Triple Jeopardy in Oral Health: Additive Effects of Immigrant Status, Education, and Neighborhood.

PURPOSE: To estimate the additive effects of parent's nativity status/language spoken at country of birth, education, and area-level socioeconomic status (SES) on untreated dental caries among children aged 5 to 9 y in Australia. METHODS: Cross-sectional population-based data were obtained from the 2014 National Child Oral Health Study (N = 12,140). Indicators of social position used to explore additive effects on dental caries included nativity status, language, university degree, and neighborhood socioeconomic level. Multiple-way interactions were examined, and departure from additivity resulting from 2- and 3-way interactions were estimated as relative excess risk due to interaction (RERI). RESULTS: Children marginalized across multiple layers of disadvantage had substantially higher frequencies of dental caries compared with children in the most advantaged category. RERI for the 3-way interaction between immigrant status, education, and neighborhood SES was negative (RERI3: -0.14; 95% confidence interval [CI]: -1.68, 1.40). When operationalizing language, education, and neighborhood SES, the joint effect of the 3 marginalized positions was additive (RERI3: 0.43; 95% CI: -2.08, 2.95). CONCLUSION: Children marginalized across multiple intersecting axes of disadvantage bear the greatest burden of dental caries, with frequencies surpassing the cumulative effect of each social position alone. Findings emphasize the need to account for intersecting inequities and their oral health effects among children with immigrant backgrounds. KNOWLEDGE TRANSFER STATEMENT: Our analysis underscores the necessity for policies and public health strategies targeting dental caries-related inequities to comprehensively account for various indicators of social disadvantage, particularly encompassing language proficiency, educational attainment, and neighborhood socioeconomic status. Within the intricate interplay of these factors, we identify a vulnerable subgroup comprising children with the highest prevalence of dental decay. Therefore, prioritizing this specific demographic should be the focal point of policies and public health initiatives aimed at fostering equitable oral health outcomes.

The Relations between Systems of Oppression and Oral Care Access in the United States.

We applied a structural intersectionality approach to cross-sectionally examine the relationships between macro-level systems of oppression, their intersections, and access to oral care in the United States. Whether and the extent to which the provision of government-funded dental services attenuates the emerging patterns of associations was also assessed in the study. To accomplish these objectives, individual-level information from over 300,000 respondents of the 2010 US Behavioral Risk Factor Surveillance System was linked with state-level data for 2000 and 2010 on structural racism, structural sexism, and income inequality, as provided by Homan et al. Using multilevel models, we investigated the relationships between systems of oppression and restricted access to oral health services among respondents at the intersections of race, gender, and poverty. The degree to which extended provision of government-funded dental services weakens the observed associations was determined in models stratified by state-level coverage of oral care. Our analyses bring to the fore intersectional groups (e.g., non-Hispanic Black women and men below the poverty line) with the highest odds of not seeing a dentist in the previous year. We also show that residing in states where high levels of structural sexism and income inequality intersect was associated with 1.3 greater odds (95% confidence interval, 1.1-1.5) of not accessing dental services in the 12 mo preceding the survey. Stratified analyses demonstrated that a more extensive provision of government-funded dental services attenuates associations between structural oppressions and restricted access to oral health care. On the basis of these and other findings, we urge researchers and health care planners to increase access to dental services in more effective and inclusive ways. Most important, we show that counteracting structural drivers of inequities in dental services access entails providing dental care for all.

Making science and doing justice: The need to reframe research on racial inequities in oral health.

This article combines a review of dental studies on race with sociological insights into systemic racism to advance a counter-narrative on the root causes of racial oral health inequities. Taking racism as a form of oppression that cuts across institutional, cultural, and behavioral dimensions of social life, we ask: How pervasive are racial inequities in the occurrence of adverse oral health outcomes? What is the direction and magnitude of racial inequities in oral health? Does the inequitable distribution of negative outcomes persist over time? How can sociological frameworks on systemic racism inform initiatives to effectively reduce racial oral health inequities? The first three questions are addressed by reviewing dental studies conducted in the past few years around the globe. The fourth question is addressed by framing racial oral health inequities around sociological scholarship on racism as a systemic feature of contemporary societies. The paper concludes with a set of practical recommendations on how to eliminate racial oral health inequities, which include engaging with a strong anti-racist narrative and actively dismantling the race discrimination system. Amid the few attempts at moving the field towards improved racial justice, this paper should be followed by research on interventions against racial oral health inequities, including the conditions under which they succeed.

Racial Inequalities in Oral Health.

Together with other social categories, race has been at the core of much scholarly work in the area of humanities and social sciences, as well as a host of applied disciplines. In dentistry, debates have ranged from the use of race as a criterion for the recommendation of specific dental procedures to a means of assessing inequalities in a variety of outcomes. What is missing in these previous discussions, though, is a broader understanding of race that transcends relations with genetic makeup and other individual-level characteristics. In this review, we provide readers with a critique of the existing knowledge on race and oral health by answering the following 3 guiding questions: (1) What concepts and ideas are connected with race in the field of dentistry? (2) What can be learned and what is absent from the existing literature on the topic? (3) How can we enhance research and policy on racial inequalities in oral health? Taken together, the reviewed studies rely either on biological distinctions between racial categories or on other individual characteristics that may underlie racial disparities in oral health. Amidst a range of individual-level factors, racial inequalities have often been attributed to lower socioeconomic status and "health-damaging" cultural traits, for instance, patterns of and reasons for dental visits, dietary habits, and oral hygiene behaviors. While this literature has been useful in documenting large and persistent racial gaps in oral health, wider sociohistorical processes, such as systemic racism, as well as their relationships with economic exploitation, social stigmatization, and political marginalization, have yet to be operationalized among studies on the topic. A nascent body of research has recently begun to address some of these factors, but limited attention to structural theories of racism means that many more studies are needed to effectively mitigate racial health differentials.

Interpersonal discrimination and markers of adiposity in longitudinal studies: a systematic review.

While the impact of interpersonal discrimination on mental health is well established, its effects on physical health outcomes have not been fully elucidated. This study systematically reviewed the literature on the prospective association between interpersonal discrimination and markers of adiposity. Medline, Web of Science, Scopus, PsycInfo, SciELO, LILACS, Google Scholar, Capes/Brazil and ProQuest databases were used to retrieve relevant information in November 2016. The results from the 10 studies that met the inclusion criteria support an association between interpersonal self-reported discrimination and the outcomes. In general, the most consistent findings were for weight and body mass index (BMI) among women, i.e. high levels of self-reported discrimination were related to increased weight and BMI. Waist circumference (WC) showed a similar pattern of association with discrimination, in a positive direction, but an inverted U-shaped association was also found. Despite a few inverse associations between discrimination and markers of adiposity, none of the associations were statistically significant. Overall, markers of adiposity were consistently associated with discrimination, mainly through direct and nonlinear associations. This review provides evidence that self-reported discrimination can play an important role in weight, BMI and WC changes.

Agreement and association between the phase angle and parameters of nutritional status assessment in surgical patients.

BACKGROUND & AIMS: To assess the agreement and the association between phase angle (PA) and parameters of nutritional status in surgical patients. METHODS: This was a cross-sectional study that involved 98 patients admitted for elective gastrointestinal or hernia repair surgery. The risk and nutritional status were evaluated through Nutritional Risk Screening 2002 (NRS 2002), Subjective Global Assessment (SGA), Body Mass Index (BMI) and Total Lymphocytes Count (TLC). These assessments were compared with the mean standardized PA (SPA), obtained by Bioelectrical Impedance Analysis (BIA). Statistical analysis included kappa coefficient, Student's t-test, Mann-Whitney test, and the construction of a ROC Curve. RESULTS: The highest kappa agreement was obtained between the SPA and the SGA (0.27; CI95% 0.06-0.48). Malnourished patients diagnosed by NRS 2002, SGA and TLC had a significantly lower mean SPA as compared to those who were well-nourished. A cut-off point of 0.8 for SPA showed 82.6% (CI95% 65.0-100.0%) sensitivity and 40.6% (CI95% 23.0-58.2%) specificity. CONCLUSION: The SPA presented weak agreement with the methods of nutritional assessment, as well as low specificity, and could not be recommended as a marker of nutritional status, despite the fact that the lowest values for SPA were found in malnourished patients.

Toothache prevalence and associated factors: a population based study in southern Brazil.

OBJECTIVES: The aim of this study was to estimate toothache prevalence and associated factors among adult residents in Pelotas, a southern Brazilian city. METHODS: A cross-sectional population-based study was carried out in individuals aged > or = 20 years (n = 3353). A multi-stage sampling scheme was adopted, and data collection was performed at participants' homes through standardized pre-tested questionnaires. Toothache in the past 6 months was regarded as the outcome. Socioeconomic and demographic data as well as health-related behavioural data were collected. All analyses were undertaken with a Poisson regression model, following a hierarchical conceptual model. RESULTS: The response rate was 93.5% and toothache prevalence was 17.7% (95% CI 16.0-19.3). Multivariable analyses revealed that toothache was more likely to be reported by those with low educational attainment and low family income. Younger subjects, women and black people were also more likely to report toothache. Current smokers and problem drinkers were at increased risk of experiencing toothache in the past 6 months. CONCLUSIONS: The toothache prevalence reported in the present study is not negligible and should initiate the formulation of preventive policies and support the planning of local oral health services.

Dental caries and associated factors among young male adults between 1999 and 2003 in Southern Brazil.

OBJECTIVE: To assess the prevalence, severity and distribution of dental caries and associated factors among young male adults from Florianopolis (Southern Brazil) and to compare these results with those from a previous study. METHOD: A cross-sectional study (n-414) was conducted among Brazilian Army subjects in 2003. Dental caries experience was recorded using the DMF-T Index (WHO, 1997). Non-clinical data were obtained through a questionnaire. The analyses included DMF-T descriptive statistics, calculation of the Gini coefficient to assess inequality in the distribution of caries and non-conditional multiple logistic regression, following a hierarchical approach. RESULTS: The response rate was 95.6%. High values of intra- and inter-examiner agreement were achieved (Kappa > 0.83). Reductions of 18.6% in prevalence and 26.7% in caries severity were accompanied by an increase of 18.6% in dental caries inequality. Individuals with eight or less years of study (OR 8.1 : CI95% 1.9-34.7), raised by mothers with eight or less years of study (OR 2.9 : CI 95% 1.7-5.0) were more likely to have dental caries. Subjects whose families earned less than six Brazilian minimum wages per month were also more likely to have dental caries (OR 2.3 : CI95% 1.4-3.8). CONCLUSIONS: Decreases in caries prevalence and severity were followed by an increased inequality in caries distribution. Low level of schooling, low maternal schooling and low monthly family income were statistically associated with dental caries.

Multicentre evaluation of the Boehringer Mannheim Hitachi 911 system for homogeneous immunoassays.

A multicentre evaluation of the new analyser, Hitachi 911, is reported for three different classes of homogeneous immunoassays (latex assays, immunoprecipitation assays, and CEDIA assays). The evaluation protocol follows ECCLS, IFCC and NCCLS guidelines. Using patient samples and commercial controls, within run and between run coefficients of variation were less than 3% in most cases, but as high as 9.7% for some CEDIA and latex assays. All the assays were linear, either in the reference or the therapeutic range of the analytes. No interference by haemolysis, lipaemia or icterus was observed. The methods were compared with other commercial methods. Coefficients of correlation were higher than 0.94 for all the methods. However, there were differences of slope and intercept for rheumatoid factor, apolipoprotein A-I and apolipoprotein B. On the Hitachi 911, all of the eight methods give precise and accurate results, and compare well with other established methods on immunoassay dedicated analysers. The discrepancies observed could be ascribed to current problems of immunoassay standardization.

Gentamicin nephrotoxicity in rats is not modified by verapamil.

To assess whether calcium could be involved in the gentamicin-induced nephrotoxicity, we have studied the effect of the calcium channel blocker verapamil on renal function in rats intoxicated by gentamicin. Male Wistar rats were divided in three groups. In group I (n = 7) they were injected with gentamicin 100 mg/kg body wt/day s.c. for 5 days. In group II (n = 6), they received gentamicin and verapamil s.c. 2 mg/rat/day. In group III rats served as control. Plasma creatinine and creatinine clearance were daily measured. Rats treated with gentamicin showed a progressive increase in plasma creatinine and a drop in creatinine clearance. No differences between rats treated with gentamicin and those with gentamicin plus verapamil were observed. The urinary flow decreased after treatment with gentamicin, this decrease being more marked in rats treated with verapamil. No differences in daily urinary sodium and potassium excretion were found between intoxicated rats treated or not with verapamil. The present results show that, in rats, verapamil has no protective effect against the nephrotoxicity of gentamicin.

Effect of gentamicin treatment on glutamine and lactate metabolism by the renal cortex of the rat.

The present study was performed to measure the uptake of main renal cortical fuel substrates (glutamine and lactate) and the release of the main renal cortical products (ammonia and glucose) by cortical slices from gentamicin-treated rats. Experiments were done in 2 groups of female Wistar rats (250 g): In gentamicin group (n = 13), rats were injected s.c. with gentamicin-sulphate 100 mg/Kg body wt/day for 5 days. Control rats (n = 13) received isotonic saline. After anesthesia and blood sampling, renal cortical slices were obtained and incubated with L-glutamine and/or lactate at 1 or 5 mM concentration, containing L-glutamate and/or pyruvate at 0.1 or 0.5 mM. Creatinine clearance was reduced to a 50% in gentamicin-treated rats. In addition these animals showed a sharp increase in urinary excretion of N-acetyl-beta-D-glucosaminidase and alkaline phosphatase. Light microscopy examination revealed extensive cell necrosis and tubular obstruction of the proximal tubules in kidneys of rats injected with gentamicin. The renal cortical gentamicin concentration of rats injected with gentamicin was 310 +/- 43 mu/g, whereas it was undetectable in control rats. Cortical slices from gentamicin-treated rats, compared to control ones, showed a reduced production of ammonia and glucose, without differences in glutamine or lactate extraction. These alterations can be explained by both the increased rate of anabolic reactions to recover cell damage associated to renal failure, as well as by a direct effect of gentamicin on the rate of carboxylation reactions.

Hiperplasia linfoide pseudotumoral de ileo terminal e ou de valvula ileo-cecal. Associacao com linfoma maligno linfocitico pouco diferenciado. / Pseudotumoral lymphoid hyperplasia of the terminal ileum and or the ileocecalis valve. Association with lymphocytic malignant lymphoma poorly differentiated

Sao apresentados tres casos de hiperplasia linfoide pseudotumoral de ileo terminal e valvula ileocecal causando obstrucao e invaginacao intestinais, todos incidindo em criancas com idade igual ou inferior a tres anos. Em um caso, houve associacao com linfoma linfocitico pouco diferenciado, nodular, da mucosa da valvula ileocecal. Sao feitas consideracoes sobre o diagnostico e o tratamento da hiperplasia linfoide localizada nessa area do intestino

Occurrence of subcutaneous zygomycosis caused by Basidiobolus haptosporus in Brazil.

There were described the first three South American cases of subcutaneous zygomycosis caused by B. haptosporus. The patients were children from nearby towns lying just north of 13 degrees latitude S. The diagnosis was based on histopathological aspects plus cultural isolation of the fungus.