)D] was categorized into four groups: ≥75 nmol/ml, 50-74.9 nmol/ml, 25-49.9 nmol/ml, and <25 nmol/ml. Data were analyzed using a binary logistic regression. Results: For children aged 1-5 years, age (OR = 1.68, 95% confidence intervals (95% CI) 1.38-2.04) and low levels of vitamin D (25-49.9 nmol/ml, and <25 nmol/ml: OR = 2.55, 95% CI 1.06-6.13) were associated with untreated caries. For children aged 6-11 years, low levels of vitamin D (50-74.9 nmol/ml: OR=1.45, 95% CI 1.16-1.82) remained associated with untreated caries. No associations were found in those between 12 and 19 years of age. Conclusion: Our findings show an association between low levels of 25(OH)D and untreated caries in children between 1 and 11 years of age, suggesting that this nutrient might interfere in the caries process.

Resumo Este estudo teve como objetivo investigar a associação entre os níveis séricos de vitamina D e cárie dentária não-tratada e fatores determinantes em crianças e jovens. Metodologia: Este estudo transversal utilizou dados da Pesquisa Nacional de Saúde e Nutrição (2013-2014). No total, 3.072 participantes com idades entre 1 e 19 anos foram incluídos em nossa amostra. A principal variável dependente, cárie não-tratada, foi definida como pelo menos uma superfície de cárie não-tratada em qualquer dente. A concentração sérica de 25-hidroxivitamina D [25(OH)D] foi categorizada em quatro grupos: ≥75 nmol/ml, 50-74,9 nmol/ml, 25-49,9 nmol/ml e <25 nmol/ml. Os dados foram analisados ​​por meio de regressão logística binária. Resultados: Para crianças de 1 a 5 anos, idade (OR = 1,68, intervalo de confiança de 95% (IC 95%) 1,38 a 2,04) e baixos níveis de vitamina D (25 a 49,9 nmol/ml e <25 nmol/ml: OR = 2,55, IC 95% 1,06-6,13) foram associados a cárie não-tratada. Para crianças de 6 a 11 anos, baixos níveis de vitamina D (50 a 74,9 nmol/ml: OR = 1,45, IC 95% 1,16 a 1,82) permaneceram associados à cárie não-tratada. Não foram encontradas associações naqueles entre 12 e 19 anos de idade. Conclusão: Nossos achados mostram uma associação entre baixos níveis de 25(OH)D e cárie não-tratada em crianças de 1 a 11 anos, sugerindo que este nutriente pode interferir no processo da cárie dentária .

Dental visits and depression mediating the association of socioeconomic status with oral health behaviors.

Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the "Patient Health Questionnaire-9") and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.