Educational inequalities and alcohol-related consequences in Brazil.

AIMS: This study aimed to test whether the alcohol harm paradox (AHP) is observed in Brazil by investigating (i) the association between educational attainment and alcohol-related consequences (ARC) and (ii) the contribution of average alcohol volume consumed (AVC), past-month heavy episodic drinking (HED), smoking, body mass index (BMI), and depression in accounting for the disparities in ARC. METHODS: We analysed data from the 2019 Brazilian National Health Survey, a nationally representative household survey. The composite ARC outcome was considered present when an individual reported a past-year episode of activity failure, amnesia, and concern by others due to alcohol consumption. Adjusted binary logistic regression models were fitted using a hierarchical approach to calculate the odds ratios (OR) and respective 95% confidence intervals (CI), and to assess the contribution of each set of variables in attenuating the educational differences in ARC. RESULTS: Those from the lowest educational strata (incomplete elementary school) exhibited higher odds of ARC than their counterparts (OR: 2.03; 95% CI: 1.73-2.37). Although smoking, BMI, and depression attenuated the educational gradient (i.e. reduced the difference between reference and riskier categories) in ARC by ~13%, the adjustment for AVC and HED amplified inequalities by 0.3% and 5.7%, respectively. CONCLUSION: We found evidence of the AHP in Brazil. Educational inequalities in ARC were scarcely attenuated by behavioural factors, and a suppression effect was noted when adjusting for AVC and HED.

Contextual inequalities in specialized dental public health care in Brazil.

The present study aimed to investigate the contextual inequalities of specialized public dental care (SPDC) in Brazil. The outcome was the trajectory of dental specialized production in municipalities with SPDC (from 2015 to 2017) obtained by group-based trajectory modeling. A Poisson regression model was used to analyze the factors associated with the high trajectory of SPDC production. The inequality indicators for SPDC production were the slope index and the concentration index according to contextual factors. The study included 954 SPDC units distributed across 893 municipalities. Among the municipalities evaluated, 62.9% had a low trajectory of SPDC. Large-sized municipalities had the highest production (IRR = 2.84, 95%CI: 1.94-4.14) and the southern region had the lowest production (IRR = 0.73, 95%CI: 0.58-0.92). Municipalities presenting a very high human development index (HDI) showed the greatest SPDC production (IRR = 3.34, 95%CI: 1.09-10.24), as well as municipalities with the highest tertile of schooling rate (IRR = 1.23, 95%CI: 1.00-1.50). The absolute inequality was 52.1 percentage points for the average monthly wage (p < 0.001), 61.0 percentage points for the HDI (p < 0.001), -22.1 for infant mortality rate (p <0.001), and 14.8 for the schooling rate (p = 0.012). Thus, there are contextual inequalities in the Brazilian SPDC. Higher scores for social indicators were associated with better SPDC performance.

The role of differential exposure and susceptibility to heavy drinking linking income inequalities and tooth loss: An investigation of the alcohol harm paradox using a four-way decomposition analysis.

OBJECTIVES: To examine the extent to which the effect of income inequalities on tooth loss is attributable to differential exposure and susceptibility to heavy drinking in older Brazilian adults. METHODS: We conducted a secondary analysis using data from The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015-2016), a nationally representative sample of community-dwelling people aged 50 years and over. Causal mediation analysis based on the counterfactual outcome framework decomposed the effect of income on tooth loss mediated by heavy drinking into four components (four-way decomposition): controlled direct effect (neither mediation nor interaction), reference interaction (interaction only), mediated interaction (both mediation and interaction) and pure indirect effect (mediation only). Proportions of effect attributable to each component were calculated to estimate the differential exposure (the sum of the third and fourth components) and differential susceptibility (the sum of the second and third components) to heavy drinking. RESULTS: The analytical sample comprised 8114 participants. After adjusting for covariates, 7.3% (95% CI: 3.8%; 10.9%) and -39.5% (95% CI: -75.8%; -3.3%) of the effects of income on tooth loss were attributable to differential exposure and susceptibility to heavy drinking, respectively, consistent with the alcohol harm paradox. When setting non-functional dentition as outcome, only the effect of differential susceptibility remained (-81.7% [95% CI: -128.2%; -35.2%]). CONCLUSION: Our findings suggest that individuals of low-income groups appear to be more susceptible to the effects of heavy drinking on tooth loss.

[Prevalence of water intake among non-institutionalized elderly individuals in Southern Brazil]. / Prevalência de ingestão hídrica e fatores associados entre idosos não institucionalizados do Sul do Brasil.

The scope of this study was to determine the percentage of elderly individuals receiving an adequate water intake and associated factors among non-institutionalized elderly individuals in the urban area of Pelotas, Rio Grande do Sul. It involved a cross-sectional, population-based study carried out in 2014 with elderly participants (≥ 60 years) of the "COMO VAI?" survey. The amount of water ingested per day of the interviewees was investigated, considering the intake of at least eight glasses per day to be adequate. The independent variables were sociodemographic, behavioral, and health characteristics, and Poisson Regression was used to investigate associations. A total of 1,451 elderly people were interviewed, with only 12.6% (95%CI 10.8; 14.7) drinking a sufficient amount. A higher percentage of the elderly with adequate water consumption was observed in younger elderly individuals, those overweight, those with five or more diseases, and those who were more impaired. A low percentage of the elderly with an adequate water intake was observed among the elderly adults in the study. The decreasing trend of water intake in relation to age highlights the importance of developing actions for the higher risk population to stress adequate water intake and the possible consequences of the lack of adequate consumption.

O objetivo deste estudo foi descrever a prevalência de idosos com uma ingestão adequada de água e seus fatores associados. Estudo transversal de base populacional realizado em 2014 com idosos (≥ 60 anos) participantes do estudo "COMO VAI?". Investigou-se o número de copos de água ingeridos/dia pelos entrevistados, considerando-se adequada a ingestão de pelo menos oito copos/dia. As variáveis independentes foram características sociodemográficas, comportamentais e de saúde. A regressão de Poisson foi utilizada para a investigação das associações. Foram entrevistados 1.451 idosos, sendo observado que uma baixa percentagem, 12,6% (IC95% 10,8; 14,7) referiu consumo adequado de água. Maior percentagem de consumo adequado de água foi observada nos idosos mais jovens, com excesso de peso, que apresentaram cinco ou mais doenças e que eram mais dependentes quanto à capacidade funcional. A tendência decrescente de ingestão de água em relação à idade torna essencial o desenvolvimento de ações voltadas para essa população de maior risco acerca da importância de uma ingestão hídrica adequada e das possíveis consequências do seu consumo inadequado.

Prática de atividade física e desigualdades em idosos antes e após a COVID-19 / Physical activity and inequalities in older adults before and after COVID-19

O objetivo do estudo foi verificar modificações na prevalência de atividade física (AF) e desigual-dades em idosos acompanhados antes e após o período de distanciamento social causado pela CO-VID-19. Trata-se de estudo prospectivo conduzido na zona urbana da cidade de Pelotas-Rio Grande do Sul, onde idosos foram acompanhados no ano de 2019/20 e 2021/22. A prevalência de AF foi avaliada através do IPAQ nos domínios do lazer e deslocamento avaliados de forma conjunta. Foram classificados como ativos fisicamente aqueles que realizavam ≥ 150 min/sem. As covariáveis/estra-tificadores avaliadas foram sexo, idade, cor da pele, classe econômica, escolaridade e morbidades. As desigualdades simples foram avaliadas através das diferenças e das razões da prevalência de AF e as desigualdades complexas através do índice de desigualdade (SII) e o índice de concentração (CIX). Os resultados indicaram que houve redução da prevalência de AF de 2019/20 para 2021/22 e que essas modificações ocorreram em todos os grupos populacionais, variando em termos de magnitude de declínio. O SII mostrou aumento da desigualdade entre os mais pobres em comparação aos mais ricos e redução da desigualdade em relação à idade, escolaridade e morbidades. Concluiu-se que a redução da AF ocorreu em todos os grupos populacionais. Em termos de desigualdades, houve aumento em termos de classe econômica e, nos casos de redução da desigualdade, tal mudança foi em virtude da diminuição de AF entre as categorias que eram mais ativas, sendo necessário políticas de saúde para resgatar níveis adequados de AF na população estudada

This study aimed to verify the modification in the physical activity prevalence (PA) and possible inequalities in older individuals monitored before and after social distancing due to COVID-19. This is a prospective study conducted in the urban area of Pelotas-Rio Grande do Sul, where the elderly was followed up in 2019/20 and 2021/22. The prevalence of PA was assessed using the IPAQ in the domain of leisure time and commuting evaluated together. Older people who performed ≥150 min/week were classified as physically active. The covariates/stratifiers assessed were sex, age, skin color, economic class, schooling, and morbidity. Simple inequalities were assessed through differences and ratios for the prevalence of PA and complex ine-qualities through the inequality index (SII) and the concentration index (CIX). The results indicated that there was a reduction in the prevalence of PA among the participants from 2019/20 to 2021/22 and that these changes occurred regardless of population characteristics. The SII showed an increase in PA inequality among the poorest compared to the richest individuals and a reduction in inequalities about age, education, and morbidities. It is concluded that the reduction in PA occurred similarly regardless of the covariates/stratifiers evaluated, that there was an increase in inequality in PA among the less economically favored, and that the reduction in inequality occurred especially from the reduction in PA, requiring health policies to rescue adequate levels of PA in the studied population

Two decades of socioeconomic inequalities in the prevalence of untreated dental caries in early childhood: Results from three birth cohorts in southern Brazil.

OBJECTIVES: To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil. METHODS: The socioeconomic data to this study were collected at the 48-month follow-up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality-SII and Concentration Index-CIX) were used. RESULTS: The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro-poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data. CONCLUSIONS: Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children.

Socioeconomic inequalities related to maternal perception of children's oral health at age 4: Results of a birth cohort.

OBJECTIVES: To estimate socioeconomic inequalities in the maternal perception of children's oral health from a birth cohort study in Brazil. METHODS: The data from this study were collected through perinatal interviews and at the 48-month follow-up from the 2015 Pelotas Birth Cohort Study. The main outcome was the maternal perception of children's oral health, dichotomized into positive (good/very good) and negative (fair/bad/very bad). The secondary outcome was untreated dental caries (absence and presence, according to the ICDAS index - International Caries Detection and Assessment System). For the statistical analysis, the absolute inequality index (Slope Index of Inequality - SII) and the relative concentration index (Concentration Index - CIX) were used. Analyses were stratified by maternal educational level, family income and wealth index. RESULTS: The prevalence of outcomes was 19.4% (95% CI 18.2; 20.7) for the negative maternal perception of children's oral health and 15.6% (95% CI 14.4; 16.8) for untreated dental caries. Socioeconomics inequalities were observed in negative maternal perception of children's oral health in both absolute and relative terms. A SII of -16.6 (95% CI -20.8; -12.5) was observed for family income, with higher prevalence in poor families. A higher prevalence of the negative maternal perception of children's oral health was observed in mothers without any educational level or a few years of study (CIX -21.1 [95% CI -24.5; -17.7]). CONCLUSIONS: This study demonstrates socioeconomics disparities in the maternal perception of children's oral health and in the prevalence of untreated caries in children. A higher concentration of negative maternal perception of children's oral health was identified among the most socioeconomically vulnerable individuals. The findings reinforce the presence of socioeconomic inequalities in subjective measures about children's oral health.

Use of dental services among adults from a birth cohort in the South region of Brazil / Uso de serviços odontológicos em adultos de uma coorte de nascimentos no sul do Brasil

ABSTRACT OBJECTIVE Measure the prevalence of use of dental services in the previous year and associated factors among 31-year-old adults from a birth cohort of 1982. METHODS This is a cross-sectional study that analyzed a birth cohort of 1982 from the city of Pelotas. In 1997, a systematic sample of 27% of the city's census sectors was defined and all households in these sectors were visited, where 1,076 15-year-old adolescents were interviewed. For the oral health studies, 900 of these individuals were randomly selected and followed up at 24 and 31 years of age. The study used data collected from 523 individuals in 2013 (at 31 years old). The outcome was visit to the dentist (use of dental services) in the previous year. Demographic factors (sex), socioeconomic factors (income, education), and oral health factors (reason and type of service, self-perception of oral health, dental pain and caries experience - DMFT) were used as independent variables. Prevalence ratios were estimated using Poisson regression. RESULTS The prevalence of use of dental services in the previous year was 55.3% (95%CI: 51.0-59.5%). In the adjusted analysis, the reason and type of service, self-perception of oral health, and DMFT were associated with the outcome. A stronger association was found with use of dental services in individuals who visited for prevention and used the private service, who were satisfied with their oral health, and who had more caries experiences. CONCLUSION 55.3% of the cohort sample used dental services in the previous year. Individuals who visited the dentist of private service for preventive reasons, who were very satisfied with their oral health, used these services in a higher proportion. In addition, a higher DMFT index also led to higher use of services.

RESUMO OBJETIVO Mensurar a prevalência de uso de serviços odontológicos no último ano e os fatores associados em adultos de 31 anos pertencentes à coorte de nascimentos de 1982. MÉTODOS Estudo transversal, aninhado na coorte de nascimentos de Pelotas de 1982. Em 1997, uma amostra sistemática de 27% dos setores censitários da cidade foi realizada e todos os domicílios desses setores foram visitados, onde 1.076 adolescentes de 15 anos foram entrevistados. Para os estudos de saúde bucal foram sorteados aleatoriamente 900 desses indivíduos, que foram acompanhados também aos 24 e 31 anos. O estudo utilizou dados coletados de 523 indivíduos em 2013 (aos 31 anos). O desfecho foi a ida ao dentista (uso do serviço) no último ano. Fatores demográficos, (sexo), socioeconômicos (renda, escolaridade) e de saúde bucal (motivo e tipo de serviço da consulta, autopercepção de saúde bucal, dor e experiência de cárie - CPOD) foram utilizados como variáveis independentes. As razões de prevalência foram estimadas usando a regressão de Poisson. RESULTADOS A prevalência de uso de serviços odontológicos no último ano foi de 55,3% (IC95%: 51,0 -59,5%). Na análise ajustada, o motivo e tipo de serviço da consulta, a autopercepção de saúde bucal e o CPOD foram associados ao desfecho. Foi encontrada maior associação com a utilização de serviços odontológicos em indivíduos que visitaram por prevenção e usaram o serviço privado, satisfeitos com a sua saúde bucal e que tinham maior experiência de cárie. CONCLUSÃO 55,3% da amostra da coorte utilizaram os seviços odontológicos no último ano. Os indivíduos que visitaram o dentista por motivo preventivo, em consulta privada, que estavam muito satisfeitos ou satisfeitos com sua saúde bucal utilizaram em maior proporção esses serviços. Além disso, o maior índice de CPOD também levou ao maior uso.

Social and racial inequity in self-rated oral health in adults in Southern Brazil.

This study aimed to estimate social and racial inequalities in self-rated oral health in adults from the Brazilian birth cohort study. This study belongs to 1982 Pelotas (Brazil) birth cohort study. Data from this study was collected for oral health conditions 31 years old (Oral Health Study). The outcome was self-rated oral health, dichotomized into positive (good/very good) and negative (regular/bad/very bad). Analyses were stratified by gender, racial/skin color groups, schooling level and income. For statistical analysis, the slope index of inequality (SII) and the concentration index (CIX) were used. The prevalence of negative self-rated oral health was 36.1%. Social inequalities were observed in self-rated oral health in both absolute and relative terms. A SII of -30.0 (95%CI: -43.6; -16.4) was observed for income, and -27.7 (95%CI: -41.9; -13.4) for schooling level. Both the individuals' income and the schooling level had negative CIX (CIXincome -14.6 [95%CI: -21.2; -8.0] and CIXschooling level -14.1 [95%CI: -20.7; -7.5]). Furthermore, the prevalence of negative self-rated oral health in black/brown/indigenous individuals from the highest income/schooling level was comparable to prevalence of the outcome in the white individuals belonging to the lowest income/schooling levels. This study results demonstrate racial disparities in oral health regardless of income and schooling levels. Furthermore, a higher concentration of negative self-rated oral health was identified among the most socioeconomically vulnerable individuals. Our findings reinforce the presence of racial and socioeconomic inequalities in oral health.

Socio-economic inequalities in dental pain in children: A birth cohort study.

OBJECTIVE: To describe socio-economic inequalities in dental pain and dental caries in 5 and 12-year-old children enrolled in a birth cohort. METHODS: This prospective study was carried out with children enrolled in a birth cohort in Pelotas, Brazil. The main outcome was history of dental pain in the last six months, collected at 5 and 12 years of age. Dental caries was evaluated as a secondary outcome. Inequalities dimensions were investigated using maternal education and family income. The inequalities indicators used were the slope index of inequality (SII) and the concentration index (CIX). RESULTS: Some 1,114 and 990 children were included in the analyses at the 5- and 12-year follow-ups, respectively. The prevalence of dental pain was 16.5% (95% CI 14.4-18.8) at 5 years and 31.6% (95% CI 28.7-34.6) at 12 years. Regarding SII, the difference in the prevalence of dental pain was 14 and 11 percentage points at 5 and 12 years, respectively, when comparing the less to the more maternal schooled strata. Relative inequalities (CIX) were found for dental pain only at age 12, considering family income (-5.8 CI95% -11.0; -0.6). Absolute socio-economic inequalities were also observed for dental caries in both ages. CONCLUSION: Dental pain in the last six months and dental caries was unequally distributed. Economically disadvantaged groups had the highest prevalence of dental pain and dental caries in both dentitions. Actions to tackle socio-economic inequalities must be designed throughout life.

Iniquidades socioeconômicas na saúde bucal de estudantes universitários do sul do Brasil / Socioeconomic inequities in the oral health of university students in southern Brazi

Objetivo: Identificar a magnitude da associação entre experiência de cárie dentária e autopercepção negativa de saúde bucal com determinantes socioeconômicos. Métodos: Estudo transversal realizado com dados de uma coorte prospectiva com os universitários ingressantes na Universidade Federal de Pelotas (UFPel) no ano de 2016. Os dados foram coletados por meio de questionário autoaplicável, incluindo características demográficas, socioeconômicas e psicossociais. Os desfechos do presente estudo foram a experiência de cárie autorrelatada (histórico de doença cárie) e autopercepção de saúde bucal (positiva versus negativa). Resultados: Um total de 3.237 alunos ingressou, dos quais 2.089 (64,5%) concordaram em participar do estudo. O modelo de regressão de Poisson mostrou que universitários com renda familiar de R$ 1001,00 a 5000,00 e R$ 5001,00 ou mais apresentaram, respectivamente, uma razão de prevalência (RP) 14% (RP = 0,86; IC95% 0,80-0,92) e 18% (RP = 0,82; IC95% 0,74 a 0,90) menor de experiência de cárie, assim como indivíduos cujas mães tinham ensino médio completo apresentaram uma prevalência 14% menor (RP = 0,86; IC95% 0,80 a 0,92) e ensino superior completo 19% (RP = 0,81; IC95% 0,75 a 0,87) menor de experiência de cárie, quando comparados aos grupos de referência. Na autopercepção de saúde bucal, os resultados para renda familiar de R$1001 a 5000,00 e R$ 5001 ou mais apresentaram, respectivamente, uma prevalência 23% (RP = 0,77; IC95% 0,64 a 0,91) e 43% (RP = 0,57; IC95% 0,45 a 0,72) menor de ter autopercepção de saúde bucal negativa e indivíduos cujas mães tinham ensino superior completo reportaram uma prevalência 21% menor de autopercepção de saúde bucal negativa quando comparados à referência (RP = 0,79; IC95% 0,66 a 0,97). Conclusões: Os achados do presente estudo confirmam que os indicadores socioeconômicos influenciam a experiência de cárie autorrelatada e a autopercepção de saúde bucal dos universitários.

Objective: To identify the magnitude of the association between dental caries experience and negative self-per-ception of oral health with socioeconomic determinants. Methods: Cross-sectional study conducted with data from a prospective cohort with university students entering the Federal University of Pelotas (UFPel) in 2016. Data were collected through a self-administered questionnaire, including demographic, socioeconomic and psychosocial characteristics. The outcomes of the present study were experience of self-reported caries (history of caries disease) and self-perceived oral health (positive versus negative). Results: A total of 3,237 students joined, of which 2,089 (64.5%) agreed to participate in the study. The Poisson regression model known that university students with an income of R$ 1001 to 5000.00 and R$ 5001 or more primary, respectively, a prevalence ratio (PR) 14% (PR = 0,86; 95%CI 0,80-0,92) and 18% (PR = 0,82; 95%CI 0,74 a 0,90) lower of caries experience, as well as individualizing mothers had completed high school prevalence a 14% (PR = 0,86; 95%CI 0,80 a 0,92) lower prevalence and complete higher education 19% (PR = 0,81; 95%CI 0,75 a 0,87) less caries experi-ence when compared to reference groups. In the self-perception of oral health, the results for income of R$ 1001 to 5000.00 and R$ 5001 or more dissipated, respectively, a 23% (PR = 0,77; 95%CI 0,64 a 0,91) and 43% (PR = 0,57; 95%CI 0,45 a 0,72) lower prevalence of having negative self-perception of oral health and qualified originating from complete higher education reported a 23% lower prevalence of negative self-perceived oral health when compared to the reference (PR = 0,79; 95%CI 0,66 a 0,97). Conclusions: The findings of the present study confirm that socioeconomic indicators influence the experience of caries and self-perceived oral health among university students

All-cause mortality over a three-year period among community-dwelling older adults in Southern Brazil.

OBJECTIVE: To evaluate all-cause mortality in approximately three years of follow-up and related sociodemographic, behavioral and health factors in community-dwelling older adults in Pelotas, RS. METHODS: This was a longitudinal observational study that included 1,451 older adults (≥ 60 years) who were interviewed in 2014. Information on mortality was collected from their households in 2016-2017 and confirmed with the Epidemiological Surveillance department of the city and by documents from family members. Associations between mortality and independent variables were assessed by crude and multiple Cox regression, with hazard ratio with respective 95% confidence intervals (95%CI). RESULTS: Almost 10% (n = 145) of the participants died during an average of 2.5 years of follow-up, with a higher frequency of deaths among males (12.9%), ?80 years (25.2%), widowhood (15.0%), no education (13.8%) and who did not work (10.5%). Factors associated with higher mortality were: being a male (HR = 2.8; 95%CI 1.9 - 4.2), age ?80 years (HR = 3.9; 95%CI 2.4 - 6.2), widowhood (HR = 2.2; 95%CI 1.4 - 3.7), physical inactivity (HR = 2.3; 95%CI 1.1 - 4..6), current smoking (HR = 2.1; 95%CI 1.2 - 3.6), hospitalizations in the previous year (HR = 2.0; 95%CI 1.2 - 3.2), depressive symptoms (HR = 2.0; 95%CI 1.2 - 3,4) and dependence for two or more daily life activities (HR = 3.1; 95%CI 1,7 - 5.7). CONCLUSION: The identification of factors that increased the risk of early death makes it possible to improve public policies aimed at controlling the modifiable risk factors that can lead to aging with a better quality of life.

Socioeconomic inequalities explain the association between source of drinking water and dental caries in primary dentition.

OBJECTIVE: To evaluate the association between source of drinking water and dental caries at age 5 and to test whether socioeconomic conditions act as confounding factors in such association. METHODS: The study was carried out in a sub-sample of the 2004 Pelotas Birth Cohort, which comprised the application of a questionnaire and clinical oral examination. The exposure was source of drinking water, collected through a question to the primary caregiver. The outcome was dental caries in primary dentition, measured through several standardized indicators of the decayed, missing and filled teeth index (dmft), assessing past and present dental caries. Socioeconomic indicators (family income and maternal education) were identified as potential confounding factors. After descriptive analysis, the association between source of water and measures of dental caries was assessed by Regression models. RESULTS: 1,084 children were evaluated and had complete information in all variables (83.2 % of the targeted sample). Dental caries experience was observed in 48.7 % of the children, with a mean of 1.9 decayed, missing or filled teeth. Most children consumed water from public water supply (76.0 %), and a socioeconomic pattern was observed, with children from lower income more likely to drink water from public supply. In crude analysis, children who consumed bottled water had a lower risk of decayed teeth, lower experience of dental caries and less severe disease. No associations were observed after adjustments for socioeconomic conditions. CONCLUSION: Underlying socioeconomic inequalities explained the association between prevalence and severity of dental caries in primary dentition and source of drinking water. CLINICAL SIGNIFICANCE: Drinking fluoridated tap water is as effective in dental caries prevention as bottled water with acceptable levels of fluoride, with the advantage of being accessible to all. Oral health prevention and treatment should be implemented as early in life as possible and should take into consideration the family's socioeconomic context.

All-cause mortality over a three-year period among community-dwelling older adults in Southern Brazil / Mortalidade por todas as causas em um período de três anos entre idosos não institucionalizados do Sul do Brasil

ABSTRACT: Objective: To evaluate all-cause mortality in approximately three years of follow-up and related sociodemographic, behavioral and health factors in community-dwelling older adults in Pelotas, RS. Methods: This was a longitudinal observational study that included 1,451 older adults (≥ 60 years) who were interviewed in 2014. Information on mortality was collected from their households in 2016-2017 and confirmed with the Epidemiological Surveillance department of the city and by documents from family members. Associations between mortality and independent variables were assessed by crude and multiple Cox regression, with hazard ratio with respective 95% confidence intervals (95%CI). Results: Almost 10% (n = 145) of the participants died during an average of 2.5 years of follow-up, with a higher frequency of deaths among males (12.9%), ?80 years (25.2%), widowhood (15.0%), no education (13.8%) and who did not work (10.5%). Factors associated with higher mortality were: being a male (HR = 2.8; 95%CI 1.9 - 4.2), age ?80 years (HR = 3.9; 95%CI 2.4 - 6.2), widowhood (HR = 2.2; 95%CI 1.4 - 3.7), physical inactivity (HR = 2.3; 95%CI 1.1 - 4..6), current smoking (HR = 2.1; 95%CI 1.2 - 3.6), hospitalizations in the previous year (HR = 2.0; 95%CI 1.2 - 3.2), depressive symptoms (HR = 2.0; 95%CI 1.2 - 3,4) and dependence for two or more daily life activities (HR = 3.1; 95%CI 1,7 - 5.7). Conclusion: The identification of factors that increased the risk of early death makes it possible to improve public policies aimed at controlling the modifiable risk factors that can lead to aging with a better quality of life.

RESUMO: Objetivo: Avaliar a mortalidade por todas as causas em aproximadamente três anos de acompanhamento e os fatores sociodemográficos, comportamentais e de saúde em idosos comunitários de Pelotas, Rio Grande do Sul. Métodos: Foi um estudo observacional longitudinal que incluiu 1.451 idosos (≥ 60 anos) entrevistados em 2014. As informações sobre mortalidade foram coletadas nos domicílios em 2016-2017, confirmadas com o setor de Vigilância Epidemiológica do município e por documentos de familiares. As associações entre mortalidade e as variáveis independentes, por regressão de Cox simples e múltipla, foram apresentadas pelos riscos relativos com os respectivos intervalos de confiança (95%). Resultados: Quase 10% (n = 145) dos participantes morreram durante uma média de 2,5 anos de acompanhamento, sendo a maior frequência de óbitos em homens (12,9%), indivíduos com ≥ 80 anos (25,2%) e viúvos (15,0%). Estiveram associadas ao maior risco de mortalidade: sexo masculino (RR = 2,8; IC95% 1,9 - 4,2), ≥ 80 anos (RR = 3,9; IC95% 2,4 - 6,2), viuvez (RR = 2,2; IC95% 1,4 - 3,7), inatividade física (RR = 2,3; IC95% 1,1 - 4,6), tabagismo atual (RR = 2,1; IC95% 1,2 - 3,8), hospitalização no último ano (RR = 2,0; IC95% 1,2 - 3,2), sintomas depressivos (RR = 2,1; IC95% 1,2 - 3,6) e dependência para duas ou mais atividades diárias (RR = 3,1; IC95% 1,7 - 5,7). Conclusão: A identificação dos fatores que aumentaram o risco de óbito precocemente possibilita melhorar políticas públicas que visem controlar os fatores de risco modificáveis para um envelhecimento com melhor qualidade de vida.

Associação entre dor dentária, uso de serviços odontológicos e absenteísmo escolar: Pesquisa Nacional de Saúde do Escolar 2015 / Asociación entre dolor dental, uso de servicios dentales y absentismo escolar: Encuesta Nacional de Salud Estudiantil, Brasil, 2015 / Association between dental pain, use of dental services and school absenteeism: 2015 National School Health Survey, Brazil

Objetivo: Analisar a associação entre dor dentária, uso de serviços odontológicos e absenteísmo escolar em adolescentes brasileiros. Métodos: Estudo transversal, sobre dados da Pesquisa Nacional de Saúde do Escolar (PeNSE 2015). A variável dependente do estudo foi o absenteísmo escolar por motivo de saúde nos últimos 12 meses. Características socioeconômicas, dor dentária e utilização de serviços odontológicos foram as variáveis independentes avaliadas. Empregou-se regressão logística, para estimar odds ratio (OR) e respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram incluídos 102.072 escolares. A prevalência de absenteísmo por motivo de saúde foi de 53,7% (IC95% 53,2;54,3). Pela análise ajustada, houve associação entre dor dentária e absenteísmo (OR=1,35 - IC95% 1,26;1,45), e aumento na ocorrência de absenteísmo conforme o maior número de consultas odontológicas. Conclusão: Os resultados sugerem que a dor dentária e a frequência de consultas odontológicas podem estar relacionadas ao absenteísmo escolar.

Objetivo: Analizar la asociación entre dolor dental, el uso de servicios dentales y el absentismo escolar en adolescentes brasileños. Métodos: Estudio transversal con datos de la Encuesta Nacional de Salud Escolar (PeNSE 2015). La variable dependiente del estudio fue el absentismo escolar por razones de salud en los últimos 12 meses. Características socioeconómicas, dolor dental y frecuencia del uso de los servicios dentales fueron las variables independientes evaluadas. La regresión logística se usó para estimar los odds ratio (OR) e intervalos de confianza del 95% (IC95%). Resultados: Se incluyeron datos de 102.072 estudiantes. La prevalencia de absentismo por razones de salud fue del 53,7% (IC95% 53,2; 54,3). En el análisis ajustado, hubo una asociación entre el dolor dental y el absentismo escolar (OR=1,35; - IC95% 1,26; 1,45), y un aumento del absentismo según el mayor número de consultas dentales. Conclusión: Los resultados sugieren que el dolor dental y la frecuencia de las visitas al dentista pueden estar relacionados con el absentismo escolar.

Objective: To analyze association between dental pain, use of dental services and school absenteeism in Brazilian adolescents. Methods: This was a cross-sectional study with data from the National School Health Survey (PeNSE 2015). The study's dependent variable was school absenteeism due to health reasons in the last 12 months. Socioeconomic characteristics, dental pain and use of dental services were the independent variables evaluated. Logistic regression was used to estimate odds ratios (OR) and respective 95% confidence intervals (95%CI). Results: Data on 102,072 schoolchildren were included. Absenteeism prevalence due to health reasons was 53.7% (95%CI 53.2;54.3). In the adjusted analysis, there was association between dental pain and school absenteeism (OR=1.35 - 95%CI 1.26;1.45), and an increase in absenteeism occurrence the greater the number of dental visits. Conclusion: The results suggest that dental pain and frequency of dental visits may be related to school absenteeism.

Regular use of dental services among university students in southern Brazil.

OBJECTIVE To verify the prevalence and factors associated with regular use of dental services in university students of the Universidade Federal de Pelotas (UFPel). METHODS This cross-sectional study interviewed 1,865 students aged 18 years or older, starting bachelor's degrees in 2017, enrolled in the second academic semester of 2017 and in the first of 2018 in classroom courses at UFPel. We considered regular users those who reported regularly going to the dentist with or without perceived dental problems. To test factors associated with regular use of dental services, demographic, socioeconomic and oral health variables were collected. Statistical analyses were based on Poisson regression models. RESULTS The prevalence of regular use of dental services was 45.0% (95%CI 42.7-47.3). University students of high economic class (PR = 1.47; 95%CI 0.91-2.36), with last private dental appointment (PR = 1.29; 95%CI 1.03-1.61), positive self-perception of oral health (PR = 2.33; 95%CI 1.79-3.03) and no report of toothache in the last six months (PR = 1.22; 95%CI 1.03-1.45) showed higher prevalence of regular use of dental services. CONCLUSION The results point to inequalities in the regular use of dental services related to socioeconomic factors and a lower use among university students with worse oral health conditions. These results suggest that public health prevention and promotion policies in higher education institutions must be carried out to ensure quality of life among these young adults.

Regular use of dental services among university students in southern Brazil / Uso regular de serviços odontológicos entre alunos de uma universidade do sul do Brasil

ABSTRACT OBJECTIVE To verify the prevalence and factors associated with regular use of dental services in university students of the Universidade Federal de Pelotas (UFPel). METHODS This cross-sectional study interviewed 1,865 students aged 18 years or older, starting bachelor's degrees in 2017, enrolled in the second academic semester of 2017 and in the first of 2018 in classroom courses at UFPel. We considered regular users those who reported regularly going to the dentist with or without perceived dental problems. To test factors associated with regular use of dental services, demographic, socioeconomic and oral health variables were collected. Statistical analyses were based on Poisson regression models. RESULTS The prevalence of regular use of dental services was 45.0% (95%CI 42.7-47.3). University students of high economic class (PR = 1.47; 95%CI 0.91-2.36), with last private dental appointment (PR = 1.29; 95%CI 1.03-1.61), positive self-perception of oral health (PR = 2.33; 95%CI 1.79-3.03) and no report of toothache in the last six months (PR = 1.22; 95%CI 1.03-1.45) showed higher prevalence of regular use of dental services. CONCLUSION The results point to inequalities in the regular use of dental services related to socioeconomic factors and a lower use among university students with worse oral health conditions. These results suggest that public health prevention and promotion policies in higher education institutions must be carried out to ensure quality of life among these young adults.

RESUMO OBJETIVO Verificar a prevalência e os fatores associados ao uso regular de serviços odontológicos em acadêmicos da Universidade Federal de Pelotas (UFPel). MÉTODOS Este estudo transversal entrevistou 1.865 estudantes de 18 anos ou mais de idade, ingressantes em 2017, matriculados no segundo semestre letivo de 2017 e no primeiro de 2018 em cursos presenciais da UFPel. Consideraram-se usuários regulares os indivíduos que relataram ir regularmente ao dentista com ou sem problemas dentários percebidos. A fim de testar fatores associados ao uso regular de serviços odontológicos, foram coletadas variáveis demográficas, socioeconômicas e de saúde bucal. As análises estatísticas foram baseadas em modelos de regressão de Poisson. RESULTADOS A prevalência de uso regular de serviços odontológicos foi de 45,0% (IC95% 42,7-47,3). Os universitários de classe econômica elevada (RP = 1,47; IC95% 0,91-2,36), com última consulta odontológica particular (RP = 1,29; IC95% 1,03-1,61), autopercepção positiva da saúde bucal (RP = 2,33; IC95% 1,79-3,03) e sem relato de dor de dente nos últimos seis meses (RP = 1,22; IC95% 1,03-1,45) apresentaram maiores prevalências de uso regular dos serviços odontológicos. CONCLUSÃO Os resultados apontam para desigualdades no uso regular dos serviços odontológicos relacionadas a fatores socioeconômicos e um menor uso entre os universitários com piores condições de saúde bucal. Esses resultados sugerem que políticas públicas de prevenção e promoção em saúde em instituições de ensino superior devem ser realizadas para garantir qualidade de vida entre esses jovens.

Skin color affect the replacement of amalgam for composite in posterior restorations: a birth-cohort study.

The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Tooth-level variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations.

Desire for tooth bleaching and treatment performed in Brazilian adults: findings from a birth cohort.

Population-based studies estimating the prevalence of tooth bleaching desire or the percentage of individuals who had performed this treatment are rare. Thus, the aim of this study was to evaluate the desire to perform tooth bleaching and the prevalence of adult individuals who had performed the treatment and investigate the association of these outcomes. A subsample (n = 536) of the 1982 Pelotas birth cohort in southern Brazil was investigated at the ages 15, 24 and 31 by clinical examinations and interviews. The prevalence of bleaching at 31 years was 15.6% [95%CI 12.6-18.9] while 85.9% [95%CI 82.7-88.7] reported they desired the treatment. Multivariate Poisson regression analysis showed that individuals who have visited the dentist within the last year showed a treatment prevalence ratio (PR) 2.31 times [95%CI 1.40-3.83] higher compared with those who had the last dental visit more than a year before the interview. Similarly, individuals with smoking habits presented an elevated PR of 1.60 [95%CI 1.00-2.55], and the low-income trajectory group showed the largest PR of desire for tooth bleaching (1.17 [95%CI 1.07-1.28]). Moreover, individuals from the high-risk caries trajectory group presented a higher prevalence of desire for tooth bleaching than individuals from low caries trajectory group. Individuals who have declared being "dissatisfied" with their dental color presented a prevalence of desire for tooth bleaching 16% greater than "satisfied" ones. Thus, the present findings confirm that tooth bleaching has become a frequently desired dental treatment to improve dental aesthetics in the population and a considerable rate of adults has performed the treatment.