Life course social mobility, race and tooth loss in adulthood: The role of dental health services.

OBJECTIVES: To evaluate the extent to which dental care factors in adulthood modify and, at the same time, mediate the association between race/ethnicity and social mobility from childhood to adulthood with two oral health outcomes in adults. METHODS: In 2012, 1222 individuals 20-59 years old participated in the second wave of the Epi-Floripa Study in Florianopolis, Brazil. Exposures included social mobility based on adulthood and childhood events, dental care in previous years, type of dental care coverage, reason for dental visits and race. The number of missing and decayed teeth were dichotomised as MT >0 and DT >0. RESULTS: The prevalence of missing and decayed teeth was 61.9% and 23.0%, respectively. Age-sex adjusted inequalities in decayed and missing teeth among Black and White individuals were 41.2 percentage points (pp) (95% CI: 3.9-78.7) and 53.1 pp (19.5:86.7), respectively. Inequalities between those persistently higher and lower in socioeconomic position were 42.6 pp (14.6-70.7) and 90.0 pp (62.1-100). The Relative Excess of Risk due to Interaction (RERI) was not statistically significant (p < 0.05). Oaxaca-Blinder decomposition analyses showed that dental care variables accounted for a small proportion of inequalities. CONCLUSIONS: This result implies that dental care is unlikely to significantly reduce or increase oral health inequalities in this particular population.

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.

A comprehensive program of cognitive stimulation with digital inclusion, physical activity and social interaction can modify BDNF levels and improve cognition in adults over 50: a randomized controlled pilot study.

OBJECTIVES: To analyze the effect of a comprehensive program of cognitive stimulation with digital inclusion, physical activity and social interaction, called "Oficina da Lembrança" (OL), on the cognitive status and concentration of biomarkers of neuroplasticity, neurodegeneration in adults aged 50 years and over attending a Memory Clinic. METHODS: In this pilot randomized controlled study, 64 patients without dementia aged 45 to 79 years, seen at a University Memory Clinic in Southern Brazil, were randomly allocated to the intervention and control groups. The intervention consisted of participation in OL for 12 weeks. Serum biomarkers (brain-derived neurotrophic factor [BDNF], S100ß, and neuron-specific enolase [NSE]) and cognitive status were analyzed as primary and secondary outcomes. The Wilcoxon test and Generalized Estimating Equations (GEE) were applied. RESULTS: Of the 64 patients invited to participate in the study, 33 (intervention: 17, control: 16) completed the study with all data. Improvement of cognitive status was significant in the intervention group (22.6 to 24.5) but not in the control group (20.1 to 21.1). There was a significant reduction of BDNF in OL participants, but no significant change was observed in the neurodegenerative biomarkers S100ß or NSE. The concentration of BDNF decreased significantly post-OL in the intervention group (-288.1, 95%CI -362.1 to -94.1), even after adjusting for sex, age, and educational level. Cognitive status was significantly improved in OL participants. CONCLUSION: The OL program improved cognitive status, reduced serum BDNF levels, and empowered digitally excluded older adults. There was no effect of this intervention on S100ß or NSE. CLINICAL TRIAL REGISTRATION: This study has a Universal Trial Number (UTN) U1111-1195-2642 and was registered in the Brazilian Clinical Trials Registry (ReBEC), number RBR-38X665.

The Controlled Direct Effect of Early-Life Socioeconomic Position on Periodontitis in a Birth Cohort.

This study used data from the 1982 Pelotas Birth Cohort Study, Brazil, to estimate the controlled direct effect of early-life socioeconomic position (SEP) on periodontitis at age 31 years, controlling for adulthood income and education, smoking, and dental hygiene. Sex was included as a covariate. Early-life SEP was measured at participant birth based on income, health services payment mode, maternal education, height, and skin color (lower versus middle/higher SEP). Periodontitis was assessed through clinical examination at age 31 years (healthy, mild periodontitis, or moderate-to-severe disease). Adulthood behaviors (smoking, dental hygiene) were the mediators, and adulthood SEP (education and income) represented the exposure-induced mediator-outcome confounders. A regression-based approach was used to assess the controlled direct effect of early-life SEP on periodontitis. Multinomial regression models were used to estimate risk ratios and their 95% confidence intervals. The prevalences of mild and moderate-to-severe periodontitis were 23.0% and 14.3%, respectively (n = 539). Individuals from the lowest early-life SEP had a higher risk of moderate-to-severe periodontitis controlled for mediators and exposure-induced mediator-outcome confounders: risk ratio = 1.85 (95% confidence interval: 1.06, 3.24), E value 3.1. We found that early-life SEP was associated with the development of periodontitis in adulthood that was not mediated by adulthood SEP and behaviors.

Chronic diseases and socioeconomic inequalities in quality of life among Brazilian adults: findings from a population-based study in Southern Brazil.

Background: To evaluate the association between sociodemographic conditions and the quality of life (QoL) in adults and investigate whether these inequalities are greater among individuals with long-lasting chronic health conditions. Methods: Cross-sectional analysis of the second wave (2012) of the EpiFloripa Study, a population-based cohort of 1720 adults living in Southern Brazil. QoL domains (physical, psychological, social relationships and environmental) were evaluated using the WHOQoL-BREF. Unadjusted and adjusted means of QoL according to socioeconomic and demographic variables were estimated and stratified by the presence of long-lasting chronic conditions (heart disease, stroke, diabetes, hypertension, chronic kidney disease, cirrhosis, tendinitis, arthritis, rheumatism and/or fibromyalgia) were peformed in 2016. Results: Among 1222 interviewed adults (56.6% females, mean age 41.7 ± 11.4 years; follow-up rate 71.1%), the prevalence of 1+ long-lasting chronic disease was 37.3% (95%CI: 34.4-40.3). Their effect on the QoL was four times higher on the physical component (-9.6; 95%CI -12.1; -7.1) than on the other domains. Adults aged 40+ years with black skin colour or lower educational level had a lower physical QoL score only when any chronic disease was present. Among those with some chronic illness, the psychological domain was also lower among those aged 40+ years and with a lower family income. No interaction between sociodemographic variables and chronic diseases was observed for the other QoL domains. Conclusions: The occurrence of long-lasting chronic diseases is associated with inequalities in QoL (physical and psychological domains), with stronger adverse effects among older adults, blacks and individuals with lower income or educational levels.

Association of Pre- Peri- and Postnatal Factors with Developmental Defects of Enamel in Schoolchildren.

OBJECTIVE: This study estimated the prevalence, extent, buccal distribution and associated factors involving enamel defects in Brazilian schoolchildren. STUDY DESIGN: A cross-sectional study using a multistage cluster random sample of 1,206 8-12-year-old Brazilian schoolchildren was carried out in Pelotas, Brazil. The prevalence of enamel defects in the permanent dentition was determined using the modified Developmental Defects of Enamel index (DDE). Sociodemographic and health data were collected from their mothers using a semi-structured questionnaire. Data were analyzed using Poisson regression modelling for DDE prevalence and negative binomial regression modelling for the extent of DDE. RESULTS: The prevalence of any enamel defects was 64.0% (95% Confidence Interval: 61.4, 67.0); the main types were diffuse opacities (35.0%), demarcated opacities (29.5%) and hypoplasia (3.7%). In general, older children had a lower prevalence and extent of enamel defects than their counterparts (p<0.001). There were no other significant associations. CONCLUSION: Enamel defects are common, especially among younger children, but the role of pre-, peri- and postnatal exposures remains unclear.

Deciduous-dentition malocclusion predicts orthodontic treatment needs later: findings from a population-based birth cohort study.

INTRODUCTION: Estimating orthodontic treatment need in the permanent dentition using information from the deciduous-dentition malocclusion may assist in defining the time for appropriate orthodontic intervention. Our objective was to investigate whether malocclusion in the deciduous teeth predicts orthodontic treatment need in the permanent dentition. METHODS: Two oral health studies nested in a birth cohort were carried out at ages 6 (n = 359) and 12 (n = 339) years. Open bite, crossbite, and canine malocclusion were assessed in the deciduous teeth. Orthodontic treatment need was determined in the permanent dentition using the dental esthetic index. Prevalence ratios were estimated using 2 dental esthetic index cutoff points: highly desirable/mandatory orthodontic treatment and only mandatory orthodontic treatment. We tested all combinations of the deciduous malocclusion and the outcomes, controlling for confounders. RESULTS: Children with only open bite and those with concurrent open bite and canine malocclusion were more likely to have either highly desirable/mandatory orthodontic treatment or only mandatory orthodontic treatment needs by age 12. The combination of crossbite and open bite in the deciduous teeth was associated with the highest risk of need for mandatory orthodontic treatment. CONCLUSIONS: Malocclusion in the deciduous teeth is a risk factor for orthodontic treatment need in the permanent dentition. Children with malocclusion at a young age should be monitored regularly, and caregivers may be able to better prepare for possible orthodontic treatment.

Gender differences in the clustering patterns of risk behaviours associated with non-communicable diseases in Brazilian adolescents.

OBJECTIVE: The aim of this study is to investigate gender differences in the clustering of risk behaviours associated with chronic non-communicable diseases in Brazilian adolescents. METHODS: A cross-sectional survey was conducted in 2011 comprising 6529 adolescents aged 15-19years from Santa Catarina State, Brazil. Excessive screen-time, insufficient moderate to vigorous physical activity (MVPA), low fruit/vegetable intake and consumption of alcohol were investigated. Poisson regression was performed in the analysis of sociodemographic factors associated with the clustering of three or more risk behaviours. RESULTS: Girls presented with higher insufficient MVPA (76.3%), while boys presented with lower fruit or vegetable intake (53.0%) and greater consumption of alcohol (40.8%). A total of 21.2% of the teenagers had one risk behaviour, 37.3% had two, 28.5% had three, and 8.0% had all of the measured risk behaviours. Adolescents who did not work and boys who lived in urban areas exhibited more risk behaviours, whereas girls aged 17-19years old and boys who had mothers with ≥12years of study exhibited fewer risk behaviours. CONCLUSION: There was a difference between genders for individual risk behaviours, and a high degree of clustering in both genders. Prevention programs could focus on these behaviours in order to reduce negative health outcomes in adolescents.

Trends in dental caries among Brazilian schoolchildren: 40 years of monitoring (1971-2011).

The study aimed to estimate the prevalence, severity, and inequality in the distribution of dental caries in schoolchildren from Florianópolis, Santa Catarina, Brazil, in 2011, and to compare the results with data from previous studies carried out since 1971. All 12- and 13-year-old schoolchildren enrolled in a public school were eligible. Dental caries were assessed according to the World Health Organisation diagnostic criteria. Decayed, missing and filled surfaces and teeth (DMFS/DMFT) indexes, the Significant Caries Index (SiC) and the Gini coefficient (to assess inequalities in the distribution of dental caries) were estimated. The response rate was 82.3% (n = 130). The prevalence of dental caries decreased from 98.0% (95% CI 96.0-100.0) in 1971 to 36.9% (95% CI 28.5-45.3) in 2011. The mean DMFT ranged from 9.2 in 1971 to 0.7 in 2011. The mean DMFS index was 1.2 (95% CI 0.8-1.6) in 2011. The Gini coefficient was 0.624 in 2002 but increased to 0.725 in 2011; the Lorenz curve showed that 70-75% of dental caries attacks was restricted to 20% of the population in 2011. A reduction of 41.2% in the mean SiC index was observed between 2002 (3.4, 95% CI 3.0-3.8) and 2011 (1.9, 95% CI 1.6-2.1). An effective decline in the prevalence and severity of dental caries in schoolchildren was observed throughout 40 years of monitoring. However, a small proportion of the population has experienced most of the caries burden in the recent years studied.

Socioeconomic status in life course is associated with dental appearance dissatisfaction.

The present study aimed to investigate the prevalence of dissatisfaction with dental appearance among 24-year-old Brazilian adults and the associated factors in life course. A subsample (n = 720) of the 1982 Pelotas Birth Cohort in southern Brazil was investigated at the ages of 15 and 24 years using clinical (caries and periodontal) examinations and interviews. The outcome was dissatisfaction with dental appearance at the age of 24 years. Covariate variables included socioeconomic factors, oral health, and dissatisfaction with general appearance collected during different periods of life. Poisson regression models with robust variance were applied. The prevalence of dissatisfaction with dental appearance was 43.5% (95%CI: 39.8-47.1). Individuals with downward income mobility (PR = 1.22, 95%CI: 1.07-1.79) and those always poor (PR = 1.21, 95%CI: 1.00-1.57) presented a higher prevalence of dissatisfaction with their dental appearance even after oral health variables and dissatisfaction with general appearance were controlled for. Moderate/severe malocclusion at 15 years (PR = 1.34, 95%CI: 1.13-1.59), highest experience of untreated dental caries at 24 years (PR = 1.82, 95%CI: 1.46-2.27), and dental pain experience at 24 years (PR = 1.29, 95%CI: 1.22-1.75) were associated with the outcome. Also, the prevalence of dissatisfaction with dental appearance was 20% higher (PR = 1.20, 95%CI: 1.01-1.43) among those dissatisfied with their general appearance. Our findings demonstrated a high prevalence of dissatisfaction with dental appearance among young adults. Lifetime economic disadvantage and dental problems (malocclusion at 15 years, untreated dental caries at 24 years, and dental pain at 24 years) were associated with dissatisfaction with dental appearance among young adults.

Prevalence and sociodemographic correlates of all domains of physical activity in Brazilian adults.

OBJECTIVE: To estimate the prevalence and sociodemographic indicators associated with physical inactivity in leisure, commuting, work, and household in adults in Florianopolis, Brazil. METHODS: Population-based cross-sectional study was conducted from September 2009 to January 2010, with adults between 20 to 59 years of age (n=1720). Sociodemographic indicators and physical inactivity in each domain were assessed by a validated questionnaire, applied through face-to-face interviews. RESULTS: The prevalence of physical inactivity in each domain was: leisure (52.5%); commuting (50.4%); work (80.9%); and household (57.6%). Women were 27% more inactive in leisure, while men were significantly more inactive at commuting and household (p<0.001). Older adults were more inactive in leisure (p=0.04) and commuting (p=0.05). Physical inactivity in leisure was higher in black adults and those who living with a partner and with lower educational level and lower income. In commuting, those living with a partner and who had higher income were more inactive. Physical inactivity at work was higher in white or brown adults, who had higher educational level and higher income. Physical inactivity in household was found to be higher in adults with higher educational level and higher income. CONCLUSIONS: Sociodemographic indicators presented different associations with physical inactivity in each domain.

Accuracy and measures of association of anthropometric indexes of obesity to identify the presence of hypertension in adults: a population-based study in Southern Brazil.

PURPOSE: This study proposes to examine the accuracy of four anthropometric indexes of obesity to identify the presence of hypertension and assess differences in the estimation and strength of effect measures of the association between each anthropometric measure and hypertension in Brazilian adults. METHODS: A population-based cross-sectional study was carried out with a sample of 1,720 adults from Florianópolis, Brazil. Receiver operating characteristic (ROC) curves were performed to identify the sensitivity and specificity of the best cutoff values for anthropometric indexes (body mass index-BMI, waist circumference-WC, waist-to height ratio-WHtR and conicity index-C-index) for prediction of hypertension. The associations between anthropometric indexes and hypertension were analyzed by Poisson regression expressed as Prevalence Ratios (95% CI) adjusted for socio-demographic variables, health behavior, height, and anthropometric indexes. RESULTS: Of the four anthropometric indexes studied, BMI, WC, and WHtR were found to have the largest areas under the ROC curve relative to hypertension in both sexes. The cutoff values in women and men associated with presence of hypertension were BMI of 24.9 and 24.6 kg/m(2), WC of 86.2 and 89.5 cm, WHtR of 0.49 and 0.50, and C-index of 1.15 and 1.18, respectively. WC and BMI had greater magnitude of association with presence of hypertension, adjusting for socio-demographic variables, health behavior, height, and anthropometric indexes in women and men, respectively. CONCLUSIONS: Anthropometric indexes provide an effective, simple, inexpensive, and non-invasive means for a first-level screening for hypertension.

Multilevel analysis of the association between posterior restorations and gingival health in young adults: a population-based birth cohort.

OBJECTIVE: To investigate the association of direct posterior restorations with gingival bleeding and dental calculus in young adults from a birth cohort. METHODS: A representative sample (n = 720) of 5914 infants born live in Pelotas, Brazil, in 1982, were prospectively investigated, and posterior restorations and periodontal health outcomes assessed when they were 24 years of age. Tooth-level exploratory variables included the presence and number of restoration's surfaces. Demographic and socio-economic characteristics, oral health instructions, dental floss usage, dental caries presence and smoking were also considered whilst gingival bleeding and dental calculus were the outcomes. Multilevel logistic regression was carried out. RESULTS: Class I cavities were found in 15.2% (95% CI 14.5-15.9) of the teeth and class II in 3.6% (3.3-4.0). Percentage of teeth with gingival bleeding was 6.1% (5.6-6.6) and that with dental calculus 22% (21.2-22.8). Even after all the individual variables were controlled for, the presence of a class I [OR1.51 (1.14-2.00)] and class II [OR 1.76 (1.04-2.97)] cavities was positively associated with gingival bleeding. Class I [OR1.36 (1.13-1.65)] and Class II [OR1.80 (1.28-2.53)] cavities were associated with dental calculus also. CONCLUSIONS: Posterior restoration and higher number of restored surfaces was associated with a higher prevalence of gingival bleeding and dental calculus around the restoration.

Perceived neighborhood problems: multilevel analysis to evaluate psychometric properties in a Southern adult Brazilian population.

BACKGROUND: Physical attributes of the places in which people live, as well as their perceptions of them, may be important health determinants. The perception of place in which people dwell may impact on individual health and may be a more telling indicator for individual health than objective neighborhood characteristics. This paper aims to evaluate psychometric and ecometric properties of a scale on the perceptions of neighborhood problems in adults from Florianopolis, Southern Brazil. METHODS: Individual, census tract level (per capita monthly familiar income) and neighborhood problems perception (physical and social disorders) variables were investigated. Multilevel models (items nested within persons, persons nested within neighborhoods) were run to assess ecometric properties of variables assessing neighborhood problems. RESULTS: The response rate was 85.3%, (1,720 adults). Participants were distributed in 63 census tracts. Two scales were identified using 16 items: Physical Problems and Social Disorder. The ecometric properties of the scales satisfactory: 0.24 to 0.28 for the intra-class correlation and 0.94 to 0.96 for reliability. Higher values on the scales of problems in the physical and social domains were associated with younger age, more length of time residing in the same neighborhood and lower census tract income level. CONCLUSIONS: The findings support the usefulness of these scales to measure physical and social disorder problems in neighborhoods.

A scoping review of the clinical application of machine learning in data-driven population segmentation analysis.

OBJECTIVE: Data-driven population segmentation is commonly used in clinical settings to separate the heterogeneous population into multiple relatively homogenous groups with similar healthcare features. In recent years, machine learning (ML) based segmentation algorithms have garnered interest for their potential to speed up and improve algorithm development across many phenotypes and healthcare situations. This study evaluates ML-based segmentation with respect to (1) the populations applied, (2) the segmentation details, and (3) the outcome evaluations. MATERIALS AND METHODS: MEDLINE, Embase, Web of Science, and Scopus were used following the PRISMA-ScR criteria. Peer-reviewed studies in the English language that used data-driven population segmentation analysis on structured data from January 2000 to October 2022 were included. RESULTS: We identified 6077 articles and included 79 for the final analysis. Data-driven population segmentation analysis was employed in various clinical settings. K-means clustering is the most prevalent unsupervised ML paradigm. The most common settings were healthcare institutions. The most common targeted population was the general population. DISCUSSION: Although all the studies did internal validation, only 11 papers (13.9%) did external validation, and 23 papers (29.1%) conducted methods comparison. The existing papers discussed little validating the robustness of ML modeling. CONCLUSION: Existing ML applications on population segmentation need more evaluations regarding giving tailored, efficient integrated healthcare solutions compared to traditional segmentation analysis. Future ML applications in the field should emphasize methods' comparisons and external validation and investigate approaches to evaluate individual consistency using different methods.

The association between vitamin D and BDNF on cognition in older adults in Southern Brazil.

OBJECTIVE: To estimate the association between vitamin D and the cognitive decline of older adults and evaluate whether this association is mediated by brain-derived neurotrophic factor (BDNF) serum concentration. METHODS: Cross-sectional study nested in a population-based cohort. Of the 604 participants in the complementary examination of the EpiFloripa Study, 576 older adults (60 years or older) were eligible for the study. The outcome is cognitive decline evaluated by the Mini-Mental State Examination, the exposure is vitamin D, and BDNF is the mediator. The control variables are age, sex, per capita family income, and educational level. The direct effect of vitamin D and BDNF on cognitive decline and the indirect effect mediated by BDNF was evaluated using path analysis, with the estimation of standardized coefficients. RESULTS: Among the participants, we observed a direct and positive effect of vitamin D on cognitive function (Coef: 0.06; 95%CI: 0.02 to 0.11; p < 0.001) and serum BDNF concentration (Coef: 21.55; 95%CI: 9.92 to 33.17; p = 0.002), i.e., the higher the vitamin D, the higher the cognitive function and serum level of BDNF. CONCLUSION: There was an association between vitamin D on serum BDNF and on cognitive decline in older adults. Moreover, BDNF did not have an effect on cognitive decline, so BDNF was not a mediator of the vitamin D effect on cognitive decline.

Prevalence and experience of dental caries among Singaporean schoolchildren: A time-trend analysis from 2007 to 2019.

OBJECTIVES: This study aimed to describe caries prevalence and experience trends of permanent teeth among Singapore schoolchildren between 2007 and 2019. METHODS: Anonymized records of all 6-year-old Primary 1 (P1), 11-year-old Primary 6 (P6) and 14-year-old Secondary 3 (S3) before the start of each school year were extracted from the Integrated Dental Electronic Assessment System (IDEAS) by school level, ethnicity and sex. Prais-Winsten regression was used to assess trends of mean decayed, missing and filled teeth (DMFT) and caries prevalence (% DMFT > 0) among the schoolchildren by school level, with reported Average Annual Percentage Change (AAPC) together with respective 95% confidence interval (CI). RESULTS: In total, 519 471 P1, 566 573 P6 and 548 138 S3 were included during the above period, and the majority were comprised of Chinese children (P1: 67.2%, P6: 68.8% and S3: 71.0%, respectively). Overall, the prevalence of caries dropped from 6.9% in 2007 to 3.5% in 2019 among P1, from 34.5% in 2009 to 20.3% in 2019 among P6 and from 41.5% in 2007 to 33.5% in 2019 among S3 schoolchildren. The mean DMFT reduced from 0.11 to 0.05 among P1, 0.72 to 0.35 among P6 and 1.05 to 0.76 among S3 schoolchildren during the same period. Caries prevalence and mean DMFT were consistently higher among girls. On average, caries prevalence decreased 5% per year in P1 (AAPC -5.0 [95% CI: -6.1, -3.9]) and P6 (AAPC -4.9 [95% CI: -5.7, -4.1]) and 2% among S3 (AAPC -2.0 [95% CI: -3.5, -0.4]) schoolchildren. Caries prevalence decreased approximately 4% ~ 5% annually among P1 and P6 schoolchildren regardless of ethnicity. The average decrease in caries prevalence was lower (about 2%) among all ethnicities at S3 school level. CONCLUSION: Dental caries in permanent dentition of Singaporean schoolchildren had decreased from 2007 to 2019. However, the decrease observed among primary school students was more than double that among secondary schoolchildren.

Federated and distributed learning applications for electronic health records and structured medical data: a scoping review.

OBJECTIVES: Federated learning (FL) has gained popularity in clinical research in recent years to facilitate privacy-preserving collaboration. Structured data, one of the most prevalent forms of clinical data, has experienced significant growth in volume concurrently, notably with the widespread adoption of electronic health records in clinical practice. This review examines FL applications on structured medical data, identifies contemporary limitations, and discusses potential innovations. MATERIALS AND METHODS: We searched 5 databases, SCOPUS, MEDLINE, Web of Science, Embase, and CINAHL, to identify articles that applied FL to structured medical data and reported results following the PRISMA guidelines. Each selected publication was evaluated from 3 primary perspectives, including data quality, modeling strategies, and FL frameworks. RESULTS: Out of the 1193 papers screened, 34 met the inclusion criteria, with each article consisting of one or more studies that used FL to handle structured clinical/medical data. Of these, 24 utilized data acquired from electronic health records, with clinical predictions and association studies being the most common clinical research tasks that FL was applied to. Only one article exclusively explored the vertical FL setting, while the remaining 33 explored the horizontal FL setting, with only 14 discussing comparisons between single-site (local) and FL (global) analysis. CONCLUSIONS: The existing FL applications on structured medical data lack sufficient evaluations of clinically meaningful benefits, particularly when compared to single-site analyses. Therefore, it is crucial for future FL applications to prioritize clinical motivations and develop designs and methodologies that can effectively support and aid clinical practice and research.

Association between obesity and periodontal disease in young adults: a population-based birth cohort.

AIM: To evaluate the association between obesity and periodontal disease and the mediating effect of oral hygiene, systemic inflammation and carbohydrate intake. MATERIAL AND METHODS: Subjects born in 1982 in Pelotas, Brazil (n = 5,914), have been followed for several times. Oral health was assessed in a representative sample of 720 individuals at 24 years. Obesity, waist circumference and number of episodes with obesity between 15 and 23 years of age were the main exposures. Mediating effect of oral hygiene, C-reactive protein level and carbohydrate consumption was also assessed. RESULTS: Obese individuals were more likely to have ≥ 2 teeth with gingival bleeding. However, after adjusting for confounders, the association was not statistically significant [OR (obese × 2 or more teeth) 1.72 (95% CI: 0.95, 3.11)] and adjustment for potential mediators decreased the OR (OR = 1.38). The risk of presenting calculus in obese subjects was 10% higher [PR 1.10 (95% CI: 1.02, 1.18)]. The number of episodes of obesity between 15 and 23 years was associated with dental calculus. Periodontal pockets were not associated with obesity. CONCLUSION: Systemic inflammation and oral hygiene may be mediating the association between obesity and gingivitis. Obesity was not associated with periodontal pockets in young adults in this cohort.

Is high body fat estimated by body mass index and waist circumference a predictor of hypertension in adults? A population-based study.

BACKGROUND: The aim of this study was to assess the predictive capacity of body fat percentage (%BF) estimated by equations using body mass index (BMI) and waist circumference (WC) to identify hypertension and estimate measures of association between high %BF and hypertension in adults. METHODS: This is a cross-sectional population-based study conducted with 1,720 adults (20-59 years) from Florianopolis, southern Brazil. The area under the ROC curve, sensitivity, specificity, predictive values, and likelihood ratios of cutoffs for %BF were calculated. The association between %BF and hypertension was analyzed using Poisson regression, estimating the unadjusted and adjusted prevalence ratios and 95% CI. RESULTS: The %BF equations showed good discriminatory power for hypertension (area under the ROC curve > 0.50). Considering the entire sample, the cutoffs for %BF with better properties for screening hypertension were identified in the equation with BMI for men (%BF = 20.4) and with WC for women (%BF = 34.1). Adults with high %BF had a higher prevalence of hypertension. CONCLUSIONS: The use of simple anthropometric measurements allowed identifying the %BF, diagnosing obesity, and screening people at risk of hypertension in order to refer them for more careful diagnostic evaluation.