Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries.

This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50 y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7% and ranged from 18.7% in China to 81.2% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20 percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.

Melatonin profiles during the third trimester of pregnancy and health status in the offspring among day and night workers: A case series.

Successful pregnancy requires adaptation in maternal physiology. During intrauterine life the mother's circadian timing system supports successful birth and postnatal development. Maternal melatonin is important to transmit circadian timing and day length to the fetus. This study aims to describe the third trimester of pregnancy among day (n = 5) and night (n = 3) workers by assessing their melatonin levels in a natural environment. Additionally, we describe the worker's metabolic profiles and compare the health status of the newborns between groups of day and night working mothers. Our results indicate an occurrence of assisted delivery (cesarean and forceps) among night workers. Moreover, the newborns of night workers showed lower Apgar index and breastfeeding difficulty indicating a worse condition to deal with the immediate outside the womb environment. Additionally, there was lower night-time melatonin production among pregnant night workers compared to day workers. These findings may be related to light-induced suppression of melatonin that occurs during night work. We conclude that night work and consequent exposure to light at unconventional times might compromise the success of pregnancy and the health of the newborn. Further studies need to be carried out to monitor pregnancy and newborn health in pregnant night workers.

Impact of shortened dental arches on oral health-related quality of life.

This study described the prevalence of adults with shortened dental arches (SDA) in Brazil, specifically assessing the differences of oral health-related quality of life [the prevalence and severity of oral impacts on daily performance (OIDP)] by dentition status. We analysed data from the 2010 National Survey of Oral Health in Brazil, including home interviews and oral examinations. The assessment of SDA used two alternative definitions: having 3-5 natural occlusal units (OUs) in posterior teeth or having 4 OUs in posterior teeth. Both definitions included having intact anterior region and no dental prosthesis. The analysis was weighted, and a complex sampling design was used. Negative binomial regression models assessed associations as adjusted for socio-demographic conditions and dental outcomes. A total of 9779 adults (35-44 years old) participated in the study. A non-negligible proportion had SDA: 9·9% and 3·8% for the first and second definition, respectively. Individuals with SDA (first definition) ranked higher in OIDP prevalence [count ratio (CR) 1·22; 1·09-1·36, 95% confidence interval (CI)] and severity (CR = 1·43; 1·19-1·72, 95% CI) than those with more natural teeth. This difference was not statistically significant when adjusted for socio-demographic and dental covariates: OIDP prevalence (CR = 1·04; 0·92-1·17, 95% CI) and severity (CR = 1·09; 0·91-1·30, 95% CI). Analogous results were obtained when the second definition of SDA was adopted. These findings suggest that a considerable contingent of adults may function well without dental prostheses, despite having several missing teeth. This conclusion challenges the traditional approach of replacing any missing tooth and instructs the allocation of more dental resources to preventive, diagnostic and restorative services.

Oral colonization by Candida species in AIDS pediatric patients.

The aim of this study was to assess the prevalence of factors associated with oral colonization by Candida spp. in pediatric patients with AIDS. The sample comprised of 117 children. Clinical status, medicines in use, and laboratory findings were obtained from hospital records; sociodemographic data were given by relatives. A dental examination assessed the prevalence of dental caries. The prevalence of oral colonization by Candida was 62%. Only seven children presented clinical manifestation of oral candidosis despite their high viral load index and low-for-age CD4 count. Candida colonization was directly associated with frequent use of antibiotics (prevalence ratio [PR] = 1.44), sulfa drugs (PR = 1.23), alteration in the oral mucosa (PR = 1.55), and untreated dental caries (PR = 1.93). It was inversely associated with the use of antiretroviral therapies (PR = 0.65). Candida albicans was the most frequently detected species (80%); phenotypic tests did not detect C. dubliniensis strains. This study observed a low prevalence of Candida-related oral lesions in these patients, which is compatible with the hypothesis that antiretroviral medicines may have contributed to reducing oral manifestations from Candida infection. The high prevalence of Candida colonization in HIV+/AIDS children with untreated dental caries reinforces the importance of oral health care in interdisciplinary health units that assist these patients.

The effect of performing corrections on reported uterine cancer mortality data in the city of São Paulo.

Reports of uterine cancer deaths that do not specify the subsite of the tumor threaten the quality of the epidemiologic appraisal of corpus and cervix uteri cancer mortality. The present study assessed the impact of correcting the estimated corpus and cervix uteri cancer mortality in the city of São Paulo, Brazil. The epidemiologic assessment of death rates comprised the estimation of magnitudes, trends (1980-2003), and area-level distribution based on three strategies: i) using uncorrected death certificate information; ii) correcting estimates of corpus and cervix uteri mortality by fully reallocating unspecified deaths to either one of these categories, and iii) partially correcting specified estimates by maintaining as unspecified a fraction of deaths certified as due to cancer of "uterus not otherwise specified". The proportion of uterine cancer deaths without subsite specification decreased from 42.9% in 1984 to 20.8% in 2003. Partial and full corrections resulted in considerable increases of cervix (31.3 and 48.8%, respectively) and corpus uteri (34.4 and 55.2%) cancer mortality. Partial correction did not change trends for subsite-specific uterine cancer mortality, whereas full correction did, thus representing an early indication of decrease for cervical neoplasms and stability for tumors of the corpus uteri in this population. Ecologic correlations between mortality and socioeconomic indices were unchanged for both strategies of correcting estimates. Reallocating unspecified uterine cancer mortality in contexts with a high proportion of these deaths has a considerable impact on the epidemiologic profile of mortality and provides more reliable estimates of cervix and corpus uteri cancer death rates and trends.

The effect of performing corrections on reported uterine cancer mortality data in the city of São Paulo

Reports of uterine cancer deaths that do not specify the subsite of the tumor threaten the quality of the epidemiologic appraisal of corpus and cervix uteri cancer mortality. The present study assessed the impact of correcting the estimated corpus and cervix uteri cancer mortality in the city of São Paulo, Brazil. The epidemiologic assessment of death rates comprised the estimation of magnitudes, trends (1980-2003), and area-level distribution based on three strategies: i) using uncorrected death certificate information; ii) correcting estimates of corpus and cervix uteri mortality by fully reallocating unspecified deaths to either one of these categories, and iii) partially correcting specified estimates by maintaining as unspecified a fraction of deaths certified as due to cancer of "uterus not otherwise specified". The proportion of uterine cancer deaths without subsite specification decreased from 42.9 percent in 1984 to 20.8 percent in 2003. Partial and full corrections resulted in considerable increases of cervix (31.3 and 48.8 percent, respectively) and corpus uteri (34.4 and 55.2 percent) cancer mortality. Partial correction did not change trends for subsite-specific uterine cancer mortality, whereas full correction did, thus representing an early indication of decrease for cervical neoplasms and stability for tumors of the corpus uteri in this population. Ecologic correlations between mortality and socioeconomic indices were unchanged for both strategies of correcting estimates. Reallocating unspecified uterine cancer mortality in contexts with a high proportion of these deaths has a considerable impact on the epidemiologic profile of mortality and provides more reliable estimates of cervix and corpus uteri cancer death rates and trends.

Volumetric and linear assessment of maxillary sinuses using computed tomography.

The purpose of this work was to compare linear and volumetric measurements of maxillary sinus (with and without lesion), using 3D (gold standard) and multiplanar reconstructions (MRP) by computed tomography in order to establish the precision and accuracy of these methods, determining which one would allow more effective assessments for this site. Linear measurements were performed in the maxillary sinus of 50 patients and compared with MPR and 3D images. We also analyzed the area and volume of this anatomic structure. Inter- and intra-observer average percentage errors for linear measurements were lower than 4%, the samples with lesion presenting higher values. The average error of accuracy was 4.94% for sinuses with lesion, and 7.41% for those without. We could verify that the antero-posterior and right-left measurements in axial view showed smaller figures of error when compared to sagittal and coronal reconstructions, respectively. The largest diameters observed for the sinuses had, in average, 39.6 mm in the antero-posterior direction, 28.35 mm in the right-left direction, and 36.3 mm in the supero-inferior. For the volume and area assessment, the values of error ranged lower than 9%, the highest values corresponding to the samples with lesion. The precision of measurements was inferior for maxillary sinus with lesion when compared with those without lesion. Measurements performed in the axial view were more precise than those performed in MPR images, and the coronal view measurements were considered to be more precise than the sagittal measurements.

Trends and patterns of cancer mortality in European countries.

This study aims at documenting differentials in the cancer mortality profile of European countries during the recent process of intense geo-political transformations. The World Health Organization Regional Office for Europe provided information on cancer mortality and several covariates for each country. In contrast with the European Union and Nordic countries, Central and Eastern Europe presented higher current levels and increasing trend of cancer mortality. Age-standardized rates for overall cancer mortality increased at an annual average of 2.43% in Central and Eastern European countries during the period from 1980 to 2001, while the European Union, Nordic countries and Switzerland underwent an average decrease of 7.27% per year. Trends in cancer death rates were associated with indices of welfare and socio-economic status at the country level: gross national product, health expenditure, unemployment, food intake, smoking habits and air pollution. Concurrent with this observation, we registered an extended gap in standings for these figures between richer and poorer European countries. These observations suggest that part of cancer mortality in Central and Eastern Europe could be prevented with current technology and health promotion. The drop of rates in Nordic and Western European countries indicates a progress in cancer control that, regrettably, does not hold for the whole Continent.