Spatial distribution of maxillofacial injuries caused by urban violence: An ecological analysis to identify high-risk areas.

OBJECTIVES: To investigate the spatial and spatial-temporal distribution of oral and maxillofacial injuries caused by urban violence, as well as to identify underlying disparities at regional level through a geostatistical approach. METHODS: This was a historical ecological cohort study of trauma cases caused by urban violence using aggregate data from victims assisted in a Brazilian medical-forensic service between January 2012 and December 2015. The longitudinal patterns of change observed in each geographic area (neighbourhoods) were evaluated using the finite mixture model (FMM). The spatial autocorrelation of events was investigated using the Getis-Ord Indicator (Gi*) to identify significant hot and cold spatial clusters. With a spatial regression model, it was also found when socioeconomic variables, residential infrastructure and neighbourhood infrastructure were associated with high incidence rates. The significance level was set at P ≤ 0.05. RESULTS: The finite mixture model revealed three different patterns of longitudinal trajectory of the incidence of oral and maxillofacial trauma caused by urban violence (TP1 to TP3, P < 0.05). TP1 was characterized by an incidence that remained stable and high over time, comprising 17.4% of the city's neighbourhoods. In TP2, it was observed that the incidence was moderate, with a slightly increasing trend in the last year evaluated, representing around 41.8% of the sample. In contrast, in TP3, it was found that the incidence was relatively low and remained stable over time, accounting for about 40.8% of the sample. The Getis-Ord (Gi*) statistic identified significant high-risk clusters in the western (P < 0.05), southern (P < 0.05), and eastern regions (P < 0.05) and low risk in the northern region (P < 0.05). The spatial regression model indicated significant association between areas with unfavourable socioeconomic conditions and higher incidence of events (ß = 0.178, SE = 0.046, P < 0.001). CONCLUSIONS: Clusters demarcating areas with high socio-spatial vulnerability for urban violence and oral and maxillofacial injuries were identified. The findings highlight the need to improve living conditions in segregated urban areas and develop intersectoral actions to improve living conditions, employment, public safety, social support, health care and prevention.

Social determinants of health and maxillofacial injuries in children and adolescents victims of violence: A novel GIS-based modelling application.

BACKGROUND: Physical violence against children and adolescents comprises a serious public health problem and often results in oral and maxillofacial traumas. Social determinants may favour the occurrence of these events, but few studies have critically evaluated the interaction between social and geographical risk factors. AIMS: To investigate the spatiotemporal distribution of oral and maxillofacial traumas resulting from violence against children and adolescents through geostatistical techniques. METHODS: This study was an ecological analysis of cases of trauma caused by violence against Brazilian children and adolescents using aggregated data from victims attended at a Center of Forensic Medicine and Forensic Dentistry between January 2012 and December 2015. Data were analysed through modelling based on geographic information system (GIS). RESULTS: Two distinct patterns of longitudinal trajectory of oral and maxillofacial trauma related to violence against children and adolescents were identified (TP1 and TP2, P < 0.05). The spatial regression analysis revealed a statistically significant association between higher incidence of cases and areas with worse socioeconomic conditions (ß = 0.047, SE = 0.020, P < 0.05). CONCLUSION: Neighbourhoods with considerable socio-spatial vulnerability for violence against children and adolescents and maxillofacial traumas were identified.

Quality of life related to oral health of patients undergoing hemodialysis and associated factors.

PURPOSE: To evaluate quality of life related to oral health (QoLROH) of Brazilians undergoing hemodialysis and to identify associated factors. MATERIAL AND METHODS: A cross-sectional study was conducted with 226 patients undergoing hemodialysis at two reference medical centers. Participants answered a sociodemographic questionnaire and the Brazilian version of the Oral Health Impact Profile (OHIP-14). Descriptive and multivariate statistics using Decision Tree Analysis by the Chi-square Automatic Interaction Detector (CHAID) algorithm, as well as Ordinal Logistic Regression analyses were performed. RESULTS: The Decision Tree revealed that the impact on QoLROH could be explained by age (p = 0.002), tooth pain in the last 6 months (p = 0.026), and region of residence (p = 0.025). CONCLUSIONS: The results suggest that being older, living in rural areas, and reporting tooth pain in the last 6 months may influence the QoLROH of patients undergoing hemodialysis.