RESUMO
OBJECTIVES: To evaluate the extent to which dental care factors in adulthood modify and, at the same time, mediate the association between race/ethnicity and social mobility from childhood to adulthood with two oral health outcomes in adults. METHODS: In 2012, 1222 individuals 20-59 years old participated in the second wave of the Epi-Floripa Study in Florianopolis, Brazil. Exposures included social mobility based on adulthood and childhood events, dental care in previous years, type of dental care coverage, reason for dental visits and race. The number of missing and decayed teeth were dichotomised as MT >0 and DT >0. RESULTS: The prevalence of missing and decayed teeth was 61.9% and 23.0%, respectively. Age-sex adjusted inequalities in decayed and missing teeth among Black and White individuals were 41.2 percentage points (pp) (95% CI: 3.9-78.7) and 53.1 pp (19.5:86.7), respectively. Inequalities between those persistently higher and lower in socioeconomic position were 42.6 pp (14.6-70.7) and 90.0 pp (62.1-100). The Relative Excess of Risk due to Interaction (RERI) was not statistically significant (p < 0.05). Oaxaca-Blinder decomposition analyses showed that dental care variables accounted for a small proportion of inequalities. CONCLUSIONS: This result implies that dental care is unlikely to significantly reduce or increase oral health inequalities in this particular population.
Assuntos
Mobilidade Social , Perda de Dente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Brasil/epidemiologia , Assistência Odontológica/estatística & dados numéricos , Cárie Dentária/epidemiologia , Serviços de Saúde Bucal/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Prevalência , Perda de Dente/epidemiologia , População Branca , População NegraRESUMO
OBJECTIVE: Data-driven population segmentation is commonly used in clinical settings to separate the heterogeneous population into multiple relatively homogenous groups with similar healthcare features. In recent years, machine learning (ML) based segmentation algorithms have garnered interest for their potential to speed up and improve algorithm development across many phenotypes and healthcare situations. This study evaluates ML-based segmentation with respect to (1) the populations applied, (2) the segmentation details, and (3) the outcome evaluations. MATERIALS AND METHODS: MEDLINE, Embase, Web of Science, and Scopus were used following the PRISMA-ScR criteria. Peer-reviewed studies in the English language that used data-driven population segmentation analysis on structured data from January 2000 to October 2022 were included. RESULTS: We identified 6077 articles and included 79 for the final analysis. Data-driven population segmentation analysis was employed in various clinical settings. K-means clustering is the most prevalent unsupervised ML paradigm. The most common settings were healthcare institutions. The most common targeted population was the general population. DISCUSSION: Although all the studies did internal validation, only 11 papers (13.9%) did external validation, and 23 papers (29.1%) conducted methods comparison. The existing papers discussed little validating the robustness of ML modeling. CONCLUSION: Existing ML applications on population segmentation need more evaluations regarding giving tailored, efficient integrated healthcare solutions compared to traditional segmentation analysis. Future ML applications in the field should emphasize methods' comparisons and external validation and investigate approaches to evaluate individual consistency using different methods.
Assuntos
Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Aprendizado de MáquinaRESUMO
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.
Assuntos
Cárie Dentária , Água Potável , Criança , Pré-Escolar , Índice CPO , Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Humanos , Prevalência , Fatores Socioeconômicos , Dente DecíduoRESUMO
The purpose of this systematic review is to assess the associations among education, income and dietary pattern (DP) in children and adolescents from high, medium and low human development countries (HHDC, MHDC and LHDC, respectively). Observational studies that evaluated the association between family income or education with the DP are obtained through electronic database searches. Forty articles are selected for review. In HHDC, education is inversely associated with "unhealthy" DP and positively associated with "healthy" DP. In cross-sectional studies from HHDC, higher income is negatively associated with "unhealthy" DP. In MHDC, there is no association between the socioeconomic variables (SE) and the DPs, although, in some studies, the unhealthy diet is positively associated with SE. Only one study conducted in LHDC showed an inverse association between income/education with "unhealthy" DP and there is no association between the SE and "healthy" DP. In conclusion, children and adolescents living in HHDC with high parental education tend to have a healthier diet. In MHDC, although an unhealthy diet is found among the high-income and educated population, the associations are not clear. Additional research is needed to clarify the associations between income and education with "unhealthy" and "healthy" DPs in MHDC and LHDC.
Assuntos
Países Desenvolvidos , Países em Desenvolvimento , Dieta/normas , Educação , Família , Comportamento Alimentar , Renda , Adolescente , Criança , Estudos Transversais , Inquéritos sobre Dietas , Feminino , Humanos , Masculino , Fatores SocioeconômicosRESUMO
Background: To evaluate the association between sociodemographic conditions and the quality of life (QoL) in adults and investigate whether these inequalities are greater among individuals with long-lasting chronic health conditions. Methods: Cross-sectional analysis of the second wave (2012) of the EpiFloripa Study, a population-based cohort of 1720 adults living in Southern Brazil. QoL domains (physical, psychological, social relationships and environmental) were evaluated using the WHOQoL-BREF. Unadjusted and adjusted means of QoL according to socioeconomic and demographic variables were estimated and stratified by the presence of long-lasting chronic conditions (heart disease, stroke, diabetes, hypertension, chronic kidney disease, cirrhosis, tendinitis, arthritis, rheumatism and/or fibromyalgia) were peformed in 2016. Results: Among 1222 interviewed adults (56.6% females, mean age 41.7 ± 11.4 years; follow-up rate 71.1%), the prevalence of 1+ long-lasting chronic disease was 37.3% (95%CI: 34.4-40.3). Their effect on the QoL was four times higher on the physical component (-9.6; 95%CI -12.1; -7.1) than on the other domains. Adults aged 40+ years with black skin colour or lower educational level had a lower physical QoL score only when any chronic disease was present. Among those with some chronic illness, the psychological domain was also lower among those aged 40+ years and with a lower family income. No interaction between sociodemographic variables and chronic diseases was observed for the other QoL domains. Conclusions: The occurrence of long-lasting chronic diseases is associated with inequalities in QoL (physical and psychological domains), with stronger adverse effects among older adults, blacks and individuals with lower income or educational levels.
Assuntos
Doença Crônica/epidemiologia , Doença Crônica/psicologia , Escolaridade , Renda/estatística & dados numéricos , Qualidade de Vida/psicologia , Classe Social , Fatores Socioeconômicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e QuestionáriosRESUMO
OBJECTIVE:: This study aimed to investigate the prevalence and factors associated with Common Mental Disorders (CMD) in adults in a capital city in Southern Brazil. METHODS:: Population-based survey conducted on 1,720 adults aged 20 - 59 years from Florianópolis, Southern Brazil. The CMD were investigated through the Self-Reporting Questionnaire (SRQ-20). The independent variables were demographic, socioeconomic, health-related behaviors, health conditions and use of health services. Multivariable Poisson regression was used for the estimation of prevalence ratios (PR) and 95%CI. RESULTS:: The prevalence of CMD was 14.7%. Adjusted analyses showed that the prevalence was higher among women, those self-reported as blacks, with lower educational level, poor, divorced/separated/widowed, inactive in leisure time, heavy smokers, people with chronic diseases, those who reported negative health self-rating, those who had medical appointments and who were hospitalized before the interview. CONCLUSION:: CMD is relatively high among population subgroups most vulnerable to social inequalities and with worse conditions related to health indicators.
Assuntos
Transtornos Mentais/epidemiologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
ABSTRACT: Objective: This study aimed to investigate the prevalence and factors associated with Common Mental Disorders (CMD) in adults in a capital city in Southern Brazil. Methods: Population-based survey conducted on 1,720 adults aged 20 - 59 years from Florianópolis, Southern Brazil. The CMD were investigated through the Self-Reporting Questionnaire (SRQ-20). The independent variables were demographic, socioeconomic, health-related behaviors, health conditions and use of health services. Multivariable Poisson regression was used for the estimation of prevalence ratios (PR) and 95%CI. Results: The prevalence of CMD was 14.7%. Adjusted analyses showed that the prevalence was higher among women, those self-reported as blacks, with lower educational level, poor, divorced/separated/widowed, inactive in leisure time, heavy smokers, people with chronic diseases, those who reported negative health self-rating, those who had medical appointments and who were hospitalized before the interview. Conclusion: CMD is relatively high among population subgroups most vulnerable to social inequalities and with worse conditions related to health indicators.
RESUMO: Objetivo: O objetivo do estudo foi investigar a prevalência e os fatores associados com Transtornos Mentais Comuns (TMC) entre adultos de Florianópolis, Sul do Brasil. Métodos: Estudo de base populacional conduzido com 1.720 adultos de 20 a 59 anos. Os TMC foram investigados pelo Self-Reporting Questionnaire (SRQ-20). As variáveis independentes foram as demográficas, socioeconômicas, comportamentos relacionados com a saúde, condições de saúde e uso de serviços de saúde. A regressão multivariável de Poisson foi empregada para a estimativa de razões de prevalência e IC95%. Resultados: A prevalência de TMC foi de 14,7%, sendo as maiores prevalências nas mulheres, nas pessoas de cor da pele preta, com baixo nível educacional, pobres, divorciados, inativos durante o lazer, fumantes pesados, pessoas com doenças crônicas, com percepção negative de saúde, que tiveram consultas médicas e foram internados nos últimos 12 meses. Conclusão: Os subgrupos populacionais mais vulneráveis aos TMC foram aqueles mais vulneráveis às iniquidades sociais e com piores condições relacionadas aos indicadores de saúde.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Transtornos Mentais/epidemiologia , Fatores Socioeconômicos , População Urbana , Brasil/epidemiologia , Prevalência , Estudos Transversais , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To assess whether short-term changes in income (IC) in adulthood were associated with self-rated oral health (SROH) and chewing difficulties (CD). METHODS: Secondary analysis of a longitudinal study in Florianópolis, Southern Brazil (EpiFloripa); a total of 1720 adults participated in 2009 and 1223 in 2012. Logistic regression analysed the variation of SROH and CD according to short-term changes in income (IC) groups ('high income-stable', 'increased income', 'decreased income' and 'low income-stable') and adjusted for covariates (age, sex, marital status, skin colour, self-reported number of teeth and education). RESULTS: After adjusting for covariates, participants in the 'decreased income' were more likely to have poor SROH and CD than those at the 'high income-stable' group (OR: 1.78, 95% CI: 1.23, 2.58; OR: 2.76, 95% CI: 1.61, 4.74, respectively). Significant differences were also found between the 'low income-stable' and 'high income-stable' groups, but these differences were explained when adjusted for potential confounders. There were no significant differences in SROH and CD between the 'increased income' and the 'high income-stable' groups. CONCLUSIONS: Overall, SROH and CD were adversely influenced by negative changes in income during adulthood in a short period of 3 years.
Assuntos
Renda/estatística & dados numéricos , Mastigação , Saúde Bucal/estatística & dados numéricos , Adulto , Fatores Etários , Brasil/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Saúde Bucal/economia , Fatores de Risco , Fatores Sexuais , Adulto JovemRESUMO
Resumo Os agravos relacionados à saúde bucal dos brasileiros representam importante problema de saúde pública devido à sua prevalência e magnitude na população. Inquéritos de base populacional são ferramentas essenciais para a eleição de grupos e demandas prioritários de atenção. O objetivo deste artigo foi descrever a situação de saúde bucal autorreferida da população brasileira, segundo fatores sociodemográficos. Realizou-se um estudo descritivo, utilizando os dados da Pesquisa Nacional de Saúde de 2013. Indicadores referentes às práticas de higiene e condições de saúde bucal foram analisados. Homens, idosos, pretos e pardos, indivíduos sem instrução e com nível fundamental incompleto, residentes na área rural e na região nordeste apresentaram as mais baixas frequências dos indicadores de higiene bucal adequada e de autopercepção da saúde bucal como boa ou muito boa. Com relação à perda dentária, a total afetou cerca de 16,0 milhões. Tanto a perda dentária total quanto a de 13 ou mais dentes foi mais frequente em mulheres, indivíduos com 60 anos e mais de idade, com baixa escolaridade, residentes na área rural. Conclui-se que os dados da Pesquisa Nacional de Saúde – PNS 2013 reforçam a necessidade de políticas e ações que minimizem as desigualdades em saúde bucal, garantindo acesso aos subgrupos populacionais mais vulneráveis de acordo com suas necessidades de saúde.
Abstract Abstract Oral diseases are a relevant public health problem in Brazil, because of their prevalence and magnitude in the population. Population-based surveys are essential tools for the election of groups and demands priority attention, . The aim of this paper was to describe the self-reported oral health status of the population, according to sociodemographic factors. A descriptive study was conducted using the National Health Survey data of 2013. Indicators associated with oral hygiene practices and oral health conditions were analyzed. Men, elders, blacks and browns, individuals with no education and with incomplete elementary level, residents in rural areas and in the northeast had the lowest frequencies of the indicators of oral hygiene and health self-perception oral as good or very good. Total loss has affected about 16.0 million. Both total tooth loss as the loss of 13 or more teeth was more frequent among women, individuals aged 60 and older, poorly educated, residents in rural areas. It is concluded that the data from the National Health Research -PNS 2013 reinforce the need for policies and actions that minimize the inequalities in oral health, ensuring access to the most vulnerable population sub-groups according to their health needs.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Saúde Bucal , Autorrelato , Brasil/epidemiologia , Inquéritos Epidemiológicos , Perda de Dente/epidemiologiaRESUMO
Neighborhood problems constitute sources of chronic stress that may increase the risk of poor self-rated health. The associations of census tract level income and perceived neighborhood problems with self-rated health were examined in Florianópolis, Santa Catarina State, Brazil (1,720 adults). Odds ratios (OR) and their 95% confidence intervals (95%CI) of poor self-rated health were estimated through multilevel models. Residents in census tracts in the lower and intermediate tertiles of income reported poorer health than those in the highest tertile. OR of reporting poorer health was 2.44 (95%CI: 2.35- 2.54) in the higher tertile of social disorder (adjusting for mental health). The chances of reporting the poorer health with neighborhood problems ranged from 1.07 (95%CI: 1.03-1.11) to 2.02 (95%CI: 1.95-2.10) for the higher tertile of social disorder (physical health) and physical problem (health-related variables). Perceived neighborhood problems were independently associated with poor health. The perception of a neighborhood among its residents should be considered by health policymakers.
Assuntos
Nível de Saúde , Características de Residência , Adulto , Brasil , Censos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multinível , Razão de Chances , Autoimagem , Fatores Socioeconômicos , Adulto JovemRESUMO
Abstract Neighborhood problems constitute sources of chronic stress that may increase the risk of poor self-rated health. The associations of census tract level income and perceived neighborhood problems with self-rated health were examined in Florianópolis, Santa Catarina State, Brazil (1,720 adults). Odds ratios (OR) and their 95% confidence intervals (95%CI) of poor self-rated health were estimated through multilevel models. Residents in census tracts in the lower and intermediate tertiles of income reported poorer health than those in the highest tertile. OR of reporting poorer health was 2.44 (95%CI: 2.35- 2.54) in the higher tertile of social disorder (adjusting for mental health). The chances of reporting the poorer health with neighborhood problems ranged from 1.07 (95%CI: 1.03-1.11) to 2.02 (95%CI: 1.95-2.10) for the higher tertile of social disorder (physical health) and physical problem (health-related variables). Perceived neighborhood problems were independently associated with poor health. The perception of a neighborhood among its residents should be considered by health policymakers.
Resumo Problemas na vizinhança representam fontes de estresse crônico que podem aumentar o risco de autoavaliação de saúde negativa. A associação entre renda do setor censitário e problemas na vizinhança com a autoavaliação de saúde foi examinada em Florianópolis, Santa Catarina, Brasil (1.720 adultos). Razões de chance e seus intervalos de 95% de confiança (IC95%) de autoavaliação de saúde negativa foram estimados por meio de modelos multiníveis. Residentes em setores censitários de renda baixa e intermediária referiram pior saúde do que aqueles do tercil mais elevado. A razão de chance de referir pior saúde foi de 2,44 (IC95%: 2,35-2,54) no tercil com mais problemas de desordem social na vizinhança (ajustando para saúde mental). A chance de referir pior saúde com problemas na vizinhança variou de 1,07 (IC95%: 1,03-1,11) a 2,02 (IC95%: 1,95-2,10) para o tercil mais elevado de desordem social (saúde física) e problemas físicos na vizinhança (relacionados à saúde). A percepção de problemas na vizinhança foi independentemente associada à pior saúde, e deve ser considerada por aqueles que elaboram as políticas.
Resumen Los problemas en barrios representan fuentes de estrés crónico que pueden aumentar el riesgo de autoevaluación de salud negativa. En la ciudad de Florianópolis, Santa Catarina, Brasil, se examinó la asociación entre la renta de las circunscripciones censales y los problemas en barrios con la autoevaluación de salud entre 1.720 adultos. Se estimaron las razones de momios (RM) y sus intervalos de confianza de un 95% de autoevaluación de salud negativa (IC95%) mediante modelos multiniveles. Los residentes en circunscripciones censales de renta baja e intermedia reportaron peor salud que aquellos del tercil más elevado. La razón de momios al informar peor salud fue un 2,44 (IC95%: 2,35-2,54) en el tercil con más problemas de desórdenes sociales en el barrio (ajustado para la salud mental). La posibilidad de informar una peor salud con problemas en el barrio varió de 1,07 (IC95%: 1,03-1,11) a 2,02 (IC95%: 1,95-2,10) para el tercil más elevado de desorden social (salud física) y problemas físicos en el barrio (relacionados con la salud). La percepción de problemas en el barrio se asoció independientemente a una salud peor, y debe ser considerada por aquellos que elaboran políticas.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Nível de Saúde , Características de Residência , Brasil , Censos , Estudos de Coortes , Análise Multinível , Razão de Chances , Autoimagem , Fatores SocioeconômicosRESUMO
OBJECTIVE To analyze oral health behaviors changes over time in Brazilian adolescents concerning maternal educational inequalities. METHODS Data from the Pesquisa Nacional de Saúde do Escolar (Brazilian National School Health Survey) were analyzed. The sample was composed of 60,973 and 61,145 students from 26 Brazilian state capitals and the Federal District in 2009 and 2012, respectively. The analyzed factors were oral health behaviors (toothbrushing frequency, sweets consumption, soft drink consumption, and cigarette experimentation) and sociodemographics (age, sex, race, type of school and maternal schooling). Oral health behaviors and sociodemographic factors in the two years were compared (Rao-Scott test) and relative and absolute measures of socioeconomic inequalities in health were estimated (slope index of inequality and relative concentration index), using maternal education as a socioeconomic indicator, expressed in number of years of study (> 11; 9-11; ≤ 8). RESULTS Results from 2012, when compared with those from 2009, for all maternal education categories, showed that the proportion of people with low toothbrushing frequency increased, and that consumption of sweets and soft drinks and cigarette experimentation decreased. In private schools, positive slope index of inequality and relative concentration index indicated higher soft drink consumption in 2012 and higher cigarette experimentation in both years among students who reported greater maternal schooling, with no significant change in inequalities. In public schools, negative slope index of inequality and relative concentration index indicated higher soft drink consumption among students who reported lower maternal schooling in both years, with no significant change overtime. The positive relative concentration index indicated inequality in 2009 for cigarette experimentation, with a higher prevalence among students who reported greater maternal schooling. There were no inequalities for toothbrushing frequency or sweets consumption. CONCLUSIONS There were changes in the prevalences of oral health behaviors during the analyzed period; however, these changes were not related to maternal education inequalities.
Assuntos
Comportamentos Relacionados com a Saúde , Mães/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Escovação Dentária/estatística & dados numéricos , Adolescente , Brasil , Criança , Estudos Transversais , Inquéritos de Saúde Bucal , Escolaridade , Feminino , Humanos , Masculino , Fatores de Risco , Fatores SocioeconômicosRESUMO
OBJECTIVES: The aim of this study was to assess the prevalence of oral mucosal lesions and their impact on oral health-related quality of life (OHRQoL) in children aged 5 years. METHODS: A sample of 1118 children from Pelotas' birth cohort, born in 2004 (response rate of 85.8%), were selected to participate in the study. Data were collected using a questionnaire applied to mothers and from the oral examinations of the children. OML were identified by type, site, and size. Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess caregivers' perception on children's OHRQoL. Descriptive, bivariate, and multivariate Poisson regression analyses were carried out, considering the impact on OHRQoL (total ECOHIS score) as the outcome. RESULTS: The prevalence of the OML was 30.1% (95% CI 27.5-32.9). Ulcers were the more prevalent type of lesion (29.4%), and the most affected site was the gums (31.0%). In bivariate analysis, there was a positive association between the presence of OML and OHRQoL impact measured by the following: mean overall score of ECOHIS (P < 0.001); extent (P < 0.001); prevalence (P = 0.030); and intensity (P = 0.010). After adjustments for sociodemographic and oral health variables, children with OML presented higher impact on OHRQoL [rate ratio (RR) 1.38 95% CI 1.11; 1.72] comparing with their counterparts. Analyzing specific domains, children with OML also presented higher impact on children symptoms (RR 1.46 95% CI 1.20; 1.66) and family functional (RR 3.14 95% CI 1.59; 6.22) domains. CONCLUSION: Almost one-third of children presented with oral mucosal lesions, and these lesions impaired children's oral health-related quality of life.
Assuntos
Mucosa Bucal/patologia , Saúde Bucal/estatística & dados numéricos , Qualidade de Vida , Brasil/epidemiologia , Pré-Escolar , Feminino , Humanos , Masculino , Doenças da Boca/epidemiologia , Doenças da Boca/psicologia , Prevalência , Fatores SocioeconômicosRESUMO
OBJECTIVE The objective of this study was to analyze whether socioeconomic conditions and the period of availability of fluoridated water are associated with the number of teeth present. METHODS This cross-sectional study analyzed data from 1,720 adults between 20 and 59 years of age who resided in Florianópolis, SC, Southern Brazil, in 2009. The outcome investigated was the self-reported number of teeth present. The individual independent variables included gender, age range, skin color, number of years of schooling, and per capita household income. The duration of residence was used as a control variable. The contextual exposures included the period of availability of fluoridated water to the households and the socioeconomic variable for the census tracts, which was created from factor analysis of the tract's mean income, education level, and percentage of households with treated water. Multilevel logistic regression was performed and inter-level interactions were tested. RESULTS Residents in intermediate and poorer areas and those with fluoridated water available for less time exhibited the presence of fewer teeth compared with those in better socioeconomic conditions and who had fluoridated water available for a longer period (OR = 1.02; 95%CI 1.01;1.02). There was an association between the period of availability of fluoridated water, per capita household income and number of years of education. The proportion of individuals in the poorer and less-educated stratum, which had fewer teeth present, was higher in regions where fluoridated water had been available for less time. CONCLUSIONS Poor socioeconomic conditions and a shorter period of availability of fluoridated water were associated with the probability of having fewer teeth in adulthood. Public policies aimed at reducing socioeconomic inequalities and increasing access to health services such as fluoridation of the water supply may help to reduce tooth loss in the future.
Assuntos
Fluoretação/estatística & dados numéricos , Perda de Dente/epidemiologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Assistência Odontológica , Humanos , Pessoa de Meia-Idade , Saúde Bucal , Prevalência , Fatores Socioeconômicos , Perda de Dente/etiologia , Adulto JovemRESUMO
INTRODUCTION: Estimating orthodontic treatment need in the permanent dentition using information from the deciduous-dentition malocclusion may assist in defining the time for appropriate orthodontic intervention. Our objective was to investigate whether malocclusion in the deciduous teeth predicts orthodontic treatment need in the permanent dentition. METHODS: Two oral health studies nested in a birth cohort were carried out at ages 6 (n = 359) and 12 (n = 339) years. Open bite, crossbite, and canine malocclusion were assessed in the deciduous teeth. Orthodontic treatment need was determined in the permanent dentition using the dental esthetic index. Prevalence ratios were estimated using 2 dental esthetic index cutoff points: highly desirable/mandatory orthodontic treatment and only mandatory orthodontic treatment. We tested all combinations of the deciduous malocclusion and the outcomes, controlling for confounders. RESULTS: Children with only open bite and those with concurrent open bite and canine malocclusion were more likely to have either highly desirable/mandatory orthodontic treatment or only mandatory orthodontic treatment needs by age 12. The combination of crossbite and open bite in the deciduous teeth was associated with the highest risk of need for mandatory orthodontic treatment. CONCLUSIONS: Malocclusion in the deciduous teeth is a risk factor for orthodontic treatment need in the permanent dentition. Children with malocclusion at a young age should be monitored regularly, and caregivers may be able to better prepare for possible orthodontic treatment.
Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Má Oclusão/epidemiologia , Dente Decíduo , Brasil/epidemiologia , Criança , Estudos de Coortes , Fatores de Confusão Epidemiológicos , Dente Canino/patologia , Estética Dentária , Feminino , Seguimentos , Previsões , Humanos , Índice de Necessidade de Tratamento Ortodôntico/estatística & dados numéricos , Estudos Longitudinais , Masculino , Mordida Aberta/epidemiologia , Vigilância da População , Prevalência , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJETIVO Analisar se condições socioeconômicas contextuais e tempo de disponibilidade de água fluoretada estão associados ao número de dentes presentes. MÉTODOS Neste estudo transversal, foram analisados dados de 1.720 adultos entre 20 e 59 anos residentes em Florianópolis, SC, em 2009. O desfecho investigado foi o autorrelato do número de dentes presentes. As variáveis independentes individuais incluíram sexo, faixa etária, cor da pele, anos de estudo e renda per capita familiar. Como variável de controle, utilizou-se o tempo de residência. As exposições contextuais foram o tempo de disponibilidade da água fluoretada nos domicílios e a variável socioeconômica para os setores censitários, elaborada a partir da análise fatorial da renda média do setor, escolaridade média e percentual de domicílios com água tratada. Foi realizada regressão logística multinível e foram testadas interações interníveis. RESULTADOS Residentes nas áreas intermediárias e mais pobres e aqueles com menos tempo de disponibilidade de água fluoretada apresentaram menos dentes presentes comparados àqueles em melhor posição socioeconômica e com disponibilidade de água fluoretada por maior período (OR = 1,02; IC95% 1,01;1,02). Houve interação entre o tempo de disponibilidade de água fluoretada, renda per capita familiar e anos de estudo. A proporção de indivíduos do estrato mais pobre e menos escolarizado, que apresentou menos dentes presentes, foi maior nas regiões com menor tempo de disponibilidade de flúor na água. CONCLUSÕES As piores condições socioeconômicas contextuais associaram-se à chance de ter menos dentes presentes na idade adulta, da mesma forma que o menor tempo de fluoretação da água. Políticas públicas que visem a reduzir desigualdades socioeconômicas e ampliem o acesso à saúde, como a fluoretação da água de abastecimento podem, futuramente, contribuir para reduzir as perdas dentárias.(AU)
OBJECTIVE The objective of this study was to analyze whether socioeconomic conditions and the period of availability of fluoridated water are associated with the number of teeth present. METHODS This cross-sectional study analyzed data from 1,720 adults between 20 and 59 years of age who resided in Florianópolis, SC, Southern Brazil, in 2009. The outcome investigated was the self-reported number of teeth present. The individual independent variables included gender, age range, skin color, number of years of schooling, and per capita household income. The duration of residence was used as a control variable. The contextual exposures included the period of availability of fluoridated water to the households and the socioeconomic variable for the census tracts, which was created from factor analysis of the tract's mean income, education level, and percentage of households with treated water. Multilevel logistic regression was performed and inter-level interactions were tested. RESULTS Residents in intermediate and poorer areas and those with fluoridated water available for less time exhibited the presence of fewer teeth compared with those in better socioeconomic conditions and who had fluoridated water available for a longer period (OR = 1.02; 95%CI 1.01;1.02). There was an association between the period of availability of fluoridated water, per capita household income and number of years of education. The proportion of individuals in the poorer and less-educated stratum, which had fewer teeth present, was higher in regions where fluoridated water had been available for less time. CONCLUSIONS Poor socioeconomic conditions and a shorter period of availability of fluoridated water were associated with the probability of having fewer teeth in adulthood. Public policies aimed at reducing socioeconomic inequalities and increasing access to health services such as fluoridation of the water supply may help to reduce tooth loss in the future.(AU)
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Fluoretação/estatística & dados numéricos , Perda de Dente/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Assistência Odontológica , Saúde Bucal , Prevalência , Fatores Socioeconômicos , Perda de Dente/etiologiaRESUMO
OBJECTIVE To analyze oral health behaviors changes over time in Brazilian adolescents concerning maternal educational inequalities.METHODS Data from the Pesquisa Nacional de Saúde do Escolar(Brazilian National School Health Survey) were analyzed. The sample was composed of 60,973 and 61,145 students from 26 Brazilian state capitals and the Federal District in 2009 and 2012, respectively. The analyzed factors were oral health behaviors (toothbrushing frequency, sweets consumption, soft drink consumption, and cigarette experimentation) and sociodemographics (age, sex, race, type of school and maternal schooling). Oral health behaviors and sociodemographic factors in the two years were compared (Rao-Scott test) and relative and absolute measures of socioeconomic inequalities in health were estimated (slope index of inequality and relative concentration index), using maternal education as a socioeconomic indicator, expressed in number of years of study (> 11; 9-11; ≤ 8).RESULTS Results from 2012, when compared with those from 2009, for all maternal education categories, showed that the proportion of people with low toothbrushing frequency increased, and that consumption of sweets and soft drinks and cigarette experimentation decreased. In private schools, positive slope index of inequality and relative concentration index indicated higher soft drink consumption in 2012 and higher cigarette experimentation in both years among students who reported greater maternal schooling, with no significant change in inequalities. In public schools, negative slope index of inequality and relative concentration index indicated higher soft drink consumption among students who reported lower maternal schooling in both years, with no significant change overtime. The positive relative concentration index indicated inequality in 2009 for cigarette experimentation, with a higher prevalence among students who reported greater maternal schooling. There were no inequalities for toothbrushing frequency or sweets consumption.CONCLUSIONS There were changes in the prevalences of oral health behaviors during the analyzed period; however, these changes were not related to maternal education inequalities.
OBJETIVO Analisar a evolução de comportamentos em saúde bucal em adolescentes em relação às desigualdades da escolaridade materna.MÉTODOS Foram analisados dados da Pesquisa Nacional de Saúde do Escolar. A amostra foi composta por 60.973 e 61.145 escolares do nono ano das 26 capitais brasileiras e do Distrito Federal em 2009 e 2012, respectivamente. Foram analisados comportamentos em saúde bucal (frequência de escovação dentária, consumo de guloseimas, consumo de refrigerantes e experimentação de cigarros) e variáveis sociodemográficas (idade, sexo, raça/cor, tipo de escola e escolaridade materna). Compararam-se os comportamentos em saúde bucal e os fatores sociodemográficos nos dois anos (teste de Rao-Scott) e calcularam-se medidas de desigualdades socioeconômicas absolutas e relativas em saúde (coeficiente angular de desigualdade e índice de concentração relativa), utilizando-se como indicador a escolaridade materna expressa em anos de estudo (> 11; 9-11; ≤ 8).RESULTADOS Quando comparado 2012 em relação a 2009, para todas as categorias de escolaridade materna, observou-se aumento da proporção de pessoas com baixa frequência de escovação, e diminuição do consumo de guloseimas e refrigerantes e da experimentação de cigarros. Em escolas privadas, o coeficiente angular de desigualdade e o índice de concentração relativa positivos indicaram maior consumo de refrigerantes em 2012 e maior experimentação de cigarros nos dois anos entre aqueles cujas mães tinham maior escolaridade, sem mudança significativa das desigualdades. Em escolas públicas, o coeficiente angular de desigualdade e o índice de concentração relativa negativos indicaram maior consumo de refrigerantes entre aqueles cujas mães tinham, nos dois anos estudados, menor escolaridade, sem mudança significativa. Já o índice de concentração relativa positivo indicou desigualdade em 2009 para experimentação de cigarros, com maior prevalência entre aqueles cujas mães tinham maior escolaridade. Não houve desigualdade para frequência de escovação e consumo de guloseimas.CONCLUSÕES As prevalências dos comportamentos em saúde bucal apresentaram mudanças no período investigado. No entanto, tais mudanças não foram relacionadas às desigualdades de escolaridade materna.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Escovação Dentária/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Saúde Bucal/estatística & dados numéricos , Mães/estatística & dados numéricos , Fatores Socioeconômicos , Brasil , Inquéritos de Saúde Bucal , Estudos Transversais , Fatores de Risco , EscolaridadeRESUMO
OBJECTIVE: To describe methods and challenges of oral health studies nested in a prospective cohort study of adults. METHODS: A sample of 2,016 adults was investigated in 2009. Household visits were performed in order to apply a questionnaire on socioeconomic, demographic, health related variables, medicine consumption, blood donation, domestic violence and a set of questions related to women's health. Oral health data included self-reported oral health, number of remaining teeth, dental services use, perception of dental treatment needs, occurrence, intensity and impact of dental pain on daily life, xerostomia and chewing impairment due to poor oral health. In addition, participants' blood pressure, weight, height and waist circumference were measured. The second wave of the study was carried out in 2012. A questionnaire on socioeconomic factors, quality of life, discriminatory experiences, 24-hour dietary recall and oral health aspects (the same used in 2009) was applied. In addition, blood pressure, weight, and waist circumference were measured and clinical oral health status was assessed (dental caries, tooth loss, and periodontal outcomes). RESULTS: Participation rate was 85.3% (n = 1,720) in 2009 and, among those, 1,222 (71.1%) were followed up in 2012. CONCLUSIONS: The follow-up of this population will contribute in the elucidation of the potentially causal associations between oral outcomes and general chronic diseases.
Assuntos
Saúde Bucal , Adulto , Brasil , Humanos , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To investigate the link between self-rated oral health and socio-demographic inequalities. METHODS: Cross-sectional study, carried out with 2,016 adults between 20 and 59 years of age in 2009, in Florianopolis, SC, Southern Brazil. We adopted a two-stage sampling design (census tracts and households). Data were collected through face-to-face interviews, conducted in the participants' households. The outcome was self-rated oral health. The exploratory variables were demographic characteristics, indicators of socioeconomic position, dental service utilization and adverse self-reported oral health conditions. Analysis was performed using multivariable poisson regression, which allowed the estimation of prevalence ratios and 95% confidence intervals. RESULTS: The prevalence of negative self-rated oral health was 33.2% (95%CI 29.8;36.6). In the adjusted analysis, being of an older age, self-classifying as light-skinned black, lower education, the most recent dental appointment being three years or more ago, attending public dental surgeries, having less than 10 natural teeth in at least one arch, self-reporting need for dental treatment, reporting dry mouth, and difficulty eating due to tooth problems were associated with negative self-rated oral health. CONCLUSIONS: Self-rated oral health reflects social inequalities in health, and it is associated with low socioeconomic status, less frequent use of dental services and poorer self-reported oral health conditions.
Assuntos
Autoavaliação Diagnóstica , Disparidades nos Níveis de Saúde , Saúde Bucal/estatística & dados numéricos , Adulto , Fatores Etários , Brasil , Estudos Transversais , Inquéritos de Saúde Bucal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto JovemRESUMO
OBJETIVO : Estimar a prevalência de dificuldade de adultos na mastigação, segundo sexo, e analisar os fatores associados. MÉTODOS : Estudo transversal de base populacional com adultos de 20 a 59 anos de idade (n = 2.016), de Florianópolis, SC, em 2009, por meio de amostragem em dois estágios, setores censitários e domicílios. A dificuldade na mastigação foi investigada por meio de pergunta sobre dificuldade de mastigação devida a problemas com os dentes ou dentadura. Analisaram-se os fatores demográficos, socioeconômicos, utilização dos serviços de saúde para consulta odontológica e condição bucal autorreferida. Foi realizada regressão logística multivariável, estratificada por sexo. RESULTADOS : A taxa de resposta foi de 85,3% (n = 1.720). A prevalência de dificuldade na mastigação foi de 13,0% (IC95% 10,3;15,8) e 18,0% (IC95% 14,6;21,3) em homens e em mulheres, respectivamente. Mulheres e homens com 50 anos ou mais, aqueles com dez dentes naturais ou menos e os que manifestaram dor dentária tiveram mais chance de apresentar dificuldade na mastigação. O efeito conjunto da perda e da dor na dificuldade na mastigação foi cerca de quatro vezes maior entre as mulheres. CONCLUSÕES : A magnitude das associações entre variáveis socioeconômicas, demográficas e de condição bucal autorreferidas foi diferente para homens e mulheres, em geral maiores para as mulheres, destacando-se a dor dentária. Os resultados sugerem que o impacto das condições bucais varia segundo o sexo. .
OBJETIVO : Estimar la prevalencia de dificultad de adultos en la masticación, de acuerdo con el sexo, y analizar los factores asociados. MÉTODOS : Estudio transversal de base poblacional con adultos de 20 a 59 años de edad (n= 2.016), de Florianópolis SC, Brasil, en 2009, por medio de muestreo en dos fases, sectores censitarios y domicilios. La dificultad en la masticación fue investigada preguntando directamente sobre tal inconveniente debido a problemas en los dientes o dentadura. Se analizaron los factores demográficos, socioeconómicos, utilización de los servicios de salud para consulta odontológica y condición bucal auto-referida. Se realizó regresión logística multivariable, estratificada por sexo. RESULTADOS : La tasa de respuesta fue de 85,3% (n= 1.720). La prevalencia de dificultad en la masticación fue de 13% (IC95% 10,3;15,8) y 18% (IC95% 14,6;21,3) en hombres y en mujeres, respectivamente. Mujeres y hombres con 50 años o más, y los que presentaban diez dientes naturales, o menos. Los que manifestaron dolor denario tuvieron mayor chance de presentar dificultad en la masticación. El efecto conjunto de la pérdida y del dolor en la dificultad para masticar fue cerda de cuatro veces mayor entre las mujeres. CONCLUSIONES : La magnitud de las asociaciones entre variables socioeconómicas, demográficas y de condición bucal auto-referidas fue diferente para hombres y mujeres, en general mayores en las mujeres, destacándose el dolor dentario. Los resultados sugieren que el impacto de las condiciones bucales varia de acuerdo al sexo. .
OBJECTIVE : The aim of this study was to estimate the prevalence of chewing impairment according to sex, and its associated factors in adults. METHODS : A cross-sectional population-based study was carried out with 2,016 subjects aged between 20 and 59 years in Florianopolis, SC, Southern Brazil, in 2009. The sampling was undertaken in two stages, census tracts and households. The outcome ‘chewing impairment’ was obtained from the question “How often do you have chewing impairment due to teeth or denture problems?”. Analyses were carried out with demographics and socioeconomic factors, dental services utilization, and self-related oral health using multivariable logistic regression and stratified by sex. RESULTS : The response rate was 85.3% (1,720 adults). The prevalence of chewing impairment was 13,0% (95%CI 10.3;15.8) and 18,0% (95%CI 14.6;21.3) among men and women, respectively. Women and men fifty years old and over, who had ten or fewer natural teeth and those who reported toothache were more likely to have chewing impairment. The combination of tooth loss and toothache on chewing impairment was almost four times higher among women. CONCLUSIONS : The magnitude of the associations among socioeconomic, demographics and self-related oral health factors was different according to sex, in general higher for women, with emphasis on toothache. The findings suggest that the impact of oral conditions varies by sex. .