Dental health status and oral health-related quality of life in older people of Puerto Montt, Chile / Estado de salud dental y calidad de vida relacionada a salud bucal en personas mayores, de Puerto Montt, Chile

Abstract: Introduction: Older people tend to have poor oral health, which can affect their quality of life. This study aimed to explore the relationship of the Oral Health-Related Quality of Life (OHRQoL) with sociodemographic variables and the dental health status of older people who belong to Elderly Clubs in the district of Puerto Montt, Chile. Material and methods: A cross-sectional study was carried out in 140 elderly people from Elderly Clubs in the district of Puerto Montt, Chile. Sociodemographic and dental variables were studied using a questionnaire and clinical examination. The GOHAI instrument validated in Chile was applied to measure the OHRQoL. Results: The mean of the total GOHAI was 50.8±8.6 points, and the median was 53. Of the 140 elderly people, 87.9% were females, the means of age and years of education were 73.2±6.2 and 7.5±4.4 years, respectively. 30% were edentulous, the number of remaining teeth was 7.8±8.1, the OHI-S was 1.3±1.0. 85.7% wore dentures, and the time of denture wearing was 8.8±9.4 years. Significant associations were found between the total GOHAI and non-belonging to an indigenous people (p=0.024), being edentulous (p=0.006), and the presence of healthy teeth (p=0.039). Conclusion: The GOHAI showed a significant relationship with not-belonging to an indigenous ethnicity, being edentulous, and the number of healthy teeth. The OHRQoL was higher in males, with formal education, edentulous, dentated without teeth mobility, with complete dentures, and moderate denture hygiene.

Introducción: Las personas mayores suelen presentar una salud bucal deficitaria, la que puede repercutir en su calidad de vida. El objetivo fue explorar la relación de la Calidad de Vida Relacionada a Salud Bucal (CVRSB) con variables sociodemográficas y del estado de salud dental en personas mayores pertenecientes a clubes del Adulto Mayor de la comuna de Puerto Montt, Chile. Material y Métodos: Se realizó un estudio transversal en 140 personas mayores de clubes del Adulto Mayor en Puerto Montt. Mediante cuestionario y examen clínico se estudiaron variables sociodemográficas y dentales y se aplicó el instrumento GOHAI validado en Chile para medir CVRSB. Resultados: La media del GOHAI total fue de 50.8±8.6 puntos y la mediana fue de 53. De las 140 personas mayores, 87.9% eran mujeres, las medias de edad y escolaridad fueron 73.2±6.2 y 7.5±4.4 años, respectivamente. El 30% era desdentado total, el número de piezas remanentes fue de 7.8±8.1, el IHO-S fue de 1.3±1.0. El 85.7% utilizaba prótesis, el tiempo de uso fue de 8.8±9.4 años. Se encontraron asociaciones significativas entre total GOHAI y la no-pertenencia a pueblo indígena (p=0.024), desdentamiento general (p=0.006) y la presencia de dientes sanos (p=0.039). Conclusión: El GOHAI presentó relación significativa con la no-pertenencia a pueblo Indígena, desdentamiento general y número de dientes sanos. La CVRSB fue mayor en hombres, con educación formal, edéntulos, dentados sin movilidad, portadores de prótesis totales e higiene de prótesis regular.

Salud bucal, higiene y hábitos bucales en personas con trastorno del espectro autista / Oral health, hygiene practices and oral habits of people with autism spectrum disorder

ABSTRACT Introduction: People with autism spectrum disorder have a higher risk of dental complications due to the characteristics of the condition itself. Objective: To describe the oral health status, hygiene practices and oral habits of a group of Chilean children, adolescents and adults with autism spectrum disorder. Methods: A descriptive study was conducted of 123 subjects with autism spectrum disorder. A questionnaire was applied which dealt with socio-demographic information, dental history, oral hygiene practices and oral habits. Each participating subject underwent oral examination to determine their experience with and prevalence of caries, scores on the Simplified Oral Hygiene Index and the gingival index, and the presence of dental trauma, deep/ogival palate, anterior open bite, and anterior and posterior crossbite. Results: 48 percent of the subjects with autism spectrum disorder brushed twice a day, and 68.0 percent required assisted tooth-brushing; 94.3 percent had oral habits, of which bruxism and oral breathing were the most frequent, accounting for 57.7 percent and 52.9 percent, respectively. Prevalence of caries was 33.3 percent, the dental caries index for permanent dentition was 1.1 ± 1.8, and the dental caries index for deciduous and permanent dentition was 2.6 ± 3.3. OHI-S for the 123 subjects was 1.30 ± 0.58. Conclusions: Most subjects required assistance with tooth-brushing and brushed twice a day. Bruxism and oral breathing were the most prevalent oral habits. A low prevalence of caries, a very low dental caries index for permanent dentition and a fair Oral Hygiene Index were observed in the 123 subjects with autism spectrum disorder(AU)

RESUMEN Introducción: Las personas con trastorno del espectro autista tienen un mayor riesgo de presentar complicaciones dentales, debido a las características propias de la enfermedad. Objetivo: Describir el estado de salud bucal, hábitos de higiene y hábitos bucales de un grupo de niños, adolescentes y adultos chilenos con trastorno del espectro autista. Métodos: Se realizó un estudio descriptivo de 123 sujetos con trastorno del espectro autista. Se aplicó un cuestionario sobre información socio-demográfica, antecedentes dentales, hábitos de higiene bucal y hábitos bucales, y se realizó un examen odontológico a cada participante para determinar la experiencia y prevalencia de caries, la puntuación según el índice de higiene bucal simplificado y el índice gingival, así como la presencia de traumatismo dentario, paladar profundo/ojival, mordida abierta anterior y mordida cruzada anterior y posterior. Resultados: El 48 por ciento de los sujetos con trastorno del espectro autista se cepillaba dos veces al día y el 68,0 por ciento tenía un cepillado asistido. El 94,3 por ciento presentaba hábitos bucales, de los cuales los más frecuentes eran el bruxismo con 57,7 por ciento y la respiración bucal con 52,9 por ciento. La prevalencia de caries fue de 33,3 por ciento, el índice total de caries en dentición permanente de 1,1 ± 1,8 y el índice total de caries en dentición temporal y permanente de 2,6 ± 3,3. El índice de higiene bucal simplificado para los 123 sujetos fue de 1,30 ± 0,58. Conclusiones: La mayor parte de los sujetos tenían un cepillado asistido y lo realizaban dos veces al día. Los hábitos bucales más prevalentes fueron el bruxismo y la respiración bucal. En los 123 sujetos con trastorno del espectro autista se observó una baja prevalencia de caries, un índice total de caries en dentición permanente muy bajo y un índice de higiene bucal regular(AU)

Conocimiento sobre enfermedad coronaria en familiares de pacientes con evento cardiovascular / Knowledge about coronary disease in relatives of patients with cardiovascular event

Objetivo: describir los conocimientos que refieren los familiares de sujetos con enfermedad cardiovascular, previo a la asistencia a un taller educativo. Materiales y métodos: estudio descriptivo en 103 familiares de pacientes con enfermedad cardiovascular, que participaron en talleres educativos relacionados con enfermedad coronaria entre marzo y agosto de 2013. Los talleres eran los siguientes: 1. La enfermedad coronaria; 2. Ejercicio en enfermedad cardiovascular; 3. Adherencia a medicamentos y 4. Factores psicosociales y enfermedad cardiovascular. Se compararon diferencias entre proporción de sujetos con conocimiento informal y formal en cada taller. Resultados:103 familiares participaron en los talleres (80% mujeres; edad promedio 49± 1.55años). El 39% refiere no tener ningún conocimiento respecto al tema a tratar. El 28% sí tiene conocimientos sobre el tema y la obtiene de fuentes informales como internet, diarios o revistas. Existió una proporción significativamente mayor de sujetos con conocimiento informal sobre ejercicio y adherencia a medicamentos. Conclusiones: estos resultados muestran que: hay poco conocimiento formal de enfermedad cardiovascular y del manejo de sus factores de riesgo, y alto nivel de apoyo del sexo femenino. La necesidad de educar, reforzar y aclarar el conocimiento para mejorar la adherencia al tratamiento y la prevención de nuevos eventos cardiovasculares, es un trabajo importante de enfermería, que debe desarrollarse prestando especial atención al entorno familiar del paciente..(AU)

Objective: to describe the knowledge referred by relatives of subjects with cardiovascular disease prior to attending an educational workshop. Materials and methods:descriptive study in 103 relatives of patients with cardiovascular disease, who participated in educational workshops related to coronary disease between March and August 2013. The workshops were the following: 1. Coronary disease; 2. Exercise in cardiovascular disease; 3. Adherence to medications and 4. Psychosocial factors and cardiovascular disease. Differences were compared between proportion of subjects with informal and formal knowledge in each workshop. Results: 103 relatives participated in the workshop (80% women, average age 49 ± 1.55 years). 39% report having no knowledge about the subject to be treated. 28% do have knowledge about the subject and get it from informal sources such as the internet, newspapers or magazines. There was a significantly higher proportion of subjects with informal knowledge about exercise and medication adherence. Conclusions: these results show that: there is little formal knowledge of cardiovascular disease and the management of its risk factors, and high level of support of the female sex. The need to educate, reinforce and clarify knowledge to improve adherence to treatment and the prevention of new cardiovascular events, is an important work of nursing, which should be developed paying special attention to the patient's family environment..(AU)

La ingesta de "once", en reemplazo de la cena, se asocia al riesgo de presentar síndrome metabólico / Five o'clock tea and the risk of metabolic syndrome

Background: Seventy four percent of Chileans replaced the traditional dinner for the consumption of "five o'clock tea" (5CT), a mealtime that includes bread and is simliar to western breakfast. The latter favors the intake of unhealthy foods. Aim: To study whether the consumption of "5CT", instead of dinner, could be a risk factor for the development of metabolic syndrome (MetSyn). Material and Methods: Anthropometric parameters, mean blood pressure, lipid profile, thyroid stimulating hormone and fasting glucose were measured in 489 subjects aged 39 ± 12 years (33% women) who attended a primary cardiovascular prevention (CV) program. A 24-hour recall and usual meal times were registered during a dietary interview. To determine the association between the consumption of "5CT" or dinner and the probability of presenting two or more components of MetSyn, we built an odds proportional model adjusted by age and sex. In addition, severity for MetSyn was calculated. Results: Nineteen percent of participants had MetSyn and 39%, two or more MetSyn components. Those who consumed "5CT" instead of dinner, had 54% more probability of having 2 or more MetSyn components (Odds ratio = 1.54, confidence intervals 1.032.32, p = 0.04). Participants who included processed carbohydrates in their last meal had a higher probability of having components of MetSyn. This probability decreased among participants who ate dinner with a low proportion of refined carbohydrates. Conclusions: Subjects who eat "5CT", instead of dinner as the last meal, have a higher cardiometabolic risk and MetSyn severity.

Cintura e índice de masa corporal: los mejores predictores antropométricos en la reducción y progresión de la agregación de factores de riesgo cardiometabólicos / Waist and body mass index: The best anthropometric predictors in the reduction and progression of the aggregation of cardiometabolic risk factor

El objetivo de este estudio fue determinar el impacto de la variación de distintas mediciones antropométricas en la evolución del síndrome metabólico (SM). El estudio fue prospectivo en 178 sujetos que asistieron a un programa de salud cardiovascular entre el año 2013 y 2016. Se recolectaron datos demográficos, historia médica, factores de riesgo cardiovascular, y se midió perfil lipídico, glicemia de ayuno, presión arterial y medidas antropométricas (IMC, perímetro de cintura y cadera y % de grasa corporal). Se consideró la agregación de 2 o más componentes de síndrome metabólico (SM), excluyendo cintura y se determinó la probabilidad de reversión del SM, considerándose como la reducción desde 2 o más componentes a 1 o ninguno. El tiempo de seguimiento promedio fue de 2 años. La edad promedio fue de 40 años y 37% eran mujeres. Según los modelos de odds proporcionales, ajustados por edad, sexo y tiempo de seguimiento, aquellos sujetos con 2 o más componentes de SM triplicaron su probabilidad de revertir el SM por cada reducción de 1 Kg/m2 de IMC por año (OR IMC = 3,03; 1,74-5,28; p<0,001). En el caso de cintura, esta probabilidad aumentó en 52% por la reducción de 1 cm por año (ORcintura =1,52; 1,28-1,81; p<0,001). Finalmente una reducción de 0,01 en el índice cintura/cadera aumentó en 26% la probabilidad de revertir el SM (ORcintura/cadera =1,26; 1,06-1,491; p<0,01); sin embargo, el % de grasa corporal no tuvo un efecto significativo Los cambios en IMC y circunferencia de cintura serían los parámetros antropométricos más confiables para monitorear la evolución del SM(AU)

The objective of this study was to determine the impact of variation of different anthropometric parameters at follow-up in the evolution of the metabolic syndrome (MetS). Prospective study in 178 subjects who attended a cardiovascular health program between 2013 and 2016. Demographical data, medical history and cardiovascular (CV) risk factors (RFs) were collected. In addition, fasting lipid profile, blood glucose, blood pressure and anthropometrical parameters (BMI, WC, hip, and fat percentage) were measured. To determine the evolution of MetS, the clustering of 2 or more of the MetS components were considered, excluding WC. Odds proportional models adjusted by age, sex and time of follow-up were built to determine the probability of reverting the MetS. MetS reversion was considered as the reduction to 1 or 0 components in subjects with 2 or more. Mean follow-up time was 2 years. Mean age was 40 years old and 37% were women. According to the odds proportional models, subjects tripled their chance of reverting MetS for each 1 kg/m2 of BMI reduction (ORBMI=3.03; 1.74-5.28; p<0.001). For WC, the chance of reverting MetS increased 52% for each reduction of 1 cm of waist (ORwaist =1.52; 1.28-1.81; p<0.001). A reduction of 0.01 in the waist to hip ratio increased in 26% the chance of reverting MetS (ORwaist/hip=1.26; 1.06-1.491; p<0.01); however, fat percentage did not have a significant effect on the evolution of the MetS. BMI and WC are the most reliable anthropometrical parameters for monitoring the evolution of MetS aggregation in the out-patient clinical setting(AU)

Superioridad del nuevo puntaje de riesgo ACC/AHA 2013 por sobre el puntaje de Framingham, en la predicción de riesgo de mortalidad cardiovascular en Santiago / Evaluation the American College of Cardiology and American Heart Association Predictive score for cardiovascular diseases

Background: Recently, the American College of Cardiology and American Heart Association (ACC/AHA) proposed a new cardiovascular risk (CV) score. Aim: To evaluate the new risk score (ACC/AHA 2013) in a Chilean population. Material and Methods: Between 2002 and 2014, body mass index (BMI), waist circumference, blood pressure, lipid profile and fasting blood glucose levels were measured and a survey about CV risk factors was responded by 3,284 subjects aged 40 to 79 years (38% females), living in urban Santiago. ACC/AHA 2013, FRAM and Chilean FRAM scores were calculated. All-cause mortality was determined in July 2014 by consulting the Death Registry of the Chilean Identification Service, with an average follow up of 7 ± 3 years. Results: The prevalence of risk factors were 78% for dyslipidemia, 37% for hypertension, 20% for smoking, 7% for diabetes, 20% for obesity and 54% for physical inactivity. The mean FRAM, Chilean FRAM and ACC/AHA scores were 8, 3 and 9%, respectively. During follow-up, 94 participants died and 34 deaths were of cardiovascular cause. Participants who died had a higher prevalence of hypertension (p < 0.01) and diabetes (p < 0. 01) and tended to be older (p = 0.06). The FRAM score for 10 years for deceased and surviving patients was 12 and 8%, respectively (p = NS). The figures for the Chilean FRAM were 5 and 2%, respectively (p = 0.09). The figures for the ACC/AHA 2013 score were 33 and 9%, respectively (p = 0.04). According to receiver operating characteristic curves, ACC/AHA 2013 had a higher area under de curve for CV mortality than FRAM and Chilean FRAM. Conclusions: The new ACC/AHA 2013 score, is better than traditional FRAM and Chilean FRAM scores in predicting cardiovascular mortality in a low risk population.

Impacto de un programa de rehabilitación cardiovascular fase II sobre la calidad de vida de los pacientes / Quality of life: impact of a phase II cardiovascular rehabilitation program

Antecedentes: La rehabilitación cardiovascular (RCV) ha demostrado mejorar la capacidad física (CF) y la calidad de vida. La relación de estos aspectos ha sido escasamente reportada en Chile. Objetivos: 1) Determinar el impacto de la RCV fase II sobre la calidad de vida, medida por la encuesta SF36 y, 2) determinar qué factores, relacionados con el paciente, pueden incidir en esta relación. Método: Estudio prospectivo en sujetos que completaron 36 sesiones de un programa de RCV y Prevención Secundaria (PREV2). Se registraron al ingreso y final de la RCV: antecedentes médicos, factores de riesgo cardiovascular (CV), parámetros antropométricos, previsión de salud, CF (determinada por los metros caminados en test de marcha de 6 minutos-TM6) y puntaje en la encuesta SF36. Resultados: 277 sujetos (78% hombres, edad 59 años). Hubo una mejoría significativa en: a) los metros caminados (diferencia final/inicial= 56 metros, p<0.0001), b) puntaje de salud física (68 vs 79; p<0.0001), c) salud emocional (68 vs 78, p<0.0001) del SF36. Los hombres caminaron más metros promedio (p<0.0001). Hubo una asociación significativa entre los deltas del TM6 final-inicial y SF36 final-inicial, sólo para salud física (p<0.01). Por un aumento de 10 metros caminados en el TM6 final se incrementa el puntaje de la SF36 para salud física (Hombres: 0.38/ Mujeres: 1.52). La mejoría en la salud emocional sólo se asoció significativamente con los cambios en la salud física (p<0.0001). Conclusion: Los pacientes que asisten a un programa de RCV mejoran significativamente su capacidad aeróbica, y su percepción de salud física y emocional.

Background: Cardiovascular rehabilitation (CVR) has been shown to improve functional capacity (FC) and quality of life. The relation between these aspects has been scarcely reported in Chile. Objectives: 1) To determine the impact of the CVR phase II program on quality of life as measured by the SF36 survey and 2) to determine which patient related factors can influence this relationship. Method: Prospective study in subjects who completed 36 sessions of an RCV and Secondary Prevention program (PREV2). Medical records, cardiovascular risk factors (CV), anthropometric parameters, health forecast, functional capacity (FC) (determined by meters walked on 6-minute Walking test-TM6) and SF36 scores were recorded at the beginning and end of the CVR. Results: Data on 277 subjects (78% men, age 59 years) was analyzed. There was a significant improvement in: a) walking meters (final / initial difference = 56 meters, p <0.0001), b) physical health score (68 vs 79, p <0.0001), c) emotional health (68 vs 78, p <0.0001) of the SF36. The men walked more meters (p <0.0001). There was a significant association between delta TM6 final-initial and SF36 final-initial only for physical health (p <0.01). For an increase of 10 meters walked in the final TM6, SF36 score for physical health increased 0.38 points in men ad 1.52 in women. Improvement in emotional health was significantly associated only with changes in physical health (p <0.0001). Conclusion: Patients attending a phase II cardiovascular rehabilitation program significantly improve their aerobic capacity, and their perception of physical and emotional health.

Actividad física y potencia aeróbica: ¿Cómo influyen sobre los factores de riesgo cardiovascular clásicos y emergentes? / Association between cardiorespiratory fitness and cardiovascular risk factors in healthy individuals

Background: Cardio respiratory fitness (FIT) is associated with a better profile in most modifiable cardiovascular risk factors (RF). In Chile, sedentary lifestyle is highly prevalent, reaching almost 90 percent. Aim: To determine the association between FIT and traditional and emergent RF in a primary prevention population. Material and methods: We prospectively studied 1973 subjects (36 percent women, mean age 56± 13 years) without history of cardiovascular disease and absence of ischemic changes on exercise testing. We assessed cardiovascular RF and determined body mass index (BMI), waist circumference, systolic and diastolic blood pressure, fasting blood lipids, glucose, C-reactive protein (CRP) and fibrinogen. FIT was measured by a Sci f-reported physical activity questionnaire and by a maximal treadmill exercise test, expressed in metabolic equivalents (METs). Results: Subjects in the highest FIT according to the treadmill test had significantly lower BMI, waist circumference, systolic and diastolic blood pressure, total cholesterol, triglycerides, glucose, CRP and fibrinogen, and higher HDL cholesterol (adjusted by age and gender). LDL cholesterol did not show significant changes. The same pattern of RF (including LDL cholesterol) and CRP was observed when using Sci f-reported physical activity as a FIT parameter There was a significant association between both methods to measure FIT (p <0.0001, Chi-square Mantel-Haenszel). Conclusions: Our findings show that a better level off IT, assessed by exercise testing or through Sci f report is associated with improved levels of traditional and emergent RF.

Relación entre capacidad aeróbica máxima, componentes del síndrome metabólico e inflamación subclínica en sujetos estudiados en una Unidad de Cardiología Preventiva Ambulatoria / Relationship between aerobic capacity, metabolic syndrome components and chronic subclinical inflammatory markers in subjects attending a primary prevention clinic

Antecedentes: El síndrome metabólico (SMET) está presente en uno de cada 4 sujetos en Chile. Existiría una relación directa entre el SMET y la inflamación subclínica crónica determinada por proteína C-reactiva ultrasensible (PCRus). La actividad física se asocia a un aumento en la sensibilidad a insulina y menor desarrollo de SMET y diabetes. Existe escasa información sobre la relación entre la actividad física, SMET y PCRus. Objetivos: Determinar la relación entre la capacidad aeróbica determinada por ergometría, los factores de riesgo del SMET y la inflamación subclínica en una población presuntamente sana. Métodos: Estudio prospectivo en una población estudiada en una unidad de cardiología preventiva ambulatoria entre noviembre de 2003 y agosto de 2005. En todos los sujetos se efectuó una evaluación sobre factores de riesgo cardiovascular, medición de IMC, cintura, cadera, perfil de lípidos, glicemia de ayuno, PCRus (desde marzo 2005), presión arterial sistólica y diastólica (PAS-PAD) en 2 días alternos, y test de esfuerzo máximo (frecuencia cardíaca alcanzada > 85 por ciento de la teórica o percepción de esfuerzo en escala de Borg > 17) medido en equivalentes metabólicos (METS). Resultados: Se estudiaron 1587 individuos (1016 hombres) de edad promedio 52 +/- 12 años. La mayoría (67 por ciento) tenía sobrepeso u obesidad, y un 25 por ciento cumplía con los criterios (ATP III) para SMET. Se demostró una correlación significativa entre la actividad física medida en METS con la edad (r= 0.57, p<0.001) y con algunos de los componentes del SMET como glicemia (r= - 0.16, p<0.001); HDL(r= -0.09, p<0.001) y PAS (r= -0.3, p<0.001). En la siguiente tabla se muestra la distribución de componentes del SMET y PCRus según cuartiles de actividad física: Los niveles de PCRus fueron significativamente menores en sujetos con SMET (+) y con mayor capacidad aeróbica versus los con menor...

Background: The metabolic syndrome (MS) is present in 1 out of 4 subjects in Chile. A direct relation between the presence of metabolic syndrome and chronic subclinical inflammation as revealed by ultra sensitive C reactive protein (CRP) has been postulated. Physical activity is associated with an increased insulin sensitivity and a lower incidence of MS and diabetes. There is limited information about the relation between physical activity, the MS and subclinical inflammation in healthy subjects. Aim: To determine the relationship between aerobic capacity measured by treadmill exercise testing, the components of MS and subclinical inflammation in a presumably healthy population. Methods: A prospective study was carried out in a primary prevention cardiac unit between november 2003 and august 2005. Risk factors for cardiovascular disease were evaluated. BMI, waist and hip circumference, fasting glucose, CRP, systolic and diastolic blood pressure were measured. METS were determined through an exercise test set to achieve 85 percent of maximal heart rate or a level 17 of Borg’s perceived effort. Results: 1587 subjects (1016 males) with mean age 52 years (SD 12) were studied. Most were overweight or obese: 25 percent met ATP III criteria for MS. METS were significantly correlated to age (r 0.57, p<0.001), fasting glucose level (r -0.16, p<0.001), HDL (r -0.09, p<0.001) and systolic BP (r -0.3, p<0.001). The distribution of mean values for MS components and CRP according to quartiles of METS is shown below: Conclusion: A strong association between aerobic capacity, MS factors and subclinical inflammation is shown in this study. It is postulated that exercise leading to improvement in aerobic capacity may have a beneficial effect upon chronic inflammation and cardiovascular risk.