Parental preferences for dental caries treatment in preschool children according to socio-demographic conditions and beliefs about the primary dentition.

AIM: To assess parental preferences for dental caries treatment and its association with socio-demographic conditions and beliefs about the primary dentition. METHODS: Study design: Cross-sectional study. This study was conducted among 512 parents of 2- to 5-year-old children in the State of Tocantins, in the North Region of Brazil. A self-administered questionnaire on preferences for dental caries treatment, socio-demographic conditions and beliefs about the primary dentition was responded by parents considering two hypothetical clinical scenarios: if their child had one or more asymptomatic caries lesions (without pain), one or more symptomatic caries lesions (toothache). Poisson regression models fitted the association between explanatory variables and the preference to conservative interventions. CONCLUSION: It can be concluded that parental preferences for dental caries treatment in preschool children depend on mother's age and education level, as well as on beliefs about the primary dentition.

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.

How much do smoking and alcohol consumption explain socioeconomic inequalities in head and neck cancer risk?

BACKGROUND: A higher burden of head and neck cancer has been reported to affect deprived populations. This study assessed the association between socioeconomic status and head and neck cancer, aiming to explore how this association is related to differences of tobacco and alcohol consumption across socioeconomic strata. METHODS: We conducted a case-control study in São Paulo, Brazil (1998-2006), including 1017 incident cases of oral, pharyngeal and laryngeal cancer, and 951 sex- and age-matched controls. Education and occupation were distal determinants in the hierarchical approach; cumulative exposure to tobacco and alcohol were proximal risk factors. Outcomes of the hierarchical model were compared with fully adjusted ORs. RESULTS: Individuals with lower education (OR 2.27; 95% CI 1.61 to 3.19) and those performing manual labour (OR 1.55; 95% CI 1.26 to 1.92) had a higher risk of disease. However, 54% of the association with lower education and 45% of the association with manual labour were explained by proximal lifestyle exposures, and socioeconomic status remained significantly associated with disease when adjusted for smoking and alcohol consumption. CONCLUSIONS: Socioeconomic differences in head and neck cancer are partially attributable to the distribution of tobacco smoking and alcohol consumption across socioeconomic strata. Additional mediating factors may explain the remaining variation of socioeconomic status on head and neck cancer.

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.

Papillary glioneuronal tumor--prognostic value of the extension of surgical resection.

OBJECTIVE: Papillary glioneuronal tumors (PGNT) is well-recognized in the literature, although reports usually have not attempted a critical analysis of their characteristics. We report two PGNT and perform a comprehensive review of the published cases, aiming to clarify their clinical, imaging and histopathological features. MATERIAL AND METHODS: We have reviewed all glioneuronal tumors diagnosed in our laboratory over the last 10 years and found 2 cases PGNTs along with their clinical, imaging and surgical data. We have processed material for light microscopy, and for immunohistochemistry study, we have used antisera against glial fibrillary acidic protein, Olig-2C, neurofilament protein, synaptophysin and Ki-67. We searched Medline (1966 through October 2007) for original articles or previous reviews. RESULTS: Case 1, a 19-year-old girl with a left, partially cystic, occipital tumor, totally removed, with no signs of recurrence 32 months after surgery, Case 2, a 9-year-old girl with a right, cystic with a solid nodule, temporal tumor, totally removed, with no signs of recurrence 19 months after surgery. Histopathology and immunohistochemistry studies favored a diagnosis of PGNT. A survey of 38 reported PGNT cases together with our two disclosed the following typical profile: young adulthood predominance, temporal lobe location, presence of cystic components: a close association with the lateral ventricles, a few anaplastic tumors, and gross total resections were usually possible with no recurrences the extent of surgical removal being the main prognostic factor. CONCLUSIONS: Although histopathology is usually characteristic, imaging features may also be important in the presurgical evaluation of PGNTs. Gross total resections are usually possible and seem to govern prognosis. However, longer follow-up data are required.

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.

Dental caries experience in Indians of the Upper Xingu, Brazil.

The present study describes the experience of dental caries in Indians communities of the Xingu, in order to supply parameters for further analysis of trends of the disease in Indians. We performed oral health examination in 288 Indians from four communities (Yawalapiti, Aweti, Mehinaku and Kamaiura) living in the southern part of the Xingu National Park, using international criteria defined by the World Health Organization. The outcome measures were the DMFT and dmft scores, and the care index. Indians of the Upper Xingu presented high levels of caries, in all age groups. The average DMFT for 11 to 13-year-old children - 5.93 - was lower than the index measured in 1993 for 12-year-old schoolchildren in nearby cities - 8.23 -, whose United Nations' human development index ranked medium. However, Indians presented a much lower care index, per age group, than these cities, and a high ratio of missing teeth for persons above 20 years old. These observations indicate low incorporation of dental care services. The irregularity of the services programmed for these communities, and the changing dietary and cultural patterns, mainly derived from their contact with the non-indigenous population of Brazil, reinforce the pressing need for health promotion initiatives aimed at these groups.

Trends and spatial distribution of oral cancer mortality in São Paulo, Brazil, 1980-1998.

We assessed oral cancer mortality data in São Paulo to study trends of the disease and its distribution by areas of the city. We standardized death rates by gender and age group, and also supplied complementary information regarding oral cancer incidence. Oral cancer mortality remained stationary at high levels during the study period. Site-specific death rates revealed high figures for two categories of site: tongue and unspecified parts of mouth. Gum cancer death rates--the most easily diagnosed site-specific oral cancer at a routine dental examination--fell sharply, possibly as a consequence of the recent expansion in community dental health services in the city. In spite of this observation, the increase of death rates related to unspecified parts of the mouth points to the deficiencies of health services in detecting most of oral cancer cases early. Spatial data analysis enabled indication of areas and socio-economic factors associated with poorer profile in oral cancer mortality, important information for the targeting of health resources directed to the screening, prevention and education in oral cancer.

The impact of AIDS, immigration and housing overcrowding on tuberculosis deaths in São Paulo, Brazil, 1994-1998.

The objective of this paper was to describe the distribution of tuberculosis (TB) mortality by area in the municipality of São Paulo, Brazil, from 1994 to 1998, and to evaluate its statistical association with several population characteristics. We surveyed TB deaths grouped by residential area, at the district level, and we calculated the rates for these areas standardized by gender and age groups. We applied simultaneous autoregressive--SAR regression analysis (autocorrelated errors model) in order to fit a "stepwise" model correlating TB deaths with the variables of interest. Significant associations were found between TB mortality rates and AIDS mortality rates, overcrowding at the household level, social development (expressed by a socioeconomic index), and rates of foreign immigration and immigration from other Brazilian States. Regression analysis allowed us to estimate the frequency of TB deaths virtually attributable to co-infection with HIV at 22.37% (95% confidence interval: 12.15-41.17%). TB death rates and utilization of public health services were not statistically associated, suggesting a reduced effectiveness of programs directed at control of the disease. The correlation between TB death rates and deprivation, measured by the socioeconomic index, indicates higher mortality in underprivileged areas. The significance of the association between housing overcrowding and TB deaths, in contrast to the absence of association with district-level overcrowding, indicates that prolonged contact is needed for disease transmission. Although the influx of foreigners and national migrants to the city diminished after the 1980s, immigration rates have been significantly correlated with TB mortality, suggesting greater vulnerability of these population segments to the disease.

Supratentorial giant cell ependymoma.

Ependymomas account for 3 to 9% of all neuroepithelial tumors and, although occurring most often within the ventricular system, they may arise from the extraventricular parenchyma as well. Several histologic patterns of these neoplasm are well known, but little attention has been devoted to a variant composed of giant elements. We describe the case of a 13-year-old girl experiencing a 3-month history of partial seizures in whom cranial magnetic resonance imaging showed an extraventricular, right parietotemporal neoplasm, adherent to the overlying dura mater. Histologic, immunohistochemical and ultrastructural findings were consistent with those of a high-grade ependymoma. The tumor was characterized by the presence of a major component of pleomorphic giant cells, as also seen in pleomorphic xantoastrocytoma, subependymal giant cell astrocytoma and glioblastoma multiforme. Similar elements have been described in two filum terminale and one supratentorial, intraventricular ependymoma, respectively. Histologic and evolutional data of those and of our own case suggest that isolated giant cells are not necessarily linked to a bad prognosis in ependymomas.

Postmortem tooth loss in human identification processes.

Teeth provide essential data for human identification. However, they are frequently lost during the process of skeletonization or under manipulation during exhumation. Because of the high frequency of postmortem tooth loss, this phenomenon was examined in three different samples, in an attempt to simulate the actual circumstances experienced in the forensic processes of identification of human remains. The method employed aimed to describe and quantify dental spaces, distinguishing between loss after death or before by extraction. The results showed a high prevalence of postmortem tooth loss: 41.37% in sample A, 56.83% in sample B and 3.96% in sample C. These losses were most frequent in the maxillary incisor group in all three samples analysed. These data underline the need for redoubled care in recovery, transportation and storage of crania, so that teeth are not lost, which could seriously compromise the identification process.

Tuberculosis in the twentieth century: time-series mortality in São Paulo, Brazil, 1900-97.

The objective of this study was to characterize tuberculosis mortality trends in the Municipality of São Paulo, Brazil, from 1900 to 1997. Standardized tuberculosis mortality rates and proportional mortality ratios were calculated and stratified by gender and age group based on data provided by government agencies. These measures were submitted to time-series analysis. We verified distinct trends: high mortality and a stationary trend from 1900 to 1945, a heavy reduction in mortality (7.41% per year) from 1945 to 1985, and a resumption of increased mortality (4.08% per year) from 1985 to 1995. In 1996 and 1997 we observed a drop in tuberculosis mortality rates, which may be indicating a new downward trend for the disease. The period from 1945 to 1985 witnessed a real reduction in tuberculosis, brought about by social improvements, the introduction of therapeutic resources, and expansion of health services. Recrudescence of tuberculosis mortality from 1985 to 1995 may reflect the increasing prevalence of Mycobacterium and HIV co-infection, besides loss of quality in specific health programs.

A comparative epidemiologic study of specific antibodies (IgM and IgA) and parasitological findings in an endemic area of low transmission of schistosoma mansoni.

The diagnostic potential of circulating IgM and IgA antibodies against Schistosoma mansoni gut-associated antigens detected by the immunofluorescence test (IFT) on adult worm paraffin sections was evaluated comparatively to the fecal parasitological method, for epidemiological purposes in low endemic areas for schistosomiasis. Blood samples were collected on filter paper from two groups of schoolchildren living in two different localities of the municipality of Itariri (São Paulo, Brazil) with different histories and prevalences of schistosomiasis. The parasitological and serological data were compared to those obtained for another group of schoolchildren from a non-endemic area for schistosomiasis. The results showed poor sensitivity of the parasitological method in detecting individuals with low worm burden and indicate the potential of the serological method as an important tool to be incorporated into schistosomiasis control and vigilance programs for determining the real situation of schistosomiasis in low endemic areas.