Validity of self-reported oral conditions among Brazilian older women: Do socio-economic factors matter?

OBJECTIVE: To validate the level of agreement between self-report and clinical examination for oral conditions and evaluate the effect of sociodemographic conditions on the validity of self-report among women aged 60 and older. METHODS: A cross-sectional study was conducted in a social community center for seniors in Southern Brazil. Sociodemographic data (age, level of education, and income) were measured. Participants were interviewed and clinically examined for the number of teeth (DMF-T index) and the use of dental prostheses. The self-reported number of teeth in each arch and the use of dental prostheses were gathered through interviews. The level of agreement was estimated using the observed agreement, Kappa statistics, sensitivity/specificity (edentulism/prostheses) and Lin's concordance correlation coefficient, and related tests (number of teeth). The validity of the oral conditions was estimated according to sociodemographic information. RESULTS: Ninety-nine women participated in the study. High levels of agreement were observed for edentulism (97.8%; 95%CI 92.8;99.7; Kappa 0.947) and the use of dental prostheses (97.0%; 95%CI 91.3;99.4; Kappa 0.922). In both conditions, despite achieving similar concordance correlation coefficients (ranging from weak to moderate), the mean number of upper teeth was lower in clinical examination (7.1 ± 5.2) compared with self-reported (8.6 ± 3.6), while the opposite was observed for lower teeth (clinical examination: 9.1 ± 3.4; self-reported: 6.6 ± 5.3). Larger differences were found among women of low income and educational levels. CONCLUSIONS: Our findings suggest that the participants' socio-economic position might influence their self-reported number of teeth.

Oral health-related quality of life in older adults-Longitudinal study.

OBJECTIVE: The aim of the present study was to investigate oral health-related quality of life (OHRQoL) and determine associations with demographic, socio-economic and oral health variables at two evaluation times (2009 and 2015) among older adults assisted by Family Health Units in the Brazil. METHODS: A longitudinal study was conducted involving the evaluation (2009) and re-evaluation (2015) of 161 older adults (≥60 years of age). Demographic, socio-economic and general health variables were collected using a standardised questionnaire. Clinical oral health variables were also collected. OHRQoL was measured using the Oral Health Impact Profile-14 (OHIP-14). Multiple regression analysis was employed for the evaluation of OHRQoL considering the variables from the two evaluations. RESULTS: The severity of impact (mean OHIP-14) was 9.12 (SD: 10.81) in 2009 and 8.50 (10.52) in 2015. The greatest impact regarded the psychological discomfort domain at both evaluations (28.8% in 2009 and 22.9% in 2015). In the adjusted multiple linear regression, the mean OHIP-14 score increased 4.8 points (95% CI: 0.11-9.49) among individuals who experienced tooth loss between the two evaluations in comparison with those who maintained the same number of teeth. An increase in the OHIP-14 score occurred between 2009 and 2015 among 40.6% of the older adults. CONCLUSIONS: The findings of the present study reveal that the oral health status of older adults exerts an influence on OHRQoL, indicating the need for oral health policies directed at this portion of the population.

Oral health-related quality of life and associated factors in Southern Brazilian elderly.

OBJECTIVE: The aim of the present study was to describe oral health-related quality of life (OHRQoL) and associated factors in elderly individuals treated at Family Health Units in urban areas of the city of Pelotas, Brazil. METHODS: The sample was composed of 438 individuals aged 60 years old or older. Demographic, socio-economic, general health and behavioural variables were collected using standardised questionnaires. OHRQoL was measured with the oral health impact profile (OHIP-14). Poisson regression analysis was employed to identify factors associated with OHRQoL. RESULTS: The mean total OHIP-14 score was 9.1 (standard deviation: 10.6), and major impacts were related to feeling conscious of psychological discomfort (28.1%) and difficulty eating (24.4%) due to teeth, mouth or dentures. The multivariate analysis revealed higher oral health impact scores among non-White individuals [Prevalence ratios (PR) = 1.33, 95% CI: 1.07-1.66; p = 0.011], those with depressive symptoms (PR = 1.61, 95% CI: 1.30-1.99; p < 0.001), tobacco users (PR = 1.46, 95% CI: 1.07-1.99; p = 0.016), non-denture users (PR = 1.42, 95% CI: 1.10-1.85, p = 0.008), those with a perceived need for dental treatment (PR = 1.99, 95% CI: 1.58-2.51; p < 0.001) and those with poor or very poor self-rated oral health (PR = 2.86, 95% CI: 1.93-4.24; p < 0.001). Lower scores were found among individuals aged 80 years or older (PR = 0.52, 95% CI: 0.33-0.82; p = 0.005) and those with household income of more than 1.5 times the minimum wage (PR = 0.65, 95% CI: 0.46-0.93; p = 0.018). CONCLUSIONS: The findings of the present study underscore the need for public policies aimed at reducing social inequalities and providing adequate dental treatment to improve OHRQoL among elderly individuals.

Palliative Sedation at Home: A Scoping Review.

Palliative Sedation (PS) is an effective measure for the relief of refractory symptoms in end-of-life patients. This intervention can be performed at home, respecting the patients' and their families' decisions. A scoping review was performed to map the available evidence in the literature on the performance of PS at home. This review included 23 studies. Most were conducted in European countries with adult cancer patients. Patients, family members and healthcare providers participated in the decision making regarding the use of PS at home. PS was used primarily to manage refractory symptoms (pain, delirium, dyspnea, and others), and in 1 of the studies PS was mentioned as a possible intervention for shortening life. The most commonly used medication was midazolam and the average duration ranged from 4 h to 7 days. There are few reports on adverse events related to PS. This intervention seems to be a feasible possibility for the management of refractory symptoms in patients at the end of life, despite the fact that it can represent specific challenges for healthcare providers, patients and families. However, the literature is limited regarding PS in children and in people with diseases other than cancer, as well as on the evaluation of possible adverse effects related to this intervention. Furthermore, it is essential to have a broad ethical, clinical and legal debate on whether to consider the use of PS for the purpose of shortening life in specific cases.

Complicaçöes cirúrgicas de 366 transplantes renais / Surgical complications of 366 renal transplantation

Com a finalidade de analisar as complicaçöes cirúrgicas verificadas após a realizaçäo de 366 transplantes renais, foram revisados e estudados os prontuários dos pacientes submetidos a este tipo de intervençäo no Hospital de Clínicas da UFPr e na Santa Casa de Curitiba, pela mesma equipe cirúrgica, no período compreendido entre novembro de 1973 e janeiro de 1997. As complicaçöes cirúrgicas encontradas consistiram em 13 (3,5 por cento) casos de fístula urinária, 4 (1,1 por cento) casos de obstruçäo ureteral, 3 (0,8 por cento) casos de refluxo vesicoureteral, 5 (1,4 por cento) casos de estenose da artéria renal, 1 (0,2 por cento) caso de trombose de artéria renal, 5 (1,4 por cento) casos de linfocele, 7 (1,9 por cento) casos de hematoma e 7 (1,9 por cento) casos de deiscëncia/infecçäo de parede. Säo comentados os dados clínicos, laboratoriais e de imagem considerados para o diagnóstico das complicaçöes, bem como as formas de tratamento e os resultados alcançados, concluindo-se que a correçäo das fístulas deve ser adaptada para as particularidades de cada caso, podendo optar-se pelo reimplante vesicoureteral ou quando possível, pela utilizaçäo da via excretora primitiva do receptor, na forma de pielopielostomia ou pieloureterostomia. Linfoceles e hematomas necessitam ampla drenagem cirúrgica e as estenoses de artéria renal säo melhor conduzidas por angioplastia(AB)