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1.
Eur J Cancer ; 130: 81-91, 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32179449

RESUMO

OBJECTIVES: The study investigated the association between hospital volume and observed survival of patients with a head and neck squamous cell carcinoma (HNSCC). METHODS: Overall, 9245 patients diagnosed with HNSCC between 2009 and 2014, were identified in the population-based Belgian Cancer Registry. This database was coupled with other databases providing information on diagnostic and therapeutic procedures, vital status, and comorbidities. The overall and relative survival probabilities were estimated using the Kaplan-Meier and the Ederer II methods, respectively. The relation between hospital volume and observed survival since diagnosis was then assessed using Cox proportional hazard models adjusted for potential confounders. RESULTS: The care for patients with HNSCC in Belgium was dispersed over more than 99 centres with half of the centres treating four or less patients with HNSCC per year. Survival probabilities were significantly better for patients treated in higher volume centres (>20 patients/year): the median survival of patients treated in these centres was 1.1 year longer (5.1 versus 4.0 years) than in lower volume centres. This association was confirmed in analyses taking the case-mix between hospitals into account: the hazard to die of any cause decreased on average with 0.4% per increase of one additionally treated patient. Beyond 20 assigned patients per year, there was no further decrease in the hazard to die. CONCLUSIONS: Statistically significant and clinically relevant improved survival probabilities were obtained in patients treated in higher volume centres (>20 patients/year) compared with their peers treated in lower volume centres. This supports the recommendation to concentrate the care for patients with HNSCC in reference centres.

2.
Oral Oncol ; 102: 104561, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31918175

RESUMO

OBJECTIVES: This study aims to investigate the relationship between comorbidities and therapeutic delay, post-treatment mortality, overall and relative survival in patients diagnosed with squamous cell carcinoma of the head and neck (HNSCC). PATIENTS AND METHODS: 9245 patients with a single HNSCC diagnosed between 2009 and 2014 were identified in the Belgian Cancer Registry. The Charlson Comorbidity Index (CCI) was calculated for 8812 patients (95.3%), distinguishing patients having none (0), mild (1-2), moderate (3-4) or severe comorbidity (>4). The relationship between CCI and therapeutic delay was evaluated using the Spearman correlation. Post-treatment mortality was modelled with logistic regression, using death within 30 days as the event. The association between comorbidity and survival was assessed using Cox proportional hazard models. RESULTS: Among 8812 patients with a known CCI, 39.2% had at least one comorbidity. Therapeutic delay increased from 31 to 36 days when the CCI worsened from 0 to 4 (rho = 0.087). After case-mix adjustment, higher baseline comorbidity was associated with increased post-surgery mortality (mild, OR 3.52 [95% CI 1.91-6.49]; severe, OR 18.71 [95% CI 6.85-51.12]) and post-radiotherapy mortality (mild, OR 2.23 [95% CI 1.56-3.19]; severe, OR 9.33 [95% CI 4.83-18.01]) and with reduced overall survival (mild, HR 1.39, [95% CI 1.31-1.48]; severe, HR 2.41 [95% CI 2.00-2.90]). That was also the case for relative survival in unadjusted analyses (mild, EHR 1.77 [95% CI 1.64-1.92]; severe, EHR = 4.15 [95% CI 3.43-5.02]). CONCLUSION: Comorbidity is significantly related to therapeutic delay, post-treatment mortality, 5-year overall and relative survival in HNSCC patients. Therapeutic decision support tools should optimally integrate comorbidity.

3.
Front Oncol ; 9: 1006, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31649876

RESUMO

Aims: The study assessed the quality of diagnosis and staging offered to patients with a head and neck squamous cell carcinoma (HNSCC) and the variability across Belgian hospitals. Methods: In total, 9,245 patients diagnosed with HNSCC between 2009 and 2014, were identified in the population-based Belgian Cancer Registry (BCR). The BCR data were coupled with other databases providing information on diagnostic and therapeutic procedures reimbursed by the compulsory health insurance, vital status data, and comorbidities. The use of diagnosis and staging procedures was assessed by four quality indicators (QI) (i.e., use of dedicated head and neck imaging studies, use of PET-CT, TNM reporting and interval between diagnosis and start of treatment), for which a target was defined before the analysis. The association between the binary QIs and observed survival was assessed using Cox proportional hazard models adjusted for potential confounders. Results: Overall, 82.5% of patients received staging by MRI and/or CT of the head and neck region before the start of treatment. In 47.6% of stage III-IV patients eligible for treatment with curative intent, a whole-body FDG-PET(/CT) was performed. The proportion of patients whose cTNM and pTNM stage was reported to the BCR was 80.5 and 78.4%, respectively. The median interval from diagnosis to first treatment with curative intent was 32 days (IQR: 19-46). For none of these QIs the pre-set targets were reached and a substantial variability between centers was observed for all quality indicators. No binary QI was significantly associated with observed survival. Conclusions: The four quality indicators related to diagnosis and staging in HNSCC all showed substantial room for improvement. For none of them the pre-set targets were met at the national level and the variability between centers was substantial. Each Belgian hospital received an individual feedback report in order to stimulate reflection and quality improvement processes.

4.
Int Dent J ; 69(6): 480-487, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31376156

RESUMO

OBJECTIVES: To describe antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 until 2016. MATERIALS AND METHODS: Reimbursement data from the Belgian National Institute for Health and Disability Insurance were analysed to evaluate antimicrobial prescribing (WHO ATC-codes J01/P01AB). Utilisation was expressed in defined daily doses (DDDs), and in DDDs and packages per 1000 inhabitants per day (DID and PID, respectively). Additionally, the number of DDD and packages per prescriber was calculated. RESULTS: In 2016, the dentistry-related prescribing rate of 'Antibacterials for systemic use' (J01) and 'Antiprotozoals' (P01AB) was 1.607 and 0.014 DID, respectively. From 2010 to 2016, the DID rate of J01 increased by 6.3%, while the PID rate declined by 6.7%. Amoxicillin and amoxicillin with an enzyme inhibitor were the most often prescribed products, followed by clindamycin, clarithromycin, doxycycline, azithromycin and metronidazole. The proportion of amoxicillin relative to amoxicillin with an enzyme inhibitor was low. The narrow-spectrum antibiotic penicillin V was almost never prescribed. CONCLUSIONS: Antibiotics typically classified as broad- or extended-spectrum were prescribed most often by Belgian dentists during the period 2000-2016. Although the DID rate of all 'Antibacterials for systemic use' (J01) increased over the years, the number of prescriptions per dentist decreased since 2013. The high prescription level of amoxicillin with an enzyme inhibitor is particularly worrying. It indicates that there is a need for comprehensive clinical practice guidelines for Belgian dentists.


Assuntos
Anti-Infecciosos , Assistência Ambulatorial , Antibacterianos , Bélgica , Odontólogos , Humanos
5.
Int J Surg ; 45: 118-124, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28734963

RESUMO

BACKGROUND: In the last decades, day surgery has steadily and significantly grown in many countries, yet the increase has been uneven. There are large variations in day-surgery activity between countries, but also within countries between hospitals and surgeons. This paper explores the variability in day-care activity for elective surgical procedures between Belgian hospitals. MATERIALS AND METHODS: The administrative hospital data of all patients formally admitted in a Belgian hospital for inpatient or day-care surgery between 2011 and 2013 were analysed and summarized in graphs. During 11 expert meetings with ad-hoc surgical expert groups the variability in day-surgery share between hospitals was discussed in depth. RESULTS: The variability in day-care share between Belgian hospitals is considerable. For 37 out of 486 elective surgical procedures, the variability ranged between 0 and 100%. High national day-care rates do not preclude room for improvement for certain hospitals as for the majority of these procedures there are "low performers". According to the consulted clinical experts, the high variability in day-care share may for the greater part be explained by medical team related factors, customs and traditions, the lack of clinical guidelines, financial factors, organisational factors and patient related factors. CONCLUSION: If a further expansion of day surgery is envisaged in Belgium the factors that contribute to the current variability in day-surgery rates between hospitals should be addressed. In addition, a feedback system in which hospitals and health care providers have the figures on their percentage of procedures carried out in day surgery compared to other hospitals and care providers (benchmarking) and the monitoring of a number of quality indicators (e.g. unplanned readmission, unplanned inpatient stay, emergency department visit) should be installed.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Procedimentos Cirúrgicos Eletivos/economia , Preços Hospitalares , Procedimentos Cirúrgicos Ambulatórios/normas , Bélgica , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Política Organizacional
6.
Int J Radiat Oncol Biol Phys ; 95(1): 267-278, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27084646

RESUMO

Because it spares many normal tissues and reduces the integral dose, proton therapy (PT) is the preferred tumor irradiation technique for treating childhood cancer. However, to the best of our knowledge, no systematic review of the clinical effectiveness of PT in children has been reported in the scientific literature. A systematic search for clinical outcome studies on PT published between 2007 and 2015 was performed in Medline (through OVID), EMBASE, and the Cochrane Library. Twenty-three primary studies were identified, including approximately 650 patients overall. The median/mean follow-up times were limited (range, 19-91 months). None of the studies were randomized, 2 were comparative, and 20 were retrospective. Most suffered from serious methodologic limitations, yielding a very low level of clinical evidence for the outcomes in all indications. For example, for retinoblastoma, very low-level evidence was found that PT might decrease the incidence of second malignancies. For chondrosarcoma, chordoma, craniopharyngioma, ependymoma, esthesioneuroblastoma, Ewing sarcoma, central nervous system germinoma, glioma, medulloblastoma, osteosarcoma, and rhabdomyosarcoma, there was insufficient evidence to either support or refute PT in children. For pelvic sarcoma (ie, nonrhabdomyosarcoma and non-Ewing sarcoma), pineal parenchymal tumor, primitive neuroectodermal tumor, and "adult-type" soft tissue sarcoma, no studies were identified that fulfilled the inclusion criteria. Although there is no doubt that PT reduces the radiation dose to normal tissues and organs, to date the critical clinical data on the long-term effectiveness and harm associated with the use of PT in the 15 pediatric cancers under investigation are lacking. High-quality clinical research in this area is needed.


Assuntos
Neoplasias/radioterapia , Terapia com Prótons , Adolescente , Criança , Pré-Escolar , Seguimentos , Humanos , Lactente , Recém-Nascido , Neoplasias/classificação , Tratamentos com Preservação do Órgão/métodos , Órgãos em Risco/efeitos da radiação , Lesões por Radiação/prevenção & controle , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
7.
Eur J Public Health ; 24(6): 893-8, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24367066

RESUMO

OBJECTIVE: This study evaluates the effectiveness of a multi-component oral health intervention in preschool children in a non-randomized intervention study with a complementary baseline control. METHODS: Participants in the main study were 2137 children born between October 2003 and July 2004 in Flanders, Belgium. In the intervention group (50.5% of participants), an oral health education program was added to a standard preventive care program during the first 3 years of life. Oral health examinations were performed by trained dentists when the children were 3 (2007) and 5 (2009) years old. Data on dietary habits, oral hygiene habits and dental attendance were obtained through structured questionnaires. Regression analyses were applied to compare the results of the intervention and control group with baseline measurements obtained before the intervention (2003) in other cohorts of 3- (N = 1291) and 5-year-olds (N = 1325) living in the same regions. RESULTS: The prevalence of caries experience was generally lower in the main study compared with the baseline cohorts, with little differences between the intervention and control group. For the oral health-related behaviours, the control group scored mostly better. Nevertheless, compared with baseline, limited differences were observed in dental attendance, tooth brushing, helping with tooth brushing and consuming in-between drinks (P < 0.05). CONCLUSION: The study illustrates that a multi-component, theory-based intervention at community level had only a limited and temporary effect on oral health-related behaviours in the community under study. Further research is needed to determine how oral health in young children can be improved in the long term.


Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Higiene Bucal , Bélgica , Pré-Escolar , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
8.
Eur J Oral Sci ; 121(1): 36-42, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23331422

RESUMO

Reports on oral health-service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health-care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health-care utilization and socio-demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental-attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral-treatment needs.


Assuntos
Assistência Odontológica para Pessoas com Deficiências/estatística & dados numéricos , Assistência Odontológica/estatística & dados numéricos , Adulto , Bélgica , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Projetos Piloto
9.
Int J Paediatr Dent ; 23(1): 39-47, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22276749

RESUMO

BACKGROUND: Caries in preschool children remains an important public health issue. AIM: To determine (i) which teeth and tooth surfaces are most susceptible to dental caries by age 3, (ii) where do caries lesions develop during 2-year follow-up, and (iii) to evaluate the impact of caries onset on the distribution of new caries experience. DESIGN: One thousand and fifty seven consecutively born children were recruited in Flanders (Belgium). Parents completed validated questionnaires on oral health-related behaviour and trained dentists examined the children at ages 3 and 5. RESULTS: Children with visible caries experience at age 3 were significantly more vulnerable in developing additional caries during follow-up. In this group, new caries experience developed primarily in the occlusal and distal surfaces of the mandibular first molars and the occlusal surfaces of the maxillary second and first molars, whereas in the caries-free group, the occlusal surfaces of both mandibular and maxillary second molars ranked first. CONCLUSIONS: This paper confirms the higher vulnerability for further caries development in those children with caries experience at age 3. Visible caries develops most frequently in the occlusal surfaces of the second molars: in high-risk children already by age 3 and in children who were caries free at baseline by age 5.


Assuntos
Suscetibilidade à Cárie Dentária/fisiologia , Cárie Dentária/classificação , Bélgica , Pré-Escolar , Índice CPO , Cárie Dentária/fisiopatologia , Esmalte Dentário/patologia , Dentina/patologia , Escolaridade , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Incisivo/patologia , Dente Molar/patologia , Saúde Bucal , Pais/educação , Medição de Risco , Classe Social , Coroa do Dente/patologia
10.
Int J Paediatr Dent ; 23(2): 84-93, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22356279

RESUMO

BACKGROUND: At present, our understanding of the use of dental care services is incomplete, certainly where preschool children are concerned. OBJECTIVES: To investigate what proportion of 3- and 5-year-olds living in Flanders (Belgium) have already visited the dentist, to describe parents' experience about their child's dental visit, and to explore factors that may have an impact on children's early dental visit. DESIGN: Data were collected from 1057 children; validated questionnaires were completed, and children were examined by trained dentist at ages 3 and 5. Logistic regression analyses were performed to explain dental attendance. RESULTS: At the age of 3, 62% and by 5 years, 21% had never visited the dentist. The first dental visit was considered a pleasant experience for the majority of children. Multivariable regression analyses revealed that children who were not first born, whose mothers had a higher educational level and whose parents had recently visited the dentist, had significantly higher odds for having visited the dentist at young age. CONCLUSIONS: Parents of young children need to be informed about and motivated for an early dental visit. Promotion campaigns should focus on firstborn children, children from less educated parents, and parents who do not regularly see a dentist.


Assuntos
Assistência Odontológica para Crianças/estatística & dados numéricos , Atitude Frente a Saúde , Bélgica , Ordem de Nascimento , Pré-Escolar , Estudos de Coortes , Serviços de Saúde Bucal/estatística & dados numéricos , Relações Dentista-Paciente , Escolaridade , Programas Gente Saudável , Humanos , Modelos Logísticos , Higiene Bucal/estatística & dados numéricos , Pais , Estudos Prospectivos , Fatores Socioeconômicos , Inquéritos e Questionários
11.
Clin Oral Investig ; 17(8): 1855-61, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23135426

RESUMO

OBJECTIVES: The objectives of this report were to survey the utilization of oral health care in children and adolescents with disabilities over a 7-year period and to compare these data with the utilization pattern of their peers without disabilities. For most countries, these data have not been published in the international literature so far. MATERIAL AND METHODS: The cohort used was the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents. The database comprised prospective data on oral and general health care utilization and sociodemographic variables collected from 2002 up to 2008. RESULTS: Data were available from 326 children and adolescents with and 53,589 without disabilities. Dental attendance rates were low in both subgroups: only 50 % had a dental visit in four or more of the seven observation years. Emergency oral and medical care was recorded significantly more often in children with disabilities whereas radiographs, restorations, and orthodontic assessments and treatments more frequently in children without disabilities. CONCLUSION: The present study demonstrated that dental attendance rates in both subgroups were low and that in those who attended, preventive oral health care was only infrequently attested. Further research is needed to elucidate whether the lower number of radiographs and restorations and the higher number of emergency visits observed in the subgroup with disabilities reflect unmet oral treatment needs. CLINICAL RELEVANCE: Objective data on health care utilization are essential to enable governments and stakeholders to devise appropriate care and to optimize access to care for persons with disabilities.


Assuntos
Serviços de Saúde Bucal/estatística & dados numéricos , Crianças com Deficiência , Saúde Bucal , Criança , Estudos de Coortes , Humanos
12.
Clin Oral Investig ; 17(8): 1869-78, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23192286

RESUMO

OBJECTIVES: The present study explored the objective and subjective oral health care needs and the association between both among Belgian adults with disabilities. MATERIALS AND METHODS: A two-stage sampling methodology was used to select a sample of adults (22-65 years old) with disabilities, from various types of residential settings, day care centers, and sheltered workplaces and spread over the ten provinces. Oral screenings were performed by 28 trained dentists; subjective oral health care needs were collected through questionnaires. RESULTS: Seven hundred seven adults with disabilities were recruited; from 656 (93 %), permission was obtained for an oral examination. In 467 (78 %) and 407 (68 %) participants, dental plaque and calculus, respectively, were observed. In 343 (56 %) participants, untreated caries lesions (into dentine) were recorded; 203 (33 %) participants had 20 or less teeth. The prosthetic replacement of missing teeth was poor. Exactly 228 (40 %) participants stated that they had a problem in the oral region, and 264 (48 %) indicated that they were in need of an appointment with a dentist. Barriers to consult a dentist were reported by 244 (42 %); fear (n = 87; 37 %), followed by financial and transportation problems (both, n = 68; 29 %), was the most frequently reported barrier. CONCLUSIONS: The preventive as well as curative oral care needs in Belgian adults with various forms of disabilities are very high. CLINICAL RELEVANCE: Efforts to tackle these vast oral health care needs should take into account the differences in needs and demands between subgroups and should comprise the improvement of access to proper care.


Assuntos
Pessoas com Deficiência , Necessidades e Demandas de Serviços de Saúde , Saúde Bucal , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Adulto Jovem
13.
Community Dent Oral Epidemiol ; 40 Suppl 1: 49-55, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22369709

RESUMO

OBJECTIVES: The aim of the present study was to investigate the pattern of emergence of permanent teeth using nonparametric techniques. MATERIALS AND METHODS: Data were obtained from the Signal-Tandmobiel project, a 6-year prospective dental study conducted in Flanders (Belgium) in which 4468 primary school children born in 1989 were annually examined. A new exploratory method for interval-censored data, the IC-biplot, was applied to estimate individual sequences of emergence. In addition, the method renders a nice graphical representation of both children and teeth in the plane where the individual sequences of emergence can easily be visualized. On the basis of the estimated individual sequences, their corresponding prevalences were calculated. RESULTS: The study revealed that between 7 and 13 different sequences of emergence can be expected depending on gender and quadrant. The prevalences of the most frequent sequences in girls varied from 35% to 85% depending on the quadrant, while in boys they varied from 28% to 32%. Most sequences in the maxilla start with 6-1-2 and in the mandible with 1-6-2. CONCLUSIONS: The IC-biplot is a flexible procedure that allows an easy visualization of the pattern of emergence of permanent teeth. Rank orders derived from the IC-biplot confirm rank orders suggested earlier in the literature.


Assuntos
Dentição Permanente , Erupção Dentária/fisiologia , Bélgica/epidemiologia , Criança , Inquéritos de Saúde Bucal , Feminino , Humanos , Masculino , Prevalência , Análise de Componente Principal , Estudos Prospectivos , Fatores Sexuais , Estatísticas não Paramétricas , Fatores de Tempo
14.
Clin Oral Investig ; 16(3): 805-12, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21695390

RESUMO

The main objective of this study was to identify the risk factors for the incidence of visible caries experience in a cohort of preschool children living in Flanders. Data were collected from 1,057 children; validated questionnaires on oral health-related behaviour were completed by parents at birth (2003-2004), at age 3 (2007) and 5 years (2009). At ages 3 and 5, the children were examined by trained dentists. Logistic regression analyses were performed with the following as outcome variables: visible caries experience at age 3 and increment in visible caries experience between ages 3 and 5. At ages 3 and 5, enamel and/or dentinal caries experience was observed in 22% and 41% of the cohort, respectively. The multivariable logistic regression analyses revealed that the presence of visible plaque accumulation on at least one primary tooth was a significant risk factor for visible caries experience at age 3 and for an increment in caries experience between ages 3 and 5. Children with previous caries experience at age 3 had significantly higher odds for new caries lesions at age 5. Presence of visible plaque and previous caries experience are confirmed as significant risk factors for visible caries experience in preschool children. Interventions aimed at caries prevention should focus on very young children and on the control of plaque accumulation. The presence of visible plaque accumulation as a screening tool to identify young children at risk for future caries experience shows high potential.


Assuntos
Cárie Dentária/epidemiologia , Placa Dentária/epidemiologia , Bélgica/epidemiologia , Alimentação Artificial , Pré-Escolar , Estudos de Coortes , Índice CPO , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Incidência , Modelos Logísticos , Masculino , Pais/psicologia , Fatores de Risco , Inquéritos e Questionários
15.
BMC Oral Health ; 10: 8, 2010 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-20409298

RESUMO

BACKGROUND: This position paper was commissioned by the European Association of Dental Public Health, which has established six working groups to investigate the current status of six topics related to oral public health. One of these areas is epidemiology of periodontal diseases. METHODS: Two theses "A systematic review of definitions of periodontitis and the methods that have been used to identify periodontitis" 1 and "Factors affecting community oral health care needs and provision" 2 formed the starting point for this position paper. Additional relevant and more recent publications were retrieved through a MEDLINE search. RESULTS: The literature reveals a distinct lack of consensus and uniformity in the definition of periodontitis within epidemiological studies. There are also numerous differences in the methods used. The consequence is that data from studies using differing case definitions and differing survey methods are not easily interpretable or comparable. The limitations of the widely used Community Periodontal Index of Treatment Need (CPITN) and its more recent derivatives are widely recognized. Against this background, this position paper reviews the current evidence base, outlines existing problems and suggests how epidemiology of periodontal diseases may be improved. CONCLUSIONS: The remit of this working group was to review and discuss the existing evidence base of epidemiology of periodontal diseases and to identify future areas of work to further enhance it.


Assuntos
Pesquisa em Odontologia/métodos , Periodontite/epidemiologia , Projetos de Pesquisa/normas , Métodos Epidemiológicos , Humanos , Perda da Inserção Periodontal/diagnóstico , Índice Periodontal , Bolsa Periodontal/diagnóstico , Terminologia como Assunto
16.
J Dent ; 37(11): 865-71, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19643523

RESUMO

OBJECTIVES: A history of caries in the primary molars is associated with an advanced emergence of their permanent successors. Hence, caries in the primary molars may have an impact on the emergence order of the permanent teeth. The aim of the present study was to fully investigate the variability in permanent tooth emergence, taking into account the (caries) status of the primary molars. METHODS: For this purpose data available from the Signal Tandmobiel project were used. In this prospective longitudinal survey data were collected from a representative sample of 4468 children, examined yearly by trained dentist-examiners. Bayesian statistical analyses taking into account the interval-censored character of the data were performed. RESULTS: 56% of all examined primary molars were sound; between 2.5 and 7.2% of the first and second primary molars were extracted due to caries. When both primary molars were sound, the most prevalent emergence order was '4-3-5-7' (first premolar-canine-second premolar-second molar) in the maxilla and '3-4-5-7' in the mandible. When both maxillary primary molars were affected by caries (i.e., decayed, filled or extracted due to caries), the sequence '4-5-3-7' was the most prevalent whereas sequences '3-4-5-7' and '4-3-5-7' were less prevalent. When both mandibular primary molars were affected by caries, the prevalence of sequences '4-3-5-7', '4-3-7-5' and '4-5-3-7' increased whereas the prevalence of sequences '3-4-5-7' and '3-4-7-5' decreased. CONCLUSIONS: A history of caries in the primary molars is associated with an altered emergence order of canines, premolars and second molars.


Assuntos
Cárie Dentária/fisiopatologia , Erupção Dentária/fisiologia , Dente Decíduo/fisiopatologia , Teorema de Bayes , Criança , Índice CPO , Dentição Permanente , Feminino , Humanos , Masculino , Dente Molar/fisiopatologia , Estudos Prospectivos , Inquéritos e Questionários
17.
Community Dent Oral Epidemiol ; 36(2): 168-78, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18333881

RESUMO

OBJECTIVES: The aim of the present study was to examine the prevalence and severity of caries experience in the primary dentition of preschool children and to assess the association of disease distribution with oral hygiene levels, reported oral health behaviours and socio-demographic factors. METHODS: Study samples comprised 1250 3-year-old and 1283 5-year-old pre-school children from four distinct geographical areas in Flanders. Information on oral hygiene and dietary habits, oral health behaviours and socio-demographic variables was collected using questionnaires completed by the parents. Clinical examinations were performed using standardized criteria. Caries experience was recorded at the level of cavitation (d(3) level). Simple as well as multivariable logistic regression analyses were performed in order to identify factors associated with prevalence and severity of caries experience. RESULTS: Visible plaque was present in 31% of 3-year-olds and 37% of 5-year-olds. In 3-year-olds, 7% presented with caries experience while this was the case in 31% of 5-year-olds. Multivariable logistic regression revealed significant associations, in 3-year-olds, of caries experience with presence of dental plaque (OR = 7.93; 95% CI: 2.56-24.55) and reported consumption of sugared drinks at night (OR = 7.96; 95% CI: 1.57-40.51). In 5-year-olds, significant associations were seen with age (OR = 7.79; 95% CI: 2.38-25.43), gender (OR = 0.37 with 95% CI: 0.19-0.71 for girls), presence of visible dental plaque (OR = 3.36; 95% CI: 1.64-6.89) and reported habit of having sugar-containing drinks in between meals (OR = 2.60 with 95% CI: 1.16-5.84 and OR = 3.18 with 95% CI: 1.39-7.28, respectively for 1x/day and > 1x/day versus not every day). In 5-year-olds with caries experience (30.8% of total sample), the severity of disease was further analysed (d(3)mft between 1 and 4 versus d(3)mft 5 or higher). Multivariable analyses showed a significant association with gender [girls more likely to have higher disease levels; OR = 4.67 (95% CI: 1.65-13.21)] and with presence of plaque (OR = 3.91 with 95% CI: 1.23-12.42). CONCLUSIONS: Presence of visible plaque accumulation and reported consumption of sugared drinks were associated with prevalence of caries experience in Flemish preschool children. Severity of disease was associated with gender and with presence of plaque. Results underline the importance of plaque control and diet management from very young age on.


Assuntos
Cárie Dentária/epidemiologia , Cárie Dentária/patologia , Bélgica/epidemiologia , Pré-Escolar , Cárie Dentária/etiologia , Placa Dentária/complicações , Sacarose na Dieta/efeitos adversos , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Modelos Logísticos , Masculino , Higiene Bucal , Prevalência , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Dente Decíduo
18.
Eur J Oral Sci ; 116(1): 11-7, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18186726

RESUMO

The aim of the present study was to investigate the variability in permanent tooth emergence sequences in Flemish children. Data were obtained in the Signal-Tandmobiel project, a 6-yr prospective longitudinal oral health screening survey in Belgium. Bayesian statistical analyses, taking into account the interval-censored character of the data, were performed. The analyses indicated that no sequence was common in a quadrant to more than 19% of the sample. When only those emergence sequences are considered with a prevalence of 1% or more, 21 variations can be expected in the maxilla and 15-22 variations in the mandible. These variations 'cover' 84-88% of all sequences. The presentation of emergence sequences solely based on means or medians should thus be regarded as misleading.


Assuntos
Dentição Permanente , Erupção Dentária/fisiologia , Fatores Etários , Bélgica , Criança , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Mandíbula/fisiologia , Maxila/fisiologia , Polimorfismo Genético/fisiologia , Fatores Sexuais , Fatores de Tempo
20.
Quintessence Int ; 38(7): 555-64, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17694211

RESUMO

OBJECTIVES: To analyze the change in pattern of plaque accumulation on buccal and occlusal surfaces of permanent teeth and associated variables in a cohort of 4,468 children examined on a yearly basis between the ages of 7 and 12 years. METHOD AND MATERIALS: Oral hygiene level on buccal surfaces was assessed using the Plaque Index of Silness and Loe; for occlusal surfaces, a simplified version of the index as described by Carvalho et al was used. Data on oral health habits were collected using questionnaires completed by the parents and by the school health care center. Multiple ordinal logistic regression models using first-order generalized estimating equations were fitted to estimate population average effects taking into account the correlated structure of the data. RESULTS: Girls brushed significantly more frequently than boys (as reported by the parents) and presented with significantly less dental plaque. In all survey years, starting to brush at a young age, no daily consumption of sugar-containing drinks, and brushing at least twice a day were significantly associated with lower plaque accumulation scores. Parental help did not seem to influence the accumulation of occlusal plaque, but it did influence the amount of buccal plaque on incisors and premolars at older ages. The presence of sealants was significantly associated with less dental plaque. CONCLUSION: Regarding future policies for preventive strategies in schoolchildren, help with brushing at older ages can be recommended. Application of sealants can be encouraged, but further research is needed to confirm whether the presence of sealants improves oral cleanliness.


Assuntos
Placa Dentária/epidemiologia , Escovação Dentária/estatística & dados numéricos , Bélgica/epidemiologia , Distribuição de Qui-Quadrado , Criança , Placa Dentária/etiologia , Placa Dentária/prevenção & controle , Índice de Placa Dentária , Dentição Permanente , Dieta Cariogênica , Comportamento Alimentar , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Índice de Higiene Oral , Selantes de Fossas e Fissuras , Fatores Sexuais , Inquéritos e Questionários
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