Depression and associated factors among Brazilian adults: the 2019 national healthcare population-based study.

BACKGROUND: Mental disorders represent a major public health challenge worldwide, affecting 80% of people living in low- and middle-income countries. Depression, a mental disorder, is a chronic disease of long duration that causes changes in the brain, resulting from a combination of genetic, physiologic, environmental, and behavioral factors. The aim of this study was to investigate possible factors associated with depression in Brazilian adults. METHODS: A population-based, cross-sectional study was carried out using the public domain database of the 2019 National Health Survey, conducted in Brazil. Depression was considered the dependent variable, and through hierarchical analysis, predictor variables were investigated such as, at the distal level-socioeconomic variables, at the intermediate level-variables related to lifestyle behavior, health condition, and history, and at the proximal level-demographic variables. Logistic regression analysis was used to obtain the adjusted Odds Ratio and the respective 95% confidence interval to identify possible factors associated with depression. RESULTS: The study included 88,531 participant records with 10.27% diagnosed with depression. The adjusted association measurements, after selecting the independent variables in the hierarchical analysis, showed the following factors associated with depression with differing magnitudes: age, brown and white race/skin color, female sex, poor, very poor, or regular self-reported health condition, diagnosis of cardiovascular disease, work-related musculoskeletal disorder, history of smoking habit, and macroeconomic region. CONCLUSIONS: An effective strategy for preventing and managing depression in Brazilian adults must include the control of health status and lifestyle behavior factors, with actions and programs to reduce people's exposure to these factors, understanding that socioeconomic-demographic differences of each population can potentially reduce the disease burden.

Acesso e utilização dos serviços de saúde e raça/cor/etnia entre mulheres: uma metanálise / Access to and utilization of health services and race/color/ethnicity among women: a meta-analysis / Acceso y utilización de los servicios de salud y raza/color/etnia entre las mujeres: un metaanálisis

Diversas barreiras podem comprometer o acesso aos serviços de saúde no Brasil, especialmente entre as mulheres negras, evidenciando a urgência em discutir esse tema à luz das iniquidades raciais e de gênero. O objetivo deste estudo foi realizar uma revisão sistemática com metanálise para avaliar as evidências científicas da associação entre raça/cor de pele/etnia e acesso e utilização dos serviços de saúde entre mulheres. A busca dos estudos foi realizada em cinco bases eletrônicas, incluindo literatura cinzenta, até março de 2022 e, após a extração de dados, foi realizada a avaliação da qualidade dos artigos. A metanálise estimou a medida de associação global (odds ratio) e seu intervalo de confiança de 95%. Também foi avaliado o indicador de Higgins e Thompson (I2) para classificação da heterogeneidade estatística dos dados. Foram identificados 428 registros, mas apenas três estudos atenderam aos critérios de elegibilidade. A raça/cor de pele/etnia negra esteve associada a desfechos negativos relacionados ao acesso/utilização dos serviços de saúde no Brasil (OR = 1,49; IC95%: 1,26-1,76; I2 = 24,01%). Neste estudo, verificou-se que existem iniquidades raciais no acesso/utilização dos serviços de saúde entre mulheres. No entanto, destaca-se a necessidade de mais estudos rigorosos para elucidar a influência da raça/cor/etnia e de elaboração de políticas públicas.

Several barriers can compromise access to health services in Brazil, especially among black women, highlighting the urgency of discussing this topic in the light of racial and gender inequalities. This study aimed to carry out a systematic review with meta-analysis to assess the scientific evidence on the association between race/skin color/ethnicity and access and use of health services among women. The search for studies was carried out in five electronic databases, including the gray literature, until March 2022, and, after data extraction, the quality of the articles was evaluated. The meta-analysis estimated the global association measure (odds ratio) and its 95% confidence interval. The Higgins and Thompson indicator (I2) was also evaluated to classify the statistical heterogeneity of the data. A total of 428 records were identified, but only three studies met the eligibility criteria. Black race/skin color/ethnicity was associated with negative outcomes related to access/use of health services in Brazil (OR = 1.49; 95%CI: 1.26-1.76; I2 = 24.01%). This study showed the presence of racial inequalities in the access/use of health services among women. However, it highlights the need for more rigorous studies to elucidate the influence of race/color/ethnicity and the elaboration of public policies.

Diversos obstáculos pueden dificultar el acceso a los servicios de salud en Brasil, principalmente para las mujeres negras, lo que muestra la necesidad de discutir el tema de las inequidades racial y de género. Este estudio tiene por objetivo realizar una revisión sistemática con metaanálisis para evaluar la evidencia científica de la asociación entre raza/color/etnia y el acceso y uso de los servicios de salud por las mujeres. Se realizó una búsqueda en cinco bases de datos electrónicas, incluida la literatura gris, en el periodo hasta marzo de 2022; y tras evaluados los datos, se llevó a cabo una evaluación de la calidad de los artículos. El metaanálisis estimó la asociación global (Odds Ratio) y su intervalo de confianza del 95%. También se evaluó el indicador de Higgins y Thompson (I²) para clasificar la heterogeneidad estadística de los datos. Se identificaron 428 registros, de los cuales solo tres estudios cumplieron los criterios de elegibilidad. La raza/color de piel/etnia negra se asoció con desenlaces negativos relacionados al acceso/uso de los servicios de salud en Brasil (OR = 1,49; IC 95%: 1,26-1,76; I² = 24,01%). Estos hallazgos destacan las inequidades raciales en el acceso/uso de los servicios de salud entre mujeres brasileñas. Sin embargo, se necesitan investigaciones más rigurosas sobre la influencia de la raza/color/etnia y la implementación de políticas públicas efectivas.

Prevalência de anemia em gestantes das Américas: uma revisão rápida com metanálise / Prevalence of anemia in pregnant women in the Americas: a rapid review with meta-analysis

A anemia em gestantes é um relevante problema de ampla expansão geográfica, típica de grandes centros urbanos que atinge diversos países, como os da América. Estimar a prevalência nas Américas de anemia materna e anemia ferropriva em gestantes.Revisão rápida com busca no Medline, via PubMed, Scopus, Web of Science, SciELO, Lilacs e Open Grey. Incluíram-se estudos do tipo transversal, que estimassem a prevalência de anemia materna e anemia ferropriva. Foram realizadas metanálises com efeito randômico. 5.148 artigos foram encontrados, apenas 39 atenderam aos critérios de elegibilidade. As metanálises apresentaram prevalência de 30% (IC95%: 28%; 32%. I2: 99,4%) para anemia materna e frequência de 32% (IC95%: 25%; 40%. I2: 96,6%) para anemia ferropriva.Anemia materna é um evento frequente na população das Américas, com 30% para anemia materna e 32% para anemia ferropriva, destacando a necessidade de medidas de prevenção e promoção à saúde mais eficazes.

Anemia in pregnant women is a relevant problem of wide geographical expansion, typical of large urban centers and that affects several countries, such as America. To estimate the prevalence of maternal anemia and iron deficiency anemia in pregnant women in the Americas.Rapid review with search in Medline, Pubmed, Scopus, Web of Science, SciELO, Lilacs and Open Grey databases. Cross-sectional studies that estimated the prevalence of maternal anemia and iron deficiency anemia were included. Random-effects meta-analyses were conducted. 5148 articles were found, only 30 met the eligibility criteria. Meta-analyses showed a prevalence of 30% (95%CI: 28%; 32%. I2: 99.4%) for maternal anemia and a frequency of 32% (95%CI: 25%; 40%. I2: 96.6%) for iron deficiency anemia. Maternal anemia is a frequent event in the population of the Americas, with prevalence of 30% for maternal anemia and 32% for iron deficiency anemia, highlighting the need for more effective prevention and health promotion measures.

Covid-19 e fatores associados em pessoas com 50 ou mais / Covid-19 and associated factors in people aged 50 years or more

Introdução: a pandemia de COVID-19 se apresentou como uma intensa crise sanitária no mundo. Foram considerados os principais fatores de risco: idade avançada, ser do sexo masculino, presença de doenças crônicas, obesidade, fator racial/étnico, bem como piores condições socioeconômicas. Objetivo: o objetivo foi investigar a associação entre a COVID-19 e faixa etária, sexo, raça/cor, condições de saúde e sintomas. Metodologia: o estudo do tipo transversal, empregou dados dos prontuários e fichas de notificação compulsória de COVID-19 dos usuários assistidos na Unidade de Saúde. Para a análise dos dados, utilizou-se o pacote estatístico STATA® da StataCorp LLC, versão 14.2. A análise bivariada, segundo a presença de COVID-19, foi realizada com o emprego do teste qui-quadrado de Pearson ou teste exato de Fisher. A análise múltipla adotada foi a modelagem de regressão logística não-condicional. Resultados: a amostra incluiu 239 indivíduos e 38% apresentaram diagnóstico positivo para COVID-19. As alterações gustativas e olfativas foram sintomas mais frequentes entre indivíduos com resultado positivo para COVID-19, quando comparados àqueles sem a doença. O modelo de regressão logística, ajustado por sintomas apresentados e raça/cor, apresentou associação estatisticamente significante entre ser idoso e ter diagnóstico positivo para COVID-19 (OR: 2,23; IC95%: 1,01 ­ 4,98). Conclusão: as alterações gustativas e a faixa etária foram as características associadas à COVID-19. O estudo valida a necessidade de elevação da qualidade dos registros gerados na Atenção Primária à Saúde, reforçando a necessidade de espaços com profissionais de saúde para que seja desenvolvida uma política de informação em saúde que fortaleça o Sistema Único de Saúde.

Introduction: the COVID-19 pandemic presented itself as an intense health crisis worldwide. The main risk factors considered were advanced age, being male, presence of chronic diseases, obesity, racial/ethnic factor as well as worse socioeconomic conditions. Objective: the aim was to investigate the association between COVID-19 and age group, gender, race/color, health conditions, and symptoms. Methodology: the cross-sectional study used data from medical records and mandatory reporting forms for individuals with COVID-19 seen at the Health Unit. For data analysis, the STATA® statistical package from StataCorp LLC, version 14.2, was used. Bivariate analysis, according to the presence of COVID-19, was performed using Pearson's chi-square test or Fisher's exact test. The multiple analysis adopted was the unconditional logistic regression modeling. Results: the sample included 239 individuals, and 38% had a positive diagnosis for COVID-19. Taste and smell changes were the most frequent symptoms among individuals with a positive result for COVID-19 when compared to those without the disease. The logistic regression model adjusted for presenting symptoms and race/color showed a statistically significant association between being elderly and having a positive diagnosis for COVID-19 (OR: 2.23; 95% CI: 1.01-4.98). Conclusion: taste changes and age group were the characteristics associated with COVID-19. The study validates the need to improve the quality of records generated in Primary Health Care, reinforcing the need for spaces with health professionals to develop a health information policy that strengthens the Unified Health System

Periodontite materna e baixo peso ao nascer: revisão sistemática e metanálise / Maternal periodontitis and low birth weight: systematic review and meta-analysis

Resumo Evidências recentes apontam para a influência de processos inflamatórios periodontais na ocorrência de baixo peso ao nascer. Embora muitos estudos empregaram métodos robustos de investigação, ainda não existe consenso sobre o tópico. Analisar sistematicamente a relação entre a periodontite materna e o baixo peso ao nascer. A busca por estudos foi realizada até abril de 2019. Os delineamentos de estudos incluídos foram coorte e caso-controle que estimaram a associação entre a periodontite e o baixo peso ao nascer, sem limite quanto ao idioma ou data da publicação. Análise de heterogeneidade dos estudos, análises de subgrupo e metanálises com modelo de efeitos randômicos foram realizadas. Foram estimadas as medidas de associação sumária por meio da Odds Ratio bruta e ajustada, com respectivos intervalos de confiança a 95%. A inspeção visual de gráficos foi empregada para avaliar viés de publicação. Um total de 21 artigos foram identificados e todos foram selecionados para a metanálise. O modelo final aponta que a periodontite em gestantes se associou ao baixo peso ao nascer (ORbruta=2,13; IC95%=1,60-2,83; I2=80,0% e ORajustada=2,64; IC95%=2,04-3,42; I2=17,4%). Gestantes com periodontite podem ter mais que o dobro de probabilidade de terem filhos com baixo peso ao nascer.

Abstract Recent evidence points to the influence of periodontal inflammatory processes on the occurrence of low birth weight. Although many studies employed robust investigation methods, there is still no general agreement on the relationship between maternal periodontitis and low birth weight. The search for studies was conducted until April 2019. The studies included cohort and case-control studies that estimated the association between periodontitis and low birth weight, with no restriction on language or date of publication. Analysis of the heterogeneity of studies, subgroup analyses and meta-analyses with a random effects model were performed. Summary association measurements were estimated using the crude and adjusted Odds Ratio, with respective 95% confidence intervals. Visual inspection of graphs was used to assess publication bias. A total of 21 articles were identified, all of which were selected for the meta-analysis. The final model indicates that periodontitis in pregnant women was associated with low birth weight (ORgross=2.13; CI95%=1.60-2.83; I2=80.0% and ORadjusted=2.64; CI95%=2.04-3.42; I2=17.4%). Pregnant women with periodontitis may be more than twice as likely to have low birth weight babies.

What is the future of Periodontal Medicine?

In the last five decades, considerable progress has been made towards understanding the etiology and pathogenesis of periodontal diseases and their interactions with the host. The impact of an individual periodontal condition on systemic homeostasis became more evident because of this knowledge and prompted advances in studies that associate periodontitis with systemic diseases and conditions. The term Periodontal Medicine describes how periodontal infection/inflammation can affect extraoral health. This review presents the current scientific evidence on the most investigated associations between periodontitis and systemic diseases and conditions, such as cardiovascular diseases, diabetes, preterm birth and low birth weight, and pneumonia. Additionally, other associations between periodontitis and chronic inflammatory bowel disease, colorectal cancer, and Alzheimer's disease that were recently published and are still poorly studied were described. Thus, the aim of this review was to answer the following question: What is the future of Periodontal Medicine? Epidemiological evidence and the evidence of biological plausibility between periodontitis and general health reinforce the rationale that the study of Periodontal Medicine should continue to advance, along with improvements in the epidemiological method, highlighting the statistical power of the studies, the method for data analysis, the case definition of periodontitis, and the type of periodontal therapy to be applied in intervention studies.

An accuracy study of the clinical diagnosis of periodontitis in pregnant women.

BACKGROUND: There exists a diverse range of criteria used in epidemiological studies for the diagnosis of periodontitis. The results from these studies should be evaluated with consideration to the diagnostic criteria used, and this may account for differences between studies especially in some population groups such as pregnant females. The objective is to evaluate the diagnostic criteria used in a variety of epidemiologic studies of periodontitis in pregnant females. METHODS: An accuracy study with cross-sectional design was performed out from a database of 671 pregnant females, using six different sets of criteria for the diagnosis of periodontitis. Women were classified for periodontitis, as follows: Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP, 2012 criterion), the gold standard, Gomes-Filho et al.(2018) criterion, Albandar et al.(2007) criterion, Bassani et al.(2007) criterion, López et al.(2002) criterion, and Nesse et al.(2008) criterion. For comparison amongst the gold standard and the other criteria, sensitivity, specificity, predictive values, and likelihood ratio were determined. RESULTS: The frequency of periodontitis ranged from 25.0% to 90.2%. The Bassani et al. (2007) criterion was found to be more sensitive among the studies, and thus more suitable for diagnostic screening studies. Gomes-Filho et al.(2018), Albandar et al. (2007), López et al. (2002), and Nesse et al. (2008) criteria were considered more specific, which makes them more useful for studies of periodontitis with the aim of using diagnosis for confirmation of disease. CONCLUSIONS: A variation in the occurrence of periodontitis was observed. The criterion must be chosen according to the research aims and population characteristics.

Oropharyngeal colostrum immunotherapy and nutrition in preterm newborns: meta-analysis

ABSTRACT OBJECTIVE To investigated the effect of oropharyngeal colostrum immunotherapy in reducing the time required for very low birth weight preterm newborns (VLBW-PTNB: < 1,500g and < 37 weeks) to achieve full enteral nutrition. METHODS Literature search was conducted using four databases, including gray literature, with additional manual search of the references of selected articles. Eligibility criteria consisted of randomized clinical trials, without restriction regarding the date or language of the publication. Two independent reviewers performed the article selection and data extraction. The random-effects meta-analysis used a non-standard technique to assess the mean difference in days to achieve full enteral nutrition, carried out by the Stata 15 statistic program. RESULTS The systematic review comprised 10 studies, and five were selected for meta-analysis, with a population of 764 VLBW-PTNB and gestational age of birth between 25 and 32 weeks. The studies were conducted between 2011 and 2018 in North America, Asia and Africa, with only one conducted in South America. Altogether, they reported the number of days it took 708 VLBW-PTNB to achieve full enteral nutrition, with newborns treated with immunotherapy showing a shorter time in only three studies. Meta-analysis showed a mean difference of -4.26 days, (95% CI -7.44; -1.08d), with high heterogeneity (I2 = 83.1%). CONCLUSION The use of oropharyngeal colostrum immunotherapy can reduce the time for VLBW-PTNB to achieve full nutrition when compared to those who used a placebo or received routine care.

What is the future of Periodontal Medicine?

Abstract In the last five decades, considerable progress has been made towards understanding the etiology and pathogenesis of periodontal diseases and their interactions with the host. The impact of an individual periodontal condition on systemic homeostasis became more evident because of this knowledge and prompted advances in studies that associate periodontitis with systemic diseases and conditions. The term Periodontal Medicine describes how periodontal infection/inflammation can affect extraoral health. This review presents the current scientific evidence on the most investigated associations between periodontitis and systemic diseases and conditions, such as cardiovascular diseases, diabetes, preterm birth and low birth weight, and pneumonia. Additionally, other associations between periodontitis and chronic inflammatory bowel disease, colorectal cancer, and Alzheimer's disease that were recently published and are still poorly studied were described. Thus, the aim of this review was to answer the following question: What is the future of Periodontal Medicine? Epidemiological evidence and the evidence of biological plausibility between periodontitis and general health reinforce the rationale that the study of Periodontal Medicine should continue to advance, along with improvements in the epidemiological method, highlighting the statistical power of the studies, the method for data analysis, the case definition of periodontitis, and the type of periodontal therapy to be applied in intervention studies.

Microbiological findings of the maternal periodontitis associated to low birthweight / Achados microbiológicos da periodontite materna associados ao baixo peso ao nascer

ABSTRACT Objective To determine the association between the presence of periodontal pathogens and low birthweight. Methods This observational and case-control study consisted of mothers of infants weighing <2,500g (Group A), and mothers of newborns weighing ≥2,500g (Group B), born at Hospital da Mulher in Feira de Santana (BA), Brazil. A semi-structured questionnaire covering demographic data, gestational history and aspects related to general and oral health was employed postpartum. Following a complete periodontal examination, biofilm samples were collected at six sites in the mouth. The participants were further categorized in terms of presence or absence of periodontitis. Differences between the groups were determined using Pearson's χ 2 test, odds ratio, and confidence intervals were obtained using the Mantel-Haenszel test. Results Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia and Prevotella intermedia were detected by polymerase chain reaction. A total of 303 postpartum women were evaluated, 224 (73.9%) in Group B. Statistically significant differences between the groups were found for age, body mass index and history of previous low birthweight babies. Group A had a higher frequency of periodontitis (33.34%) than Group B (16.22%). P. gingivalis and P. intermedia were detected more frequently among women with periodontitis (74.19% and 88.70%, respectively). Conclusion In this population, there was no association between the presence of maternal periodontal pathogens and the occurrence of low birthweight infants.

RESUMO Objetivo Determinar a associação entre a presença de patógenos periodontais e o baixo peso ao nascer. Métodos Trata-se de estudo observacional e caso controle. Participaram mães de bebês com peso <2.500g (Grupo A) e de recém-nascidos com peso ≥2.500g (Grupo B) nascidos no Hospital da Mulher, em Feira de Santana, (BA). Dados demográficos, história gestacional e aspectos relacionados à saúde geral e bucal foram obtidos por meio de questionário semiestruturado, aplicado no período pós-parto. Após exame periodontal completo, as amostras de biofilme foram coletadas em seis locais na boca. As participantes foram também categorizadas quanto à presença ou ausência de periodontite. As diferenças entre os grupos foram obtidas pelo teste do χ 2 de Pearson, odds ratio e os intervalos de confiança pelo teste de Mantel-Haenszel. Resultados Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia e Prevotella intermedia foram detectados por reação em cadeia de polimerase. Avaliaram-se 303 mulheres pós-parto, sendo 224 (73,9%) do Grupo B. Diferenças estatisticamente significativas entre os grupos foram observadas quanto à idade, ao índice de massa corporal e a história de partos prévios com bebês de baixo peso ao nascer. O Grupo A apresentou maior frequência de periodontite (33,34%) do que o Grupo B (16,22%). P. gingivalis e P. intermedia foram detectados com maior frequência em mulheres com periodontite (74,19% e 88,70%, respectivamente). Conclusão Nessa população, não houve associação entre a presença de patógenos periodontais maternos e a ocorrência de bebês com baixo peso ao nascer.

Factors associated with dental caries, periodontitis and intra-oral lesions in individuals with HIV / AIDS.

This study aimed to investigate the factors associated with oral diseases in individuals with HIV/AIDS. A cross sectional study was carried out which included 312 individuals registered in the Specialized Care Services for HIV/AIDS in three municipalities of the State of Bahia: Feira de Santana, Santo Antonio de Jesus and Juazeiro, Brazil. Socioeconomic-demographic characteristics related to life style and to dental caries, periodontitis and intra-oral mucosal lesions were investigated in patients with HIV/AIDS infection. Prevalence Ratio with 95% Confidence Interval and significance level of 5% were employed for the statistical analysis. The majority of the individuals evaluated were male with a mean age (± standard deviation) of 41.5 ± 11.3 years, and a mean time of HIV infection diagnosis (± standard deviation) of 5.2 ± 4.4 years. The presence of dental caries was observed in 78.7% of the sample, periodontitis in 25.4% and 36.2% showed intra-oral lesions. Oral health status showed a statistically significant association with the following variables: gender, age, schooling level, current occupation, family income, past and current smoking, antiretroviral use time, latest viral burden dosage, latest CD4-positive T lymphocyte count, use of complete/partial dental prosthesis, need for dental prosthesis, and use of dental floss. With the exception of those factors directly related to HIV/AIDS i.e., antiretroviral use time, latest viral burden dosage and latest CD4-positive T lymphocyte count, the factors associated with oral diseases in this population were the same as those associated with oral diseases in the non-HIV/AIDS population.

Condição bucal de gestantes e puérperas no município de Feira de Santana, em três diferentes períodos entre os anos de 2005 e 2015 / Condición bucal de gestantes y puérperas en el municipio de Feira de Santana, en tres diferentes momentos entre los años 2005 y 2015 / Oral health status of pregnant and puerperal women in the municipality of Feira de Santana, at three different times between 2005 and 2015

Objetivo: avaliar a condição bucal de gestantes e puérperas, usuárias de serviços públicos de saúde de Feira de Santana, BA, Brasil, em três momentos distintos do período 2005-2015. Métodos: estudo sobre características socioeconômico-demográficas, condição e cuidado com a saúde, estilo de vida e condição bucal de 1.245 participantes, obtidas de banco de dados de três investigações - I Estudo de intervenção (2005-2007), II Estudo caso-controle (2010-2011), III Estudo caso-controle (2012-2015). Resultados: comparando-se os três períodos, as frequências de gengivite (24,41% versus 8,90% versus 5,77%; p<0,01) e periodontite (44,64% vs 9,16% vs 11,55%; p<0,01) diminuíram; relativamente à condição dentária, as piores situações no número de dentes presentes, hígidos, extraídos e índice CPO-D observaram-se no período III, comparativamente ao período II. Conclusão: a condição periodontal melhorou nos anos estudados, coincidentemente com o processo de implantação de políticas de assistência pré-natal, saúde da mulher e saúde bucal, e de redistribuição de renda no município.

Objetivo: evaluar la condición bucal de gestantes y puérperas, usuarias de servicios públicos de salud de la ciudad de Feira de Santana/BA, en tres momentos distintos comprendidos entre 2005 y 2015. Metodos: se trata de un estudio con información sobre características socioeconómicas-demográficas, de condición y cuidado com la salud, de estilo de vida y de condición bucal de 1245 participantes obtenidas en un banco de datos de tres investigaciones previas: I (2005-2007), II (2010-2011), III (2012-2015). Resultados: tanto la frecuencia de gingivitis (24,41% versus 8,90% versus 5,77%; p<0,01) y periodontitis (44,64% vs 9,16% vs 11,55%; p<0,01) disminuyó; em relación a la condición dental, las peores situaciones en cuanto al número de dientes presentes, hígidos, extraídos y el índice CPO-D se observaron en el período III, en comparación con las del período II. Conclusión: se há mejorado la condición periodontal a lo largo de los años, período que coincide com el proceso de implantación de políticas de salud de la mujer, salud bucal, así como redistribución de ingresos en el municipio.

Objective: to evaluate the oral health condition of pregnant/postpartum women attending public services in the city of Feira de Santana, BA, Brazil, at three different times between 2005 and 2015. Methods: this is a study socioeconomic and demographic characteristics, health condition and health care, lifestyle and oral health status of 1,245 participants obtained from a database of three previous investigations: I Intervention Study (2005-2007); II Case-Control Study (2010-2011); III Case-Control Study (2012-2015). Results: comparing the three periods, the frequency of gingivitis (24.41% versus 8.90% versus 5.77%; p<0.01) and periodontitis (44.64% vs 9.16% vs 11.55%; p<0.01) was found to decrease; the worst dental conditions regarding the number of teeth present, healthy and extracted and the DMFT index were found in period III compared to period II. Conclusion: an improvement was seen in the participants' periodontal condition over time, which coincides with the implementation of policies pertaining to women's health, oral health and income redistribution in this city.

Hipertensão materna e baixo peso ao nascer: estudo caso-controle em dois municípios do semiárido nordestino / Maternal hypertension and low birth weight: case-control study of two brazilian northeastern semiarid cities / Hipertensión materna y bajo peso al nascer: estudio caso-control en dos ciudades del nordeste de Brasil

A hipertensão arterial materna pode ocasionar insuficiência placentária, interferir na nutrição fetal e, ainda, resultar no nascimento de um bebê com baixo peso. O objetivo deste estudo foi investigar a relação entre hipertensão materna e baixo peso ao nascer em puérperas usuárias do Sistema Único de Saúde, em dois municípios da região semiárida do Nordeste brasileiro. Trata-se de estudo do tipo caso-controle. Foram investigadas 1.567 puérperas, sendo 388 casos e 1.179 controles, utilizando- -se um questionário estruturado e o exame clínico para coleta de dados de saúde bucal. A análise de associação foi realizada pela estimativa da medida de associação Odds Ratio, considerando-se um intervalo de confiança de 95%. O efeito da associação principal foi estimado adotando-se um modelo de regressão logística não condicional. Os resultados mostraram associação entre hipertensão materna e baixo peso ao nascer, após ajuste para índice de massa corporal pré-gestacional, escolaridade materna, idade materna e número de consultas pré-natal (OR 2,51; IC 1,61-3,91; p 0,000). Concluiu-se que há relação entre hipertensão materna e baixo peso ao nascer em gestantes da região semiárida, o que reforça a necessidade de ações de prevenção e controle, visando a melhora dos indicadores de saúde materno-infantil.

Maternal hypertension may cause placental insufficiency, interfere to fetal nutrition and, yet, cause low birth weight to the baby. The objective of this study was to investigate the relation between maternal hypertension and low birth weight to puerperal women assisted by the Unified Health System from two municipalities of semi-arid Brazilian Northeast. It was a case-control study. 1567 puerperal women were investigated, from which 388 cases and 1179 controls, using a structured questionnaire and clinical exam to collect oral health data. Odds Ratio association measure was used to association analysis, considering a 95% confidence interval. The main effect of association was estimated by the adoption of a unconditional logistic regression model. Results present association between maternal hypertension and low birth weight, after the adjust to pregestational body mass index, maternal formation, maternal age and the amount of prenatal consultations (OR 2,51; IC 1,61-3,91; p 0,000). In conclusion, there is a relation between maternal hypertension and low birth weight to semi-arid pregnant women, which reinforces the need of preventive actions and control, towards the improvement of maternal-infant health indicators.

Hipertensión materna puede ocasionar insuficiencia placentaria, interferir en la nutrición fetal y aún resultar en el nacimiento de un bebé con bajo peso. El objetivo de este estudio fue investigar la relación entre hipertensión materna y bajo peso al nacer en mujeres que han dado la luz que utilizan el Sistema Único de Salud, en dos municipalidades del semiárido del nordeste brasileño. Este es un estudio caso-control. Fueron investigadas 1567 mujeres que han dado a luz, siendo 388 casos y 1179 controles, utilizando un cuestionario estructurado y el examen clínico para la recolección de datos de salud bucal. El análisis de asociación fue realizado por la estimativa de la medida de asociación Odds Ratio, considerando el intervalo de confianza de 95%l El efecto de la asociación principal fue estimado con la adopción de un modelo de regresión logística no condicional. Los resultados mostraron la asociación entre hipertensión materna y baso peso al nacer. Después del ajuste para el el ínice del masa corporal pre-gestacional, escolaridad materna, edad materna, y el número de consultas prenatal (OR 2,51; IC 1,61-3,91; p 0,000). Concluyese que hay relación entre la hipertensión meterna y el baso peso al necer en embarazadas de la región semiárida, lo que refuerza la necesidad de las acciones de prevención y control, para la mejora de los indicadores de salud materno-infantil.

Effect of maternal periodontitis and low birth weight--a case control study.

INTRODUCTION: Since the 1990s, evidence has been raised that there is an association between maternal periodontal disease and undesirable gestational events, for example low birth weight; this issue is controversial. OBJECTIVE: To evaluate whether there is an association between maternal periodontitis and low birth weight (LBW). METHODS: A case-control study was carried out on 951 mothers that had been cared for by the Brazilian Unified Health System in Petrolina-PE and Juazeiro-BA, Brazil. The case group (n = 269) consisted of mothers of newborns with birth weight <2500 g and a control group (n = 682) of mothers of newborns with birth weight ≥2500 g. An interview was realized, using a questionnaire as well as a full mouth examination to diagnose the periodontal condition. Women who had at least four teeth with probing depth ≥4 mm and clinical attachment loss ≥3 mm, with bleeding on probing at the same site, were diagnosed with periodontitis. The birth weight was obtained through the hospital book record. The main association was evaluated using the multivariate regression model, considering confounders. RESULTS: The frequency of periodontitis was 16.4% (case group) and 17.4% (control group). Periodontitis did not show an association with LBW (ORcrude = 0.92; 95% CI = 0.63-1.35), even after adjustment for the following confounders: maternal age, pre-gestational body mass index, number of pre-natal consultations, number of pregnancies, maternal schooling level, smoking habit during pregnancy and hypertension (ORadjusted = 1.00; 95% CI = 0.61-1.68). CONCLUSION: The findings of this study showed no association between maternal periodontal disease and low birth weight, even after appropriate adjustments for confounding factors.

Satisfação dos usuários adultos com a atenção em saúde bucal na estratégia de saúde da família / Adult users’ satisfaction in relation to attention to oral health in the family health strategy

ResumoO objetivo deste estudo foi avaliar os níveis de satisfação dos usuários adultos do município de Lauro de Freitas, no Estado da Bahia, em relação aos serviços de saúde bucal oferecidos pela Estratégia de Saúde da Família (ESF). É um estudo descritivo, quantitativo, com a aplicação de dois instrumentos validados: o Questionário de Avaliação da Satisfação dos Usuários com os Serviços Públicos de Saúde Bucal (QASSaB) e parte do Questionário do Projeto SBBrasil 2010. A amostra foi de 418, com erro amostral de 5%. Foi feita a distribuição de frequência das variáveis quantitativas e de medidas de tendência central e de dispersão, por meio do programa estatístico SPSS. Os resultados mostraram que a maior parte dos entrevistados era do sexo feminino (78,2%), da raça/cor preta (47,0%) e solteira (46,1%). Em relação à morbidade bucal referida, a maioria reportou a necessidade de tratamento odontológico (91,4%). Dor de dente nos últimos seis meses foi relatada por 52,5%. Em relação às dimensões ambiente físico, aceitabilidade, eficiência, equidade, relações humanas e qualidade técnico-científica dos equipamentos, observou-se um bom grau de satisfação. Concluiu-se que, apesar de ainda persistirem muitos desafios para a melhoria da qualidade da atenção em saúde bucal na ESF, a satisfação dos usuários adultos foi alta.

The objective of this study was to evaluate the levels of satisfaction of the adult users of the municipality of Lauro de Freitas, state of Bahia, Brazil in relation to the oral-health services offered by the Family Health Strategy - ESF. This quantitative, descriptive study applied two validation instruments, the User-Satisfaction-Evaluation Questionnaire in conjunction with the Public Oral-Health Service and one part of the questionnaire from theSB Brasil2010Project. The sample size was 418 individuals, with a sampling-error rate of 5%. The quantitative variables and measurement of central tendencies and dispersion were distributed using the SPSS statistics program. The results demonstrated that most of those interviewed were women (78.2%), African descent (47.0%), and single (46.1%). In terms of the aforementioned oral morbidity, the majority reported the need for odontological treatment (91.4%). 52.5% reported toothache in the previous six months. A high degree of satisfaction was observed in relation to the dimensions of the physical environment, acceptability, efficiency, equality, human relations, and the technical-scientific quality of the equipment. In conclusion, despite the many challenges that persist to improving the quality of the oral-health services of the ESF, the level of satisfaction of adult users was high.

Perfil dos portadores de VHB/VHC usuários do serviço de assistência especializada em DST/HIV/AIDS de Juazeiro/BA / Profile of patients with HBV / HCV users of the specialized care service in STD / HIV/AIDS Juazeiro/BA / Perfil de los portadores de VHB/VHC usuarios del servicio de asistencia especializada em DST/VIH/ SIDA de Juazeiro/BA

Hepatites virais apresentam-se como grave problema de saúde pública e assumem grande importância devido ao número de indivíduos atingidos e à possibilidade de complicações. O objetivo do estudo foi caracterizar o perfil dos portadores VHB e VHC, usuários do Serviço de Assistência Especializada em DST/HIV/AIDS de Juazeiro (BA). Trata-se de estudo transversal exploratório. Dados de 69 usuários foram coletados em 2010 por meio de questionário aplicado aos participantes e de pesquisa nos prontuários. Para análise da associação entre o tipo de infecção e algumas das variáveis categóricas estudadas, aplicou-se o teste Qui-Quadrado, adotando-se um nível de significância de 5 por cento. A idade média dos participantes foi 52,7 anos com predomínio do sexo masculino, de casados/união estável e com cinco ou mais anos de estudo. A prática de atividade física foi pouco frequente (39,1 por cento); o uso de tabaco e álcool no presente mostrou decréscimo em relação ao consumo passado; a frequência de escovação dentária foi alta (68,3 por cento), ao contrário do uso de fio dental (26,1 por cento). Observou-se associação estatisticamente significativa com sexo, idade, presença de outras doenças e uso de fio dental. Para as variáveis anos de estudo e tabagismo não foram observadas diferenças entre portadores de VHB e VHC, a despeito de terem se mostrado limítrofes. Estes resultados sugerem um estilo de vida menos saudável entre os portadores de VHC. Concluiu-se que ocorre predomínio da infecção no sexo masculino, entre os mais velhos e com maior escolaridade, havendo mudança de comportamento quanto ao uso do tabaco e álcool.

Viral hepatitis is a severe public health problem and it is of great importance due to the number of individuals affected and the possibility of complications. The aim of this exploratory cross-sectional study was to characterize the patient profile of HBV and HCV, users of the Specialized Care Service in STD / HIV / AIDS of Juazeiro, Bahia, Brazil. Data were collected from 69 users in 2010, through a questionnaire that the participants answered as well as research of the medical records. To analyze the association between the type of infection and some of the categorical variables studied, the Chi-Square test was applied, adopting a significance level of 5 percent. The average age of participants was 52.7 years (+ 9.5), predominantly male, married / stable union and five or more years of education. Physical activity practice was uncommon (39.1 percent), although the use of tobacco and alcohol showed a decrease compared to past consumption, the frequency of tooth brushing was high (68.3 percent), unlike the use of dental floss (26.1 percent). Statistically significant association was observed between the type of infection and the variables gender, age, presence of other diseases and use of dental floss. For the variables years of schooling and smoking there were no difference between carriers of HBV and HCV, in spite of them been on the borderline. However, these results seem to suggest a less healthy lifestyle among patients with HCV. It was concluded that there is a predominance of infection in males, between the older and more educated, having changing behavior regarding the use of tobacco and alcohol.

Las hepatitis virales son un importante problema de salud pública y tienen gran importancia debido al número de personas afectadas y a la posibilidad de complicaciones. El objetivo de este estudio, de tipo transversal exploratorio, fue caracterizar el perfil de los portadores de VHB y VHC, usuarios del Servicio de Asistencia Especializada en DST/VIH/SIDA de Juazeiro (BA). En 2010, fueron recolectados los datos de de 69 usuarios a través de un cuestionario aplicado a los participantes, además de la investigación en los históricos médicos. Para el análisis de asociación entre el tipo de infección y algunas variables categóricas estudiadas, se aplicó el test Qui-Cuadrado, con nivel de significación de 5 por ciento. El promedio de edad de los participantes fue de 52,7 años, con predominio del sexo masculino, casado/unión estable y con cinco años ó más de estudio. La práctica de actividad física fue poco frecuente (39,1 por ciento), el uso del tabaco y alcohol en el presente reveló decrécimo con relación al consumo pasado, la frecuencia del uso de cepillo dental fue alta (68,3 por ciento), al contrario del uso de hilo dental (26,1 por ciento). Se observó asociación estadísticamente significativa entre sexo, edad, presencia de otras enfermedades y la utilización de hilo dental. Para las variables años de estudio y tabaquismo, no fueron observadas diferencias entre portadores de VHB y VHC, a pesar de haberse mostrado limítrofes. Estos resultados sugieren un estilo de vida menos saludable entre los portadores de VHC. Se concluye que hay un predominio de la infección en los hombres, entre los de mayor edad y con más escolaridad, habiendo cambio de comportamiento cuanto al uso de tabaco y alcohol.

Influence of periodontal therapy on C-reactive protein level: a systematic review and meta-analysis

The influence of oral infections, especially periodontal disease, on systemic diseases has been extensively discussed in the literature. Because periodontal disease is a persistent infection, it promotes an inflammatory response. C-reactive protein is a marker for inflammatory reactions that is frequently studied, since elevated levels of this protein are related to coronary events. OBJECTIVE: The aim of this study was to investigate the effect of periodontal therapy on reducing the serum levels of C-reactive protein, by means of a systematic review of the literature and meta-analysis. MATERIAL AND METHODS: A systematic review of the English-language literature was conducted in the PUBMED-MEDLINE database, using the key words "periodontal disease", "C-reactive protein", "periodontal therapy" and "periodontal treatment", in accordance with the terms for Medical Subject Headings (MeSH), to evaluate the effect of periodontal therapy on C-reactive protein levels. A qualitative analysis of studies of randomized clinical trial design was performed using CONSORT, with subsequent meta-analysis. RESULTS: The literature search initially retrieved 46 potentially relevant studies available in the databases. From these, in accordance with the inclusion criteria, only 11 were selected, of which only 4 fulfilled the criteria of randomized clinical trial design. According to CONSORT, the studies evaluated generally presented good quality with regard to the criteria analyzed. Through meta-analysis, the reduction in mean levels of C-reactive protein (-0.231; p=0.000) after introducing periodontal treatment was estimated. The result was statistically significant, without evidence of heterogeneity between the studies (p=0.311). CONCLUSIONS: The findings indicated that non-surgical periodontal treatment had a positive effect with regard to reduction of the serum levels of C-reactive protein.

Fatores associados à pneumonia nosocomial em indivíduos hospitalizados / Factors associated with nosocomial pneumonia in hospitalized individuals

OBJETIVO: Identificar os fatores associados à pneumonia nosocomial em hospital público de Feira de Santana, Bahia. MÉTODOS: Este estudo caso-controle foi realizado em 211 indivíduos adultos (46 casos e 165 controles), com idade média de 41 anos, atendidos na Clínica Médica, Clínica Cirúrgica ou na Unidade de Terapia Intensiva Adulta do Hospital Geral Clériston Andrade, em Feira de Santana. Os casos foram constituídos por indivíduos que desenvolveram infecção do trato respiratório (pneumonia nosocomial) após admissão hospitalar. Os controles foram formados por não portadores de pneumonia nosocomial. Informações socioeconómicas, história médica, estilo de vida e hábitos de higiene bucal foram obtidos por meio de entrevistas. Os prontuários foram checados para registro da condição de saúde do indivíduo e diagnóstico de pneumonia. Exame clínico bucal foi realizado por cirurgião-dentista treinado. Na análise bivariada, foi estimado o odds ratio (OR) como medida de associação e seus respectivos intervalos de confiança de 95 por cento (IC 95 por cento) com uso do método de Mantel-Haenzel. RESULTADOS: A frequência de pneumonia nosocomial na amostra foi de 21,8 por cento. A ocorrência de hipertensão e o tempo de internamento foram maiores nos casos do que nos controles (p < 0,05). A falta de uso de fio dental e de enxaguatório bucal foram maiores no grupo controle (p = 0,01). CONCLUSÃO: Os achados apontam a hipertensão, tempo de internamento > 5 dias e ausência do fio dental e enxaguatório bucal como fatores possivelmente associados à pneumonia nosocomial, apontando-os como alvos efetivos de prevenção.

OBJECTIVE: To identify factors associated with nosocomial pneumonia in individuals admitted to apublic hospital in Feira de Santana, Bahia. METHODS: This case control study was carried out in 211 adult individuals (46 cases and 165 controls), of a mean age of 41 years, treated at clinical wards, surgical wards or the adult intensive care unit of Cleriston Andrade General Hospital in Feira de Santana. The cases comprised individuals who developed respiratory tract infections (nosocomial pneumonia) after hospital admission. The controls consisted of patients without nosocomial pneumonia. Information on socioeconomic status, medical history, lifestyle and oral hygiene habits was obtained through interviews. The medical records were checked to verify subjects' health status and the diagnosis opneumonia. A clinical oral examination was performed by a trained dental surgeon. Odds ratio (OR) was estimated in the bivariate analysis as an association measurement, along with the respective 95 percent confidence interval through the Mantel-Haenszel method. RESULTS: The frequency of nosocomial pneumonia in the sample was 21.8 percent. The occurrence of hypertension was higher and hospital stay duration was longer in the cases than in controls (p ≤ 0.05). Lack of dental floss and mouthwash use were higher in the controls (p = 0.01). CONCLUSION: The findings indicate that arterial hypertension, length of hospital stay of five days and lack of dental floss and mouthwash use are factors likely associated with nosocomial pneumonia, suggesting that these factors should be targeted for effective prevention.

Fatores associados à doença periodontal em indivíduos atendidos em um hospital público de Feira de Santana, Bahia / Factors associated with periodontal disease among individuals attended at a public hospital in Feira de Santana, Bahia / Factores asociados con la enfermedad periodontal en personas tratados en un hospital público de Feira de Santana, Bahia

A doença periodontal, dentre outros fatores de riscos, pode ser um provável contribuinte de agravos sistêmicos. O objetivo deste artigo é descrever os fatores associados a doença periodontal em indivíduos hospitalizados no Hospital Geral Clériston Andrade, na cidade de Feira de Santana, Bahia. Trata-se de estudo exploratório em amostra de 100 indivíduos divididos em dois grupos, de acordo o diagnóstico da doença periodontal: Grupo 1 gengivite/periodontite leve (n igual 56); e Grupo 2 periodontite moderada/grave (n igual 44). Informações sociodemográficas e sobre saúde geral e bucal foram obtidas por meio de questionários estruturados e fichas de prontuários arquivados no hospital. Exame clínico periodontal foi realizado por único cirurgião-dentista treinado para obtenção precisa das medidas bucais. Mediante análise de regressão de Poisson múltipla hierarquizada, influência dos fatores de estudo sobre a doença periodontal foi testada separadamente por níveis. Os achados evidenciaram no modelo final que, além da precária condição bucal dos indivíduos hospitalizados, houve influência das variáveis idade, infecção do trato respiratório e hábito de fumar (p<0,10). No entanto, apenas idade apresentou-se estatisticamente associada à periodontite moderada/grave (RP igual 4,67; IC 95 porcento: 2,73-7,99). Concluiu-se que o impacto de fatores clássicos sob a condição periodontal reforça a adoção de práticas mais efetivas de educação em saúde bucal e cuidados de higiene em pacientes hospitalizados como rotina diária por equipe capacitada e multiprofissional.

Periodontal disease, among other risk factors, may be a likely contributor to systemic disease. The present study had the aim of describing factors associated with periodontal disease among individuals hospitalized at Clériston Andrade General Hospital, in the city of Feira de Santana, Bahia. This is an exploratory study was conducted on a sample of 100 individuals, who were divided into two groups according to their diagnosis of periodontal disease: Group 1: gingivitis/ mild periodontitis (n equal 56); and Group 2: moderate/severe periodontitis (n equal 44). Sociodemographic and general and oral health information was obtained from structured questionnaires and the medical files archived at the hospital. Clinical periodontal examinations were performed by asingle dental surgeon who had been trained to obtain precise oral measurements. Through hierarchical Poisson multiple regression analysis, the influence of the study factors on periodontal disease was tested separately for the hierarchical levels. The findings from the final model showed that, In addition to poor oral health among the hospitalized individuals, the variables of age, respiratory tract infection and smoking habit had an influence (p<0.10). However, only age showed a statistical association with moderate/severe periodontitis (PR equal 4.67; 95 percent CI: 2.73-7.99). It was concluded that the impact of classic factors on periodontal condition emphasizes that oral health education and hygiene care practices with greater effectiveness should be used among hospitalized patients, as the daily routine for the capacitated multiprofessional team.

La enfermedad periodontal, entre otros factores de riesgo, puede ser un factor probable que las enfermedades sistémicas El objetivo de este trabajo es describir los factores asociados con la enfermedad periodontal en individuos hospitalizados en el Hospital General deClériston Andrade, de la ciudad de Feira de Santana, Bahía. Este es un estudio exploratorio en uma muestra de 100 pacientes divididos en dos grupos, según el diagnóstico de la enfermedad periodontal: Grupo 1: gingivitis / periodontitis leve (n igual 56) y Grupo 2: periodontitis moderada /grave (n igual 44). La información sociodemográficos sobre la salud general y bucal se obtuvieron mediante cuestionarios estructurados y registros médicos presentados en los registros del hospital. El examen clínico fue realizado por un dentista calibrado para obtener medidas exactas de la boca. Mediante análisis de regresión de Poisson la influencia de múltiples factores sobre la enfermedad periodontal fue probado por niveles separados. Los resultados mostraron en el modelo final que, además del mal estado de salud bucal de los pacientes hospitalizados, hubo influencia de lãs variables edad, la infección del tracto respiratorio y el tabaquismo (p<0.10). Sin embargo, sólo la edad fue estadísticamente asociado con periodontitis moderada/grave (RP igual 4,67, IC 95por ciento: 2,73 a 7,99). Se concluyó que el impacto de los factores clásicos de la enfermedad periodontal refuerza la adopción de una educación para la salud bucal más eficaz y cuidado de la higiene bucal em pacientes hospitalizados como rutina diaria de un equipo capacitado y polivalente.