Time trend and Age-Period-Cohort analysis of potentially HPV-related oral and pharyngeal cancer incidence in Singapore between 1968 and 2017.

OBJECTIVES: To examine trends and age-period-cohort effects (APC) on oral and pharyngeal cancers incidence in Singapore between 1968 and 2017 by human papillomavirus (HPV) status. METHODS: All diagnosed oral and pharyngeal cancers and population size were extracted from the Singapore Cancer Registry and the Department of Statistics Singapore, respectively. Anatomical subsites were used as a proxy for HPV infection. Prais-Winsten regression assessed trends of age-standardised incidence rate (ASIR) (per 100,000 person-years); Poisson regression assessed APC effects on HPV-related and HPV-unrelated cancers. RESULTS: Over 50 years, 1,618 HPV-related and 2,977 HPV-unrelated oral and pharyngeal cancers were diagnosed, with the highest ASIR in Indians (6.93), followed by Chinese (2.81), and Malays (1.81). Overall, ASIR HPV-related cancers were stable while HPV-unrelated cancers decreased. The male-female ASIR ratio reduced from 5.82 (1968-1977) to 4.0 (2008-2017) for HPV-related cancers, and from 2.58 (1968-1977) to 1.52 (2008-2017) for HPV-unrelated cancers. HPV-unrelated ASIR in males decreased, but in females only among Indians. HPV-related ASIR decreased only among Indian females. The cohort born between 1983 and 1992 had the lowest incidence of HPV-related cancers in males but the highest in HPV-unrelated cancers. Period effect mainly contributed to HPV-related cancer among males with increased incidence after 1997. Overall, the age effect was more pronounced in males. CONCLUSIONS: HPV-related cancers accounted for 1/3 of oral and pharyngeal cancers. A significant decline was observed only for HPV-unrelated cancers. The cohort effect was mainly attributed to HPV-unrelated cancer incidence, while the period effect largely contributed to HPV-related cancer incidence, but only among males.

Vector role and human biting activity of Anophelinae mosquitoes in different landscapes in the Brazilian Amazon.

BACKGROUND: Environmental disturbance, deforestation and socioeconomic factors all affect malaria incidence in tropical and subtropical endemic areas. Deforestation is the major driver of habitat loss and fragmentation, which frequently leads to shifts in the composition, abundance and spatial distribution of vector species. The goals of the present study were to: (i) identify anophelines found naturally infected with Plasmodium; (ii) measure the effects of landscape on the number of Nyssorhynchus darlingi, presence of Plasmodium-infected Anophelinae, human biting rate (HBR) and malaria cases; and (iii) determine the frequency and peak biting time of Plasmodium-infected mosquitoes and Ny. darlingi. METHODS: Anopheline mosquitoes were collected in peridomestic and forest edge habitats in seven municipalities in four Amazon Brazilian states. Females were identified to species and tested for Plasmodium by real-time PCR. Negative binomial regression was used to measure any association between deforestation and number of Ny. darlingi, number of Plasmodium-infected Anophelinae, HBR and malaria. Peak biting time of Ny. darlingi and Plasmodium-infected Anophelinae were determined in the 12-h collections. Binomial logistic regression measured the association between presence of Plasmodium-infected Anophelinae and landscape metrics and malaria cases. RESULTS: Ninety-one females of Ny. darlingi, Ny. rangeli, Ny. benarrochi B and Ny. konderi B were found to be infected with Plasmodium. Analysis showed that the number of malaria cases and the number of Plasmodium-infected Anophelinae were more prevalent in sites with higher edge density and intermediate forest cover (30-70%). The distance of the drainage network to a dwelling was inversely correlated to malaria risk. The peak biting time of Plasmodium-infected Anophelinae was 00:00-03:00 h. The presence of Plasmodium-infected mosquitoes was higher in landscapes with > 13 malaria cases. CONCLUSIONS: Nyssorhynchus darlingi, Ny. rangeli, Ny. benarrochi B and Ny. konderi B can be involved in malaria transmission in rural settlements. The highest fraction of Plasmodium-infected Anophelinae was caught from midnight to 03:00 h. In some Amazonian localities, the highest exposure to infectious bites occurs when residents are sleeping, but transmission can occur throughout the night. Forest fragmentation favors increases in both malaria and the occurrence of Plasmodium-infected mosquitoes in peridomestic habitat. The use of insecticide-impregnated mosquito nets can decrease human exposure to infectious Anophelinae and malaria transmission.

Factors associated with deterioration of self-rated chewing ability among adults aged 60 years and older over a 6-year period.

AIM: To assess factors associated with the deterioration of self-rated chewing ability among adults aged 60 years and older over a 6-year period. METHODS: We carried out a case-control study nested in a cohort involving 890 individuals living in the city of Sao Paulo from 2000 to 2006. The outcome was the reduction of self-rated chewing ability. Covariates on demographic, socioeconomic, behavior, cognitive, and functional and physical status variables were investigated. Simple and multiple analyses were carried out using unconditional logistic regression with hierarchical selection of variables. RESULTS: We analyzed 236 cases and 654 controls. In the unadjusted assessment, the reduction of self-rated chewing ability was associated with being aged older than 74 years, widowed, low schooling/income, not having a microwave oven or a car, physical inactivity, poor/regular self-rated health, to feel disgusted, poor/regular self-rated memory, one or more compromised daily life activities, dependence for daily life activities and to report less than half of teeth. Older adults aged older than 74 years and widowers had twice the odds of the outcome in the final model. Adjusted for demographic variables, individuals with lower income showed a similar increase of odds (OR 2.06 95% CI 1.31-3.23). To report poor/regular memory (OR 1.85 95% CI 1.28-2.67) and less than half remaining teeth (OR 1.76 95%CI 1.06-2.93) were significant factors in the adjusted model. CONCLUSION: Advanced age, low income, widowhood, poor/regular memory and less than half remaining teeth were important risk indicators for the reduction of self-rated chewing ability among individuals aged 60 years or older.

Prolonged pacifier use during infancy and smoking initiation in adolescence: evidence from a historical cohort study.

AIM: To investigate the association between prolonged pacifier use during childhood and smoking in adolescence and early adulthood. METHODS: A historical cohort study including patients from a dental private office was designed. Dental records were used, which contained complete data about sucking habits from 314 children (2-10 years of age) who had attended a private dental office from 1988 to 1994 in Ibiá, Brazil. Then, we collected data about the smoking habits from 261 subjects who were successfully contacted again from 2004 to 2006. Our outcome variable was smoking, and subjects who had smoked more than 100 cigarettes during their lifetime were classified as smokers. Poisson regression analysis matched the association between oral habits and smoking. Incidence rate ratios (IRR) and 95% confidence intervals (95% CI) were calculated. The level of significance was set at 5%. RESULTS: We observed a statistically significant association between prolonged pacifier use (more than 24 months) and smoking (IRR = 4.48; 95% CI 2.32-8.65). Breastfeeding, in contrast, was a protective factor (IRR = 0.64; 95% CI 0.42-0.96). CONCLUSIONS: Prolonged pacifier use during childhood is positively associated with smoking initiation in adolescence and early adulthood.

Is income area level associated with blood pressure in adults regardless of individual-level characteristics? A multilevel approach.

This population-based health survey was carried out in Florianopolis, Brazil, to assess the association between adult systolic blood pressure (SBP) and contextual income level, after controlling for potential individual-level confounders. A statistically significant negative association between SBP levels and contextual income was identified after adjusting for individual-level characteristics. SBP levels in the highest and in the intermediate tertiles of contextual income were 5.78 and 2.82 mm Hg lower, respectively, than that observed in the bottom tertile. The findings suggest an association between income area level and blood pressure, regardless of well-known individual-level hypertension risk factors.

Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach.

BACKGROUND: Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level. OBJECTIVES: To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics. METHODS: The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed. RESULTS: Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics. CONCLUSIONS: Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

[Dental caries in Brazil: decline, polarization, inequality and social exclusion]. / Cárie dentária no Brasil: declínio, polarização, iniqüidade e exclusão social.

OBJECTIVE: To examine the caries situation in Brazilian schoolchildren between 1980 and 2003 and to determine the distribution of caries and access to treatment in this population group. METHODS: We employed secondary data concerning the number of decayed, missing or filled teeth (DMFT). The studies whose data were used differed in terms of study type, study design, sampling methods, and diagnostic criteria, but yielded national estimates that are considered valid for the DMFT index. Therefore, a trend analysis based on these studies was thought to be feasible. RESULTS: Analysis of DMFT values revealed a high frequency of dental caries in 1980 and a moderate frequency in the 1990s. In 2003, the DMFT index was still within the moderate range. Between 1980 and 2003, a 61.7% decrease in DMFT frequency was observed. The percentage of children with no DMFT increased from 3.7% in 1986 to 31.1% in 2003. On the other hand, in the segment of the study population least affected, the percentage of children who received care increased from 26.3 in 1986 to 34.7 in 2003, yet in the group with DMFT this percentage fell from 50.2 in 1986 to 39.3 in 2003. In the segment with DMFT >/=6, the percentage of those who received care remained stable (28%). During the study period, 60% of the dental caries were found in 20% of the study population. CONCLUSION: An important decline in DMFT was observed between 1980 and 2003, perhaps as a result of increased access to fluoridated water and toothpaste and of changes in the goals of public oral health programs. Despite the improvement, caries is unevenly distributed in the pediatric population; a small proportion of individuals carries most of the disease burden. In addition, the proportion of teeth with caries that went untreated did not change between 1980 and 2003. Reducing socioeconomic disparities and adopting public health measures that target and reach the most vulnerable groups remain a challenge for policy makers in Brazil.

Cárie dentária no Brasil: declínio, polarização, iniqüidade e exclusão social / Dental caries in Brazil: decline, polarization, inequality and social exclusion

OBJETIVO: Analisar a evolução da experiência de cárie dentária entre escolares brasileiros no período de 1980 a 2003 e determinar a distribuição da cárie e o acesso dessa população ao tratamento da doença. MÉTODO: Foram utilizados dados secundários produzidos no período de 1980 a 2003, empregando o índice dentes permanentes cariados, perdidos e restaurados (CPOD). Os estudos que deram origem aos dados variaram quanto ao tipo de investigação, delineamento, plano amostral e critério diagnóstico para a doença, mas produziram estimativas nacionais consideradas válidas para os valores do índice CPOD, admitindo-se como possível a presente análise de tendência. RESULTADOS: Os valores de CPOD indicaram um nível alto de cárie dentária nos anos 1980, declinando para um nível moderado nos anos 1990. Em 2003, o valor do CPOD ainda era moderado (2,8). Entre 1980 e 2003, o declínio nos valores do CPOD foi de 61,7 por cento. A porcentagem de escolares com CPOD igual a zero aumentou de 3,7 por cento em 1986 para 31,1 por cento em 2003. Por outro lado, enquanto no segmento menos atingido pela doença (CPOD de 1 a 3), o índice de cuidados aumentou de 26,3 por cento em 1986 para 34,7 por cento em 2003, no segmento com CPOD de 4 a 5 o índice de cuidados caiu de 50,2 por cento em 1986 para 39,3 por cento em 2003. No segmento com CPOD de 6 ou mais, o índice de cuidados se manteve estável (28.0 por cento). Aproximadamente 20 por cento da população passou a concentrar cerca de 60 por cento da carga de doença. CONCLUSÃO: Um declínio relevante do CPOD foi observado no período do estudo, sendo a hipótese explicativa mais plausível a elevação no acesso a água e creme dental fluorados e as mudanças nos programas de saúde bucal coletiva. A despeito da melhora, a distribuição da cárie ainda é desigual. Os dentes atingidos por cárie passaram a se concentrar numa proporção menor de indivíduos. Ademais, não se alterou a proporção de dentes cariados não tratados. A redução das disparidades socioeconômicas e medidas de saúde pública dirigidas aos grupos mais vulneráveis permanecem como um desafio para todos os que formulam e implementam as políticas públicas no Brasil.

Fluoreto em água: estudo de metodologia analítica e níveis encontrados na Regiäo de Campinas / Fluoride in water: analytical methodology study and levels and found in Campinas'Region

Foi efetuado estudo comparativo de três métodos analíticos para a determinaçäo de fluoreto em água de abastecimento: SPADNS, alizarina com disco comparador colorimétrico e eletrodo de íon seletivo; este último foi selecionado como o mais adequado para o controle de fluoreto em águas para a rede de Láboratórios de Saúde Pública, devido a sua exatidäo, precisäo e rapidez. Foram analisadas 759 amostras de águas de abastecimento público dos municípios da regiäo de Campinas, de janeiro a julho de 1994, com o objetivo de subsídiar as autoridades sanitárias. Foi observado que dos 76 municípios estudados apenas 33, 43,4(por cento) fluoretaram com regularidade; 9, 11,8(por cento) fluoretaram de modo descontinuo e 30, 39,5(por cento) näo procederam a fluoretaçäo. Os dados obtidos demonstraram a importância de lavantamentos sistemáticos para instruir a açäo da vigilância, uma vez que, comparando-se estes resultados com levantamento realizado em 1991, constatou-se uma sgnificativa reduçäo no número de municípios que efetuaram a fluoretaçäo de modo regular.