Dependence in instrumental activities of daily living and its implications for older adults' oral health.

We aimed to assess the association between dependence in instrumental activities of daily living (IADL) and oral health in older adults. We conducted a cross-sectional study of 280 people aged ≥60 years served at public primary health care centers in Northeastern Brazil. Sociodemographic, oral discomfort and general health data were collected. The Lawton and Brody scale were used to assess IADL. This research adheres to the STROBE checklist. Most participants were married (n = 139; 49.6%), women (n = 182; 65.0%) and retired (n = 212; 75.7%). A total of 37 (13.2%) older adults had some degree of dependence in IADL. Dependence in IADL was associated with: retirement (p<0.040), poor general health (p = 0.002), speech problems (p = 0.014), use of medications (p = 0.021), difficulty chewing and swallowing food (p = 0.011), voice changes (p = 0.044), edentulism (p = 0.011), use of toothbrush (p<0.001), use of toothpaste (p<0.001), and visit to the dentist in the previous year (p = 0.020). Functional disability was associated with older age, cardiovascular diseases, speech problems, chewing and swallowing difficulties, use of medication and brushing deficiency. The functional dependence in IADL can be considered an indicator of oral health status in older adults.

Subjective well-being and oral discomfort in older people.

ABSTRACTBackground:The study aims to assess the relationship between oral discomfort and subjective well-being (SWB) in older people. METHODS: A quantitative cross-sectional study was conducted in four Reference Centers for Social Welfare in Fortaleza, Northeastern Brazil. A census was held and individual interviews were carried out with all the older people (n = 246) enrolled in the centers. A questionnaire addressing sociodemographic data (age, gender, marital status, income, and education) and oral discomfort (dry mouth, difficulty in chewing and swallowing food, problems with the taste of food, burning mouth sensation, pain for no apparent reason, and mouth swelling) and the 62-item SWB scale were used. RESULTS: Participants were 246 people aged 60-89 years (mean of 69 ± 6.9 years). The majority were women (n = 199; 80.9%), had incomplete primary education (n = 161; 65.4%), had an income of up to one minimum wage (n = 182; 74%), were retired (n = 169; 68.7%), were white (n = 100; 40.7%), and had no partner (n = 177; 72%). The mean SWB score (subscale 1) was associated with age (p = 0.010), gender (p = 0.019), health in the previous year (p = 0.027), systemic diseases (p = 0.007), speech problems (p = 0.016), vision problems (p = 0.006), number of teeth (p = 0.010), and dry mouth (p = 0.044). SWB (subscale 2) was associated with gender (p = 0.029), skin color (p = 0.023), general health (p < 0.001), health in the previous year (p < 0.001), systemic diseases (p = 0.001), drinking (p = 0.022), soft tissue problems (p = 0.001), and pain for no apparent reason (p = 0.025). CONCLUSION: The relationship between oral discomfort and SWB reveals that older people's poor oral health leads to physical, psychological, and/or social problems that directly interfere with their well-being.

Older adults' dependence in activities of daily living: Implications for oral health.

OBJECTIVE: To assess the relationship between ADL and oral health status in older adults. DESIGN AND SAMPLE: Quantitative, analytical, cross-sectional research with 280 people aged ≥60 in public primary health care centers in the city of Fortaleza, Northeastern Brazil. MEASURES: Collection of sociodemographic data, oral discomfort data, and general health data and application of the Community Oral Health Indicator-COHI and the activities of daily living scale. RESULTS: Significant differences in functional dependence were found between age groups (p < .001), incomes (p = .034), and levels of education (p = .003). Tooth loss (OR = 2.13; p = 0.025), having no teeth (OR = 2.97), difficulties in chewing and swallowing food (OR = 2.56; p = 0.003), problems with taste of food (OR = 2.06; p = .044), poor self-rated general health (OR = 3.7; p = .001), hearing problems (OR = 2.23; p = .009) and speech problems (OR = 3.15; p = .002) increased chances for functional dependence. Dependent individuals were less likely to use toothpaste, thereby increasing the potential for caries (p = .013). Age 80 or older (p < .001), ages 70-79 (p < .001), three or more visible dental cavities (p = .030) and difficulty chewing and swallowing food (p = .027) remained associated with dependence in ADL in the logistic regression model. CONCLUSION: Functional dependence in activities of daily living has implications for the oral health status of older people.

Acute kidney injury in critically ill obstetric patients: a cross-sectional study in an intensive care unit in Northeast Brazil / Lesão renal aguda em pacientes obstétricas gravemente doentes: um estudo transversal em uma unidade de terapia intensiva do nordeste do Brasil

Abstract Introduction: Acute kidney injury (AKI) is a complication still poorly studied in the setting of obstetric patients, which is associated with increased mortality. Objective: The aim of this study was to investigate the frequency and risk factors of AKI among critically ill obstetric patients. Methods: A cross-sectional study was conducted with all patients admitted to an intensive care unit (ICU) due to obstetric complications, in Fortaleza, Brazil, in the period between January 2012 and December 2014. AKI was defined according to AKIN criteria. Results: A total of 389 patients were included, aged between 13 and 45 years. The main causes of ICU admission were pregnancy-related hypertensive syndromes (54.5%), hemorrhage and hemorrhagic shock (12.3%), heart diseases (9.0%), respiratory insufficiency (8.2%) and sepsis (5.4%). AKI was found in 92 cases (24%), and this was the most frequent complication. General mortality was 7.5%, and mortality due to AKI was 21% (p = 0.0007). In the multivariate analysis, risk factors for AKI were cesarian delivery (95% CI = 0.23-0.85, p = 0.01) and thrombocythopenia (95% CI = 1.50-4.36, p = 0.001). AKI was an independent risk factor for death (OR = 6.64, 95% CI = 3.11-14.15, p < 0.001). Conclusion: AKI was the main complication among critically ill obstetric patients and it was associated with increased mortality. Most cases were associated with pregnancy-related hypertensive disorders, which are complications that can be easily identified and treated during prenatal care.

Resumo Introdução: A lesão renal aguda (LRA) é uma complicação ainda pouco estudada no contexto das pacientes obstétricas, que está associada com aumento da mortalidade. Objetivo: Investigar a frequência e os fatores de risco da LRA entre pacientes obstétricas. Métodos: Foi realizado estudo transversal com todas as pacientes admitidas em uma unidade de terapia intensiva (UTI) devido a complicações obstétricas em Fortaleza, Brasil, no período de janeiro de 2012 a dezembro de 2014. LRA foi definida de acordo com o critério AKIN. Resultados: Foram incluídas 389 pacientes, com idade entre 13 e 45 anos. As principais causas de admissão na UTI foram síndromes hipertensivas da gestação (54,5%), hemorragia e choque hemorrágico (12,3%), cardiopatias (9,0%), insuficiência respiratória (8,2%) e sepse (5,4%). LRA foi encontrada em 92 casos (24%), e esta foi a complicação mais frequente. A mortalidade geral foi de 7,5%, e a mortalidade por LRA foi de 21% (p = 0,0007). Na análise multivariada, os fatores de risco para LRA foram parto cesariano (IC 95% = 0,23-0,85, p = 0,01) e plaquetopenia (IC 95% = 1,50-4,36, p = 0,001). LRA foi um fator de risco independente para óbito (OR = 6,64, IC 95% = 3,11-14,15, p < 0,001). Conclusão: LRA foi a complicação mais frequente em pacientes obstétricas gravemente doentes e esteve associada com aumento da mortalidade. A maioria dos casos esteve associada às síndromes hipertensivas da gravidez, que são complicações passíveis de tratamento durante o pré-natal.

Acute kidney injury in critically ill obstetric patients: a cross-sectional study in an intensive care unit in Northeast Brazil.

INTRODUCTION: Acute kidney injury (AKI) is a complication still poorly studied in the setting of obstetric patients, which is associated with increased mortality. Objective: The aim of this study was to investigate the frequency and risk factors of AKI among critically ill obstetric patients. METHODS: A cross-sectional study was conducted with all patients admitted to an intensive care unit (ICU) due to obstetric complications, in Fortaleza, Brazil, in the period between January 2012 and December 2014. AKI was defined according to AKIN criteria. RESULTS: A total of 389 patients were included, aged between 13 and 45 years. The main causes of ICU admission were pregnancy-related hypertensive syndromes (54.5%), hemorrhage and hemorrhagic shock (12.3%), heart diseases (9.0%), respiratory insufficiency (8.2%) and sepsis (5.4%). AKI was found in 92 cases (24%), and this was the most frequent complication. General mortality was 7.5%, and mortality due to AKI was 21% (p = 0.0007). In the multivariate analysis, risk factors for AKI were cesarian delivery (95% CI = 0.23-0.85, p = 0.01) and thrombocythopenia (95% CI = 1.50-4.36, p = 0.001). AKI was an independent risk factor for death (OR = 6.64, 95% CI = 3.11-14.15, p < 0.001). CONCLUSION: AKI was the main complication among critically ill obstetric patients and it was associated with increased mortality. Most cases were associated with pregnancy-related hypertensive disorders, which are complications that can be easily identified and treated during prenatal care.

Fatores associados à morte materna em unidade de terapia intensiva / Factors associated with maternal death in an intensive care unit

RESUMO Objetivo: Identificar os fatores associados à morte materna em pacientes internadas em unidade de terapia intensiva. Métodos: Estudo do tipo transversal realizado em unidade de terapia intensiva materna. Foram selecionados todos os prontuários de pacientes admitidas no período de janeiro de 2012 a dezembro de 2014. O critério de inclusão foi todas as pacientes obstétricas e puérperas, e o de exclusão as com diagnóstico de mola hidatiforme, gravidez ectópica e anembrionada, e as internadas por causas não obstétricas. Foi realizada análise comparativa entre os desfechos óbito e alta hospitalar. Resultados: Foram incluídas 373 pacientes, com idade entre 13 a 45 anos. As causas de internação na unidade de terapia intensiva foram síndromes hipertensivas relacionadas à gestação, cardiopatias, insuficiência respiratória e sepse; as complicações foram lesão renal aguda (24,1%), hipotensão (15,5%), hemorragia (10,2%) e sepse (6,7%). Ocorreram 28 óbitos (7,5%). As causas de óbito foram choque hemorrágico, falência múltipla de órgãos, insuficiência respiratória e sepse. Os fatores de risco independentes para óbito foram lesão renal aguda (OR = 6,77), hipotensão (OR = 15,08) e insuficiência respiratória (OR = 3,65). Conclusão: A frequência de óbitos foi baixa. Lesão renal aguda, hipotensão e insuficiência respiratória foram os fatores de risco independentes associados à mortalidade materna.

ABSTRACT Objective: To identify factors associated with maternal death in patients admitted to an intensive care unit. Methods: A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis. Results: A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65). Conclusion: The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death.

Factors associated with maternal death in an intensive care unit. / Fatores associados à morte materna em unidade de terapia intensiva.

OBJECTIVE:: To identify factors associated with maternal death in patients admitted to an intensive care unit. METHODS:: A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis. RESULTS:: A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65). CONCLUSION:: The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death.

Brazilian adolescents' oral health trends since 1986: an epidemiological observational study.

BACKGROUND: Oral health is part of general health, and in adolescence, it represents a good individual health indicator. Three country-based oral health epidemiological studies have been developed in Brazil (1986, 2003 and 2010). The objective of this study was to analyze oral disease trends among Brazilian adolescents and to compare these trends to the World Health Organization's goals with a focus on public health policies implemented between 1986 and 2010. METHODS: This is an epidemiological observational study performed with secondary data from Brazilian Oral Health surveys (1986, 2003 and 2010). The DMFT (number of decayed, missing and filled teeth) index was used for the 12-year-old and 15- to 19-year-old groups, and periodontal disease (CPI) and the percentage of individuals who needed and/or had prostheses were evaluated in the 15- to 19-year-old group. RESULTS: Between 1986 and 2010, DMFT decreased from 6.65 to 2.07 (68.9 % reduction) in the 12-year-old group and from 12.68 to 4.25 (66.5 % reduction) in the 15- to 19-year-old group. In all groups, the missing component had the strongest decrease. Adolescents had a reduction of 20.3 % in access to dental care. In 2003, in the 15- to 19-year-old group, 89.5 % of teenagers had at least one decayed tooth, while in 2010, the value was 76.1 %. In 2010, the percentage of adolescents without gingival problems varied among different regions of Brazil, with 30.8 % in the North and 56.8 % in the Southeast. Regarding DMFT, the difference between the North and Southeast Regions was 84 %. CONCLUSIONS: Improvement trends regarding adolescent oral health were observed, which seem to be supported by health education and promotion activities along with the reorganization of the Brazilian health system.