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Aim: To estimate the prevalence of periodontal disease in Brazilian adults and to test its association with skin colour after controlling for socio-demographic variables., Methods: The periodontal status of 11,342 Brazilian adults was informed by a nationwide oral health survey. Socio-demographic variables included skin colour, gender, schooling, per capita income, age and geographical region. The association between periodontal disease and skin colour was tested by a logistic regression model, adjusting for covariates. Interactions between skin colour and socio-demographic variables were tested., Results: The prevalence of periodontal diseases was 9.0% [95% confidence interval (CI) 7.6-10.3]. Lighter-skinned black people (pardos) and dark-skinned black people (pretos) presented higher levels of periodontal disease when compared with white people [odds ratio (OR)=1.5; 95% CI 1.2; 1.8; OR=1.6; 95% CI 1.2; 2.1, respectively] even after controlling for age, gender, schooling, per capita income and geographic region. No interactions were statistically significant., Conclusion: Skin colour was significantly associated with periodontal disease among Brazilian adults after adjustment for socio-economic and demographic covariates.

Aims: There is a lack of tools for accurately identifying the risk of readmission for heart failure in elderly patients with arrhythmia. The aim of this study was to establish and compare the performance of the LACE [length of stay ('L'), acute (emergent) admission ('A'), Charlson comorbidity index ('C') and visits to the emergency department during the previous 6 months ('E')] index and machine learning in predicting 1 year readmission for heart failure in elderly patients with arrhythmia. Methods: Elderly patients with arrhythmia who were hospitalized at Sichuan Provincial People's Hospital between 1 June 2018 and 31 May 2020 were enrolled. The LACE index was calculated for each patient, and the area under the receiver operating characteristic curve (AUROC) was calculated. Six machine learning algorithms, combined with three variable selection methods and clinically relevant features available at the time of hospital discharge, were used to develop machine learning models. AUROC and area under the precision–recall curve (AUPRC) were used to assess discrimination. Shapley additive explanations (SHAP) analysis was used to explain the contributions of the features. Results: A total of 523 patients were enrolled, and 108 patients experienced 1 year hospital readmission for heart failure. The AUROC of the LACE index was 0.5886. The complete machine learning model had the best predictive performance, with an AUROC of 0.7571 and an AUPRC of 0.4096. The most important predictors for 1 year readmission were educational level, total triiodothyronine (TT3), aspartate aminotransferase/alanine aminotransferase (AST/ALT), number of medications (NOM) and triglyceride (TG) level. Conclusions: Compared with the LACE index, the machine learning model can accurately identify the risk of 1 year readmission for heart failure in elderly patients with arrhythmia. [ABSTRACT FROM AUTHOR]

This research study aimed to evaluate the level of moral and ethical development of first-year students in a dental school. The students were presented with a dilemma that touched on personal and conflicting values. In responding to the questions posed, they had to present their criteria for judgments and norms that directly influence their behavior. Answers were then analyzed, leading to the categorization of interviewees into five stages of moral development according to Kohlberg's moral development system. The first, lowest stage in Kohlberg's system was reached by 11 percent of students. Most interviewees (47 percent) were in stage two, where individuals are conscious of their own conflicting interests, but an individualistic and instrumental set of morals tends to regulate those interests. Thirty percent of interviewees were identified with stage three, and 8.3 percent were found in stage four, whose main characteristic is the perception of self as a member of society, thus integrating interpersonal perspectives. Only one student reached stage five, in which the person recognizes universal rights and establishes a hierarchy of priorities. No individuals were found in stage six of moral development. The level of moral development found was low for students at this level, which may compromise the optimal moral development of the future dentist. The low level of moral development found may jeopardize the work of the future professionals, their treatment of patients, and society as a whole.

Pattussi MP, Peres KG, Boing AF, Peres MA, da Costa JSD. Self-rated oral health and associated factors in Brazilian elders. Community Dent Oral Epidemiol 2010; 38: 348–359. © 2010 John Wiley & Sons A/S Objective: Self-rating provides a simple direct way of capturing perceptions of health. The objective of this study was to estimate the prevalence and associated factors of poor self-rated oral health among elders. Methods: National data from a cross-sectional population-based study with a multistage random sample of 4786 Brazilian older adults (aged 65–74) in 250 towns were analysed. Data collection included oral examinations (WHO 1997) and struct-ured interviews at elderly households. The outcome was measured by a single five-point-response-scale question dichotomized into ‘poor’ (fair/poor/very poor) and ‘good’ (good/very good) self-rated oral health. Data analyses used Poisson regression models stratified by sex. Results: The prevalence of poor self-rated oral health was 46.6% (95% CI: 45.2–48%) in the whole sample, 50.3% (48–52.5) in men and 44.2% (42.4–46) in women. Higher prevalence ratios (PR) were found in elders reporting unfavourable dental appearance (PR = 2.31; 95% CI: 2.02–2.65), poor chewing ability (PR = 1.64; CI: 1.48–1.8) and dental pain (PR = 1.44; CI: 1.04–1.23) in adjusted analysis. Poor self-perception was also associated with being men, black, unfavourable socioeconomic circumstances, unfavourable clinical oral health and with not using or needing a dental prosthesis. Conclusion: Assessment and understanding of self-rated oral health should take into account social factors, subjective and clinical oral symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Evidence shows that price is an important policy lever in reducing consumption of alcohol and tobacco. However, there is little evidence of the cross‐price effect between alcohol and tobacco. Methods: This paper uses an econometric model which estimates participation and consumption elasticities, on data from the UK Living Costs and Food Survey 2006–2017 and extends the literature by, for the first time, estimating joint price elasticities for disaggregated alcohol and tobacco products. This paper presents new price elasticities and compares them to the existing literature. Results: The own‐price elasticity estimates are all negative for both participation and consumption. There is no pattern to the estimates of cross‐price elasticities. The elasticity estimates, when used in the Sheffield Tobacco and Alcohol Policy Model, produce bigger changes in consumption for the same change in price compared to other elasticity estimates in the existing literature. Discussion and Conclusions: Consumption of alcohol and tobacco are affected by the prices of one another. Policymakers should bear this in mind when devising alcohol or tobacco pricing policies. [ABSTRACT FROM AUTHOR]

Objectives: To estimate socioeconomic inequalities in the maternal perception of children's oral health from a birth cohort study in Brazil. Methods: The data from this study were collected through perinatal interviews and at the 48‐month follow‐up from the 2015 Pelotas Birth Cohort Study. The main outcome was the maternal perception of children's oral health, dichotomized into positive (good/very good) and negative (fair/bad/very bad). The secondary outcome was untreated dental caries (absence and presence, according to the ICDAS index – International Caries Detection and Assessment System). For the statistical analysis, the absolute inequality index (Slope Index of Inequality – SII) and the relative concentration index (Concentration Index – CIX) were used. Analyses were stratified by maternal educational level, family income and wealth index. Results: The prevalence of outcomes was 19.4% (95% CI 18.2; 20.7) for the negative maternal perception of children's oral health and 15.6% (95% CI 14.4; 16.8) for untreated dental caries. Socioeconomics inequalities were observed in negative maternal perception of children's oral health in both absolute and relative terms. A SII of −16.6 (95% CI −20.8; −12.5) was observed for family income, with higher prevalence in poor families. A higher prevalence of the negative maternal perception of children's oral health was observed in mothers without any educational level or a few years of study (CIX −21.1 [95% CI −24.5; −17.7]). Conclusions: This study demonstrates socioeconomics disparities in the maternal perception of children's oral health and in the prevalence of untreated caries in children. A higher concentration of negative maternal perception of children's oral health was identified among the most socioeconomically vulnerable individuals. The findings reinforce the presence of socioeconomic inequalities in subjective measures about children's oral health. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to examine individual and contextual factors associated with the frequency of dental service utilization among adolescents, adults and older adults Brazilians. Methods: This cross‐sectional study used secondary data from the Brazilian 2019 National Health Survey (94 114 individuals). The outcome 'when was your last dental appointment?' was categorized into three groups: up to 1 year, more than 1 year and never had a dental appointment. Andersen's behavioural model was used to select contextual and individual variables. Multinomial logistic regression analysis was performed to calculate the odds ratio (OR) and 95% confidence intervals (95% CI). Results: The following variables showed increased probability to the outcome had the last dental appointment more than 1 year ago: older adult, illiterate or incomplete primary school, and without private dental insurance. The outcome never had a dental appointment was significantly associated with illiterate (OR 26.65; 95% CI 17.63–40.29), male (OR 2.38; 95% CI 2.17–2.61), without private dental insurance (OR 5.20; 95% CI 3.48–7.76), self‐rated oral health as bad or very bad (OR 2.67; 95% CI 2.31–3.09), household not enrolled in primary care teams (OR 1.29; 95% CI 1.11–1.49), household in a rural area (OR 1.86; 95% CI 1.69–2.05), high household crowding (OR 1.08; 95% CI 1.04–1.14) and low household income per capita (OR 0.99; 95% CI 0.99–0.99). Conclusions: This study showed that contextual and individual factors induce inequity in dental appointments. Moreover, Andersen's behavioural model demonstrated inequitable access for dental services in Brazil, in which social structure and enabling characteristics, rather than the need for the service, determine who receives health care. Living in a household enrolled in primary care teams favoured regular dental appointments. Thus, these findings may help policymakers improve health access by expanding coverage of dental services in primary health care. [ABSTRACT FROM AUTHOR]

Policy PointsPolicymakers should invest in programs to support rural health systems, with a more targeted focus on spatial accessibility and racial and ethnic equity, not only total supply or nearest facility measures.Health plan network adequacy standards should address spatial access to nearest and second nearest hospital care and incorporate equity standards for Black and Latinx rural communities.Black and Latinx rural residents contend with inequities in spatial access to hospital care, which arise from fundamental structural inequities in spatial allocation of economic opportunity in rural communities of color. Long‐term policy solutions including reparations are needed to address these underlying processes. Context: The growing rate of rural hospital closures elicits concerns about declining access to hospital‐based care. Our research objectives were as follows: 1) characterize the change in rural hospital supply in the US South between 2007 and 2018, accounting for health system closures, mergers, and conversions; 2) quantify spatial accessibility (in 2018) for populations most at risk for adverse outcomes following hospital closure—Black and Latinx rural communities; and 3) use multilevel modeling to examine relationships between structural factors and disparities in spatial access to care. Methods: To calculate spatial access, we estimated the network travel distance and time between the census tract–level population‐weighted centroids to the nearest and second nearest operating hospital in the years 2007 and 2018. Thereafter, to describe the demographic and health system characteristics of places in relation to spatial accessibility to hospital‐based care in 2018, we estimated three‐level (tract, county, state‐level) generalized linear models. Findings: We found that 72 (10%) rural counties in the South had ≥1 hospital closure between 2007 and 2018, and nearly half of closure counties (33) lost their last remaining hospital to closure. Net of closures, mergers, and conversions meant hospital supply declined from 783 to 653. Overall, 49.1% of rural tracts experienced worsened spatial access to their nearest hospital, whereas smaller proportions experienced improved (32.4%) or unchanged (18.5%) access between 2007 and 2018. Tracts located within closure counties had longer travel times to the nearest acute care hospital compared with tracts in nonclosure counties. Moreover, rural tracts within Southern states with more concentrated commercial health insurance markets had shorter travel times to access the second nearest hospital. Conclusions: Rural places affected by rural hospital closures have greater travel burdens for acute care. Across the rural South, racial/ethnic inequities in spatial access to acute care are most pronounced when travel times to the second nearest open acute care hospital are accounted for. [ABSTRACT FROM AUTHOR]

Introduction: Dentists usually refer to difficulties in performing the diagnosis of oral mucosal lesions. This may be attributed to limited access to theoretical lectures and practical training on this subject along the graduation course. The primary aim of this cross‐sectional study was to verify if there is an association between the perception of time dedicated to lectures/training and oral diagnosis abilities in oral medicine. The secondary aim was to evaluate the association between self‐‐confidence to perform oral mucosal lesions diagnosis and performance in a diagnostic abilities test. Materials and Methods: The sample comprised 36 final‐year dental students of a South‐Brazilian dental school. The participants answered a questionnaire on their perception of time dedicated to lectures on oral medicine along the course (sufficient or insufficient) and their self‐confidence to diagnose oral mucosal lesions or oral cancer (yes or not). The students were also submitted to a diagnostic abilities test based on 30 clinical photos of oral lesions, which should be classified as benign, potentially malignant or malignant. Moreover, the participants had to inform their clinical impression for each case. Finally, the participants informed their decision making for the case (refer the patient to a specialist or not). Results: Students with higher self‐confidence showed a higher percentage of correct answers on classification of the nature of lesions (81.1% vs. 68.5%, p =.03, teste t de Student) and on their clinical impression (66.3% vs. 41.7%, p <.01, Student's t‐test). The perception of time dedicated to theoretical lectures on oral medicine as sufficient did not influence the students' diagnostic abilities (p >.05, Student's t‐test) Conclusion: It may be concluded that self‐confidence to diagnose oral lesions is associated with dental students' diagnostic abilities. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil. Methods: The socioeconomic data to this study were collected at the 48‐month follow‐up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality–SII and Concentration Index–CIX) were used. Results: The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro‐poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data. Conclusions: Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children. [ABSTRACT FROM AUTHOR]

Objectives: Obtaining robust evidence about the local mortality levels, trends and impact of oral cavity/base of tongue cancers and lip cancer, especially for women, is imperative in the fight against cancer. This descriptive retrospective ecological time‐series study explored trends in oral cavity/base of tongue cancers and lip cancer mortality rates for women in Brazil from 1980 to 2018, by geographic region and anatomical location. Methods: The crude and age‐adjusted annual mortality rates were obtained by sex, anatomical location and macro‐regions of Brazil. The number of deaths from oral cavity/base of tongue cancers and lip cancers in Brazil was based on official population counts and estimates. The annual percentage change was calculated based on age‐adjusted rates. Data set were analysed using the Joinpoint Regression program. Results: A total of 81,918 individuals died of oral cavity/base of tongue cancers and lip cancer between 1980 and 2018 in Brazil. The age‐adjusted mortality rate for women was 0.47 and 0.57 per 100,000 in 1980 and 2018, respectively. The cumulative female mortality rates standardized by age were 0.01/100,000 for lip cancer and 0.5/100,000 for oral cavity and base of tongue cancers. A decrease in deaths related to oral cavity and base of tongue cancers was identified in the 1980s; however, over the last two decades, there has been an increase in the number of deaths of women with cancer at the base of tongue and neighbouring areas and on the floor of mouth. Importantly, Brazilian regions showed wide variability in trends of oral cavity, base of tongue and lip cancers rate and, in 2018, the regions with the highest rates were the Southeast, South and Northeast for both sexes and specifically for women. The North region showed the greatest recent significant upward trend. Conclusions: During the last 38 years, Brazil has shown a significant increase in the trend of the mortality rate due to oral cavity/base of tongue and lip cancers in women. Preventive strategies with control of risk factors should be strongly emphasized in order to improve the survival rates of individuals with oral cavity/base of tongue and lip cancers. [ABSTRACT FROM AUTHOR]

Background: Concern is growing about inequality in cancer treatment, and a call has been made for more knowledge of the underlying causes of this inequality. Studies show that patients with low socioeconomic status in general face a greater risk of inequality than patients with a high socioeconomic status. Aim: The aim of the present study was to uncover how institutional factors may exacerbate inequality in cancer treatment for patients with low socioeconomic status exemplified by patients with head and neck cancer, most of whom have low socioeconomic status. Method: Inspired by Fairclough, we undertook a critical discourse analysis investigating the treatment pathway of patients with head and neck cancer on the basis of policy papers. Results: These papers, which we conceived as formative instruments, harboured a discourse of efficiency and a discourse of participation, together carving out an effective cancer treatment pathway provided patients act in line with the recommendations. Discussion: The discourses of efficiency and participation are not unfamiliar in health care, and prior research shows that they may pose difficulties for patients with low socioeconomic status. Conclusion: The discoursal framing of head and neck cancer treatment may exacerbate inequality because most patients with a low socioeconomic status fail to comprehend and act in accordance with these discourses. [ABSTRACT FROM AUTHOR]

Objectives: The understanding of how subjective socioeconomic status (SSS) relates to objective socioeconomic status (OSS), and how both conditions act together in oral health outcomes is still unclear. This study aims to test the independent and joint association between OSS and SSS with oral health, to assess the role of socioeconomic status discrepancies, and to evaluate the role of SSS in the association between OSS and oral health. Methods: Data from 1140 adults from a population‐based study in Southern Brazil were used. We applied diagonal reference models DRM to disentangle the effects of OSS (education) and SSS (MacArthur Scale) to oral health outcomes. The outcomes were functional dentition clinically evaluated (FD ≥20 teeth) and self‐reported oral health SROH. We also examined the discrepancy between OSS and SSS to oral health indicators and the effect measure modification (EMM) of SSS on the association between OSS and oral health. Results: Subjective socioeconomic status and OSS contributed equally to SROH, while OSS explained a substantially higher amount of FD than SSS (0.85 vs 0.15). An EMM of SSS was found on the association between OSS and fair/poor SROH, with a relative excess risk due to interaction (RERI) of 1.08. Less evidence of EMM was found for FD (RERI = 0.14). Individuals with lower SSS and OSS had four times the risk of the outcomes than the reference group. Conclusions: Adults with concordant lower SSS and OSS have a worse oral health than those with concordant higher status. There was evidence that the association between OSS and SROH is modified by SSS. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the association between systemic non-communicable diseases (NCDs; including lung, kidney, mental and cardiovascular diseases, arthritis, cancer and spinal problems), common risk factors, and tooth loss (TL), as an endpoint of prevalent oral NCDs (periodontitis and caries).Methods: A total of 60,271 noninstitutionalized adults (≥30 years) were evaluated, using data from the 2019 Brazilian National Health Survey. Negative binomial regressions were performed, adjusting for sex, age, ethnicity, educational attainment, oral hygiene, risk factors for periodontitis and caries (diabetes, smoking, and a cariogenic diet). The dependent variable was TL expressed as a numerical value.Results: Diabetes, current smoking and a frequent cariogenic diet were significantly associated with TL-Incidence Rate Ratio (IRR [95% CI]): 1.11 (1.08 to 1.14), 1.28 (1.25 to 1.31), and 0.97 (0.94 to 0.99), respectively. Significant associations were observed for TL and all assessed NCDs, except kidney diseases, cancer and musculoskeletal diseases related to work, with IRR ranging from 1.06 for hypertension and asthma to 1.16 for rheumatoid arthritis. Regular consumption (4 to 7 d/wk) of vegetables, fruits and beef; alcohol up to 8 doses/wk; and physical exercise were associated with a lower IRR for TL (P < 0.05). Obesity, but not overweight, was associated with increased TL (1.05 [1.03 to 1.07]). Smoking, hypertension, arthritis, other mental diseases and spinal problems further increased the IRR for TL in individuals with diabetes (P < 0.05).Conclusion: We conclude that certain chronic systemic conditions are associated with TL in Brazilian adults. This is likely because of shared risk factors; however, causal associations cannot be examined in this cross-sectional dataset. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the influence of community water fluoridation on ethnic inequalities in untreated dental caries among children and adolescents in Brazil while taking the human development context into account. Methods: Data from a nationwide Brazilian epidemiological population oral health survey were used (SB Brazil 2010). Outcomes were caries prevalence measured by the proportion of individuals with one or more untreated decayed teeth and caries severity defined by the mean number of untreated decayed teeth (DT). Three different contexts were considered: 1—cities with no water fluoridation; 2—cities with water fluoridation and low Human Development Index (HDI); and 3—cities with water fluoridation and high HDI. The exposure was ethnic/racial group (White, Pardo, Black) and covariates were age, sex and household income. Multilevel logistic and negative binomial regressions were performed with 6696 children (aged 5 years) and 11 585 adolescents (aged 12 and 15‐19 years). Results: For both children and adolescents, ethnic differences in caries prevalence and mean DT were found in the nonfluoridated cities with low HDI and also in cities with high HDI, most of which were fluoridated. For example in nonfluoridated cities with low HDI, 5‐year‐old Pardo children were more likely to have untreated decay (OR = 1.22; 95% CI: 1.02, 1.46) and had more decayed teeth (RR = 1.18; 95% CI: 1.04, 1.34) than their White counterparts after adjusting for sex and household income. No statistically significant differences were observed in fluoridated cities with low HDI. Conclusion: Water fluoridation appears to be associated with reduced ethnic inequalities in dental caries prevalence and mean DT among children and adolescents in more disadvantaged settings. [ABSTRACT FROM AUTHOR]

Objectives: Low socioeconomic position (SEP) has been associated with higher incidences and mortality of lip, oral cavity and pharynx (LOP) cancers in the vast majority of countries with available data. The origins of health inequalities in cancer are socioeconomic, although they vary by time and country. Evidence from Low‐and Middle‐income Countries (LMICs) remains scarce. This study aims to identify and describe socioeconomic inequalities in LOP cancers incidence and mortality in Costa Rica. The hypothesis tested is that people leaving in low‐SEP districts in Costa Rica have greater incidence and mortality rates of lip, oral cavity and pharynx cancers. Methods: The 10th revision of the International Classification of Diseases (ICD‐10) was used to define cancer sites. Data come from a national population‐based Cancer Registry with 100% completeness to study incidence. Incidence rate included all new cases of LOP cancer diagnosed from January 1, 2011, and December 31, 2015, for a total of 2 798 517 individuals, 13 832 524 years of follow‐up and 601 LOP cases. Mortality rate was extracted from the National Death Index, including 2 739 733 individuals, 23 950 240 person‐years of follow‐up and 586 LOP cancer deaths, from January 1, 2010, to December 31, 2018. The 2011 Census (with 94% of Costa Rican inhabitants) was used to characterize the urbanicity and wealth of 477 districts. Survival models were performed for both incidence and mortality, allowing to consider existing competitive risks. Cox models were used for incidence, and parametric survival models based on a Gompertz distribution for mortality. Results: The study found that people who lived in the most socioeconomically disadvantaged areas had lower probabilities of developing LOP cancers than people in the richest districts. The same pattern for mortality, however, was not significant. Conclusions: The hypothesis that incidence and mortality of LOP cancers will show a positive social gradient was not confirmed in this study, contradicting the existing literature. This could be explained by the social distribution of risky health behaviours, more frequent in socially advantaged populations. [ABSTRACT FROM AUTHOR]

Objectives: Existing curricula and recommendations on the incorporation of structural competency and vulnerability into medical education have not provided clear guidance on how best to do so within emergency medicine (EM). The goal of this scoping review and consensus building process was to provide a comprehensive overview of structural competency, link structural competency to educational and patient care outcomes, and identify existing gaps in the literature to inform curricular implementation and future research in EM. Methods: A scoping review focused on structural competency and vulnerability following Arksey and O'Malley's six‐step framework was performed in concurrence with a multistep consensus process culminating in the 2021 SAEM Consensus Conference. Feedback was incorporated in developing a framework for a national structural competency curriculum in EM. Results: A literature search identified 291 articles that underwent initial screening. Of these, 51 were determined to be relevant to EM education. The papers consistently conceptualized structural competency as an interdisciplinary framework that requires learners and educators to consider historical power and privilege to develop a professional commitment to justice. However, the papers varied in their operationalization, and no consensus existed on how to observe or measure the effects of structural competency on learners or patients. None of the studies examined the structural constraints of the learners studied. Conclusions: Findings emphasize the need for training structurally competent physicians via national structural competency curricula focusing on standardized core competency proficiencies. Moreover, the findings highlight the need to assess the impact of such curricula on patient outcomes and learners' knowledge, attitudes, and clinical care delivery. The framework aims to standardize EM education while highlighting the need for further research in how structural competency interventions would translate to an ED setting and affect patient outcomes and experiences. [ABSTRACT FROM AUTHOR]

Background: Population‐based studies assessing the factors associated with use of and need for dental prosthesis among older adults are scarce. Objective: To evaluate the use of and need for dental prosthesis and associated factors in the older adult population of a southern city of Brazil. Material and methods: A cross‐sectional study, involving community‐dwelling older adults (≥60 years), was performed. A probabilistic per cluster sampling was used, and 282 participants from Veranópolis, Brazil, were included. A clinical oral health examination was performed, and a structured questionnaire was applied. Bivariate and multivariate analyses were performed to verify associations using Poisson regression with robust variance. Results: The prevalence of use of dental prosthesis was 87.2% (n = 246), while the prevalence of need for dental prosthesis was 27% (n = 76). Older adults with medium/high levels of education had 17.8% (P =.019) lower prevalence ratio (PR) for use of dental prosthesis. Unmarried and retired older adults had, respectively, 11.1% (PR:1.111; 95%CI:1.022‐1.207) and 19.5% (PR:1.195; 95%CI:1.009‐1.415) higher PR for use of prosthesis. Those without access to dental care had 11.8% (P =.012) higher PR for use of dental prosthesis. Older adults living in rural areas had 64.7% (PR:1.647; 95%CI:1.079‐2.514) higher PR of need for dental prosthesis. Conclusion: High and low prevalence of use of and need for dental prosthesis, respectively, were detected in this sample. Level of education, marital status, retirement status and access to dental care were associated with the use of dental prostheses. However, only residence area was associated with the need for oral rehabilitation. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the effect of metabolic syndrome (MetS) on tooth loss in adults from a population-based sample.Methods: Cross-sectional analysis based on data from a cohort study (2009 to 2014) with adults from Southern Brazil. MetS (exposure), lack of functional dentition and number of lost teeth (outcomes) were assessed using self-reported, laboratory and clinical data. Possible confounders included sex, age, family income, education level, smoking status, and sugar consumption. The effect of MetS on the outcomes was estimated using conventional logistic or negative binomial regression models. Marginal structural modeling (MSM) with stabilized weights (a counterfactual analytical method) was also used to enhance group comparability and estimate causal effects.Results: A total of 1,283 participants had available information for the outcomes. Individuals with MetS were more likely to experience a lack of functional dentition than those without MetS (odds ratio [OR] from logistic regression, 1.7; 95% CI, 1.0 to 2.9; OR from MSM, 3.2; 95% CI, 2.3 to 4.6). Moreover, the number of teeth lost was 20% higher in participants with MetS compared with those without MetS in conventional analysis (mean ratio [MR], 1.2; 95% CI, 1.1 to 1.3). The MR increased to 1.7 (95% CI, 1.5 to 2.0) when using MSM.Conclusion: Our findings provide evidence on the effect of MetS on tooth loss. [ABSTRACT FROM AUTHOR]

Objective: To analyse the provision of oral cancer (OC) care services in the Dental Specialties Centers (Centros de Especialidades Odontológicas‐CEO) in Brazil and identify changes over two cycles of external evaluation of the Program for the Improvement of Access and Quality‐PMAQ, in 2014 and 2018. Method: This is a nationwide panel ecological study, including 916 CEO. Data from interviews with managers and dentists of the CEO were used, including variables related to training on OC, clinical protocols, biopsies, referral for diagnosis and treatment, and registration of users with OC. We carried out Latent Transition Analysis (LTA) to identify patterns (latent status LS) of service adequacy and work processes' changes between the two assessment cycles. We tested models with three, four, and five LS, selecting the one with the best conceptual interpretability and good model fit parameters. Data from the LS were plotted on choropleth and hotspots maps in Brazil allowing us to identify areas with the better or worse provision of specialized OC services. Results: The model with four LS was chosen. The four LS were named: 1.'Most indicators inadequate for OC care' (the worst); 2. 'Most indicators suitable for OC care' (the best); 3. 'CEO with a poor relation with Primary Health Care (PHC) services'; and 4. 'CEO with a poor relation with tertiary hospital services'. The comparison of the LS transition between the two cycles revealed that 419 (45.7%) CEO remained in the same LS (1→1, 3→4, 2→2); 228 (24.9%) switched to a worse status (2→1, 2→4, 3→1) and 269 (29.4%) switched to a better LS (1→2, 1→4, 3→2). While the majority of the CEO improved, we identified a decline of 17.8% in those who reported performing biopsies and 18.3% in the number of CEO that had hospitals for referring confirmed OC cases. Almost all Brazilian states had CEO that improved the work process. The Southeast and South regions had the highest percentage of CEO with the better work process in both cycles. Hotspots showed areas concentrating improvements in the work process in the Northeast region. However, some hotspots in the North revealed some CEO where the work process deteriorated or remained unsatisfactory. Conclusions: There are regional inequities in the provision of OC care in CEO. Most services improved their work process or remained stable. However, the biopsies and the referral to hospital care for confirmed cases declined, indicating that CEO need to improve planning and care provision to reduce OC morbimortality. [ABSTRACT FROM AUTHOR]

Timely diagnosis and treatment of oral and oropharyngeal cancers are central for the patient's survival. Our objective was to document the impact of the COVID‐19 pandemic on the rate of hospitalizations due to these cancers in Brazil's National Health System (SUS). The number of hospitalizations by these cancers during the first periods of the pandemic—and between the same period of 2016 to 2019—was retrieved from the SUS Hospital Information System. We compared hospitalization rates between pre‐ and pandemic periods, by State. The hospitalization rate for oral and oropharyngeal cancer during the pandemic was lower than that of the same period of previous years. The decline between 2019 and 2020 was of 49.3%, reaching 60% in the North. The reduction in hospitalization during an extended period suggests that oral and oropharyngeal cancer care will be postponed, with potentially detrimental impact on survival. [ABSTRACT FROM AUTHOR]

Objectives: Oral health inequalities impose a substantial burden on society and the healthcare system across Canadian provinces. Monitoring these inequalities is crucial for informing public health policy and action towards reducing inequalities; however, trends within Canada have not been explored. The objectives of this study are as follows: (a) to assess trends in income‐related inequalities in oral health in Ontario, Canada's most populous province, from 2003 to 2014, and (b) to determine whether the magnitude of such inequalities differ by age and sex. Methods: Data representative of the Ontario population aged 12 years and older were sourced from the Canadian Community Health Survey (CCHS) cycles 2003 (n = 36,182), 2007/08 (n = 36,430) and 2013/14 (n = 41,258). Income‐related inequalities in poor self‐reported oral health (SROH) were measured using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) and compared across surveys. All analyses were sample‐weighted and performed with STATA 15. Results: The prevalence of poor SROH was stable across the CCHS cycles, ranging from 14.1% (2003 cycle) to 14.8% (2013/14 cycle). SII estimates did not change (18.7‐19.0), while variation in RII estimates was observed over time (2003 = 3.85; 2007/08 = 4.47; 2013/14 = 4.02); differences were not statistically significant. SII and RII were lowest among 12‐ to 19‐year‐olds and gradually higher among 20‐ to 64‐year‐olds. RII was slightly higher among females in all survey years. Conclusion: Absolute and relative income‐related inequalities in SROH have persisted in Ontario over time and are more severe among middle‐aged adults. Therefore, oral health inequalities in Ontario require attention from key stakeholders, including governments, regulators and health professionals. [ABSTRACT FROM AUTHOR]

Objectives: Obesity is an important risk factor for chronic diseases and can also result in greater mortality. The aim of this longitudinal study was to investigate whether poor oral health acts as a risk factor for obesity as indicated by body mass index (BMI) and waist circumference (WC). Methods: We included in this analysis all participants who volunteered in a cohort study entitled 'Carlos Barbosa Cohort Study—CBCS' in the city of Carlos Barbosa, Southern Brazil. The interview questionnaire comprised socio‐demographic information, behavioural questions and medical history. Oral examinations and anthropometric assessments were carried out. The outcome was obesity measured by both BMI (≥30 kg/m2) and WC (>0.80 for women and >0.94 for men). Variables were collected longitudinally. Those associated with the outcome and epidemiologically relevant to the conceptual framework participated in the analysis and were adjusted for socio‐demographic, behavioural, general and oral health conditions. Results: Six hundred and thirty‐three independently living elders participated. The baseline mean age was 67.5 ± 6.1 years. Individuals who never visited a dentist (OR = 3.02, 95% CI: 1.25‐7.26) as well as participants who needed a dental prosthesis in the lower arch (OR = 4.38, 95% CI: 1.34‐14.32) were more likely to be obese, through BMI and WC measures, respectively. Edentulous participants with complete dentures in both arches (OR = 0.23, 95% CI: 0.06‐0.84) and those who perceived their oral health as unsatisfactory (OR = 0.41, 95% CI: 0.19‐0.88) had a lower likelihood of being obese, according to BMI and WC measures. Conclusions: Older persons with poor oral health may be at risk for general and central obesity, a relationship that may have important clinical implications. [ABSTRACT FROM AUTHOR]

Objectives: It is evident that discriminatory attitudes affect different dimensions of personal life, including health. This study aimed to verify the association between perceived discrimination in health services and preventive dental attendance in Brazilian adults. Methods: This cross‐sectional study used secondary data from the 2013 National Health Survey (PNS), a representative survey of the Brazilian population. The response rate was 91.9%, with 60,202 adults agreeing to complete the oral health self‐perception questionnaire. Data were analysed using the software STATA 14.0. A descriptive sample analysis was conducted that considered sample weight as well as an association between health discrimination and factors associated with preventive dental attendance through Poisson regression models. Results: Adjusted analysis demonstrated that, regarding the reasons that led to discrimination, lack of money, social class and type of working occupation showed a negative association with preventive dental attendance. Conclusion: Our findings show that discrimination perpetuates health inequities. Those with worse social conditions need more assistance as they struggle with discrimination and end up going for a check‐up after the disease is established or advanced. Preventive care, which could change the health condition of the disadvantaged population, is often a reality only for those less vulnerable. [ABSTRACT FROM AUTHOR]

Objectives: To investigate differences between Pardos (mixed) and Blacks with their White counterparts in the use of public dental service among a sample of Brazilian adults taking into consideration the role of individual and contextual characteristics. Methods: A total of 6196 adults aged 35‐44 years were sampled from the 2010 Brazilian National Oral Health Survey and nested in one of 27 Brazilian State Capitals. Binary multilevel logistic analyses were conducted. Use of public dental service in the last visit was the outcome, and self‐reported colour/race (Pardo, Black, White) was the explanatory variable. Individual covariates were sex, level of education, family income, self‐reported need for treatment, dental pain in the last 6 months, presence of decayed, filled and missing teeth. The State Capital covariates were proportion of Pardos/Blacks, Human Development Index, Gini coefficient, Integration of dental teams into Brazil Family Health Program and dentist per population rate. Results: Pardos and Blacks were 1.25 (95% CI 1.10‐1.42) and 1.73 (95% CI 1.41‐2.11) times, respectively, more likely to visit the public dental service than Whites. Adjustments for level of education and income were more relevant in affecting the estimates between groups than any other covariate, but differences persisted. Colour/race was independently associated with the type of service used in the last dental visit after fully adjusted for individual and State Capital characteristics. Conclusions: Racial differences in dental service utilization were evident for middle‐aged adults in Brazil. The results found highlight the importance of investments in public dental service as Pardos and Blacks relied more on this type of service than Whites. [ABSTRACT FROM AUTHOR]

Aims: To report the experience of coronal dental caries in the Australian adult population.Methods: Dentate people aged 15 years and over were online or telephone interviewed, and dental examined (n = 5022). The number of decay, missing and filled surfaces (DMFS) were recorded. Independent variables were demographic, socioeconomic conditions and dental care characteristics. Proportions of DMFS >0, average DMFS and its components were calculated.Results: Overall, 32.1% had decayed surfaces, with a higher proportion found in males (34.7%) and 40% higher in those living in remote areas than in those living in major city and regional areas. The prevalence of decayed surfaces varied from 37.4% (lowest income group) to 25.0% (highest income group). The mean number of decayed surfaces was three times higher in the lowest income group compared to the highest one. Uninsured people had a higher prevalence of decayed surfaces and lower mean of filling surfaces than insured group. Participants with an unfavourable pattern of dental visiting had two times higher prevalence of decay than their counterparts. Overall, three quarters (77.4%) had at least one filling in their permanent dentition. This percentage increased from 61.6% among 15-34 year olds, to 88.0% among those aged 55-74 years.Conclusion: Socioeconomic inequalities in caries experience persist in Australia. [ABSTRACT FROM AUTHOR]

Objectives: It is well known that oral health status is associated with oral health‐related quality of life (OHRQoL) in the general population. The aim of this study was to describe and analyse OHRQoL among older people in short‐term care and its associated factors. Materials and Methods: This cross‐sectional study included 391 older people in 36 short‐term care units. Data were collected via clinical oral assessments, questions about self‐perceived oral and general health, Katz Index of Activities of Daily Living (Katz‐ADL) and the Revised Oral Assessment Guide (ROAG). OHRQoL was measured using the Oral Health Impact Profile (OHIP‐14). Multivariate logistic regression models were applied in the analysis. Results: Poor OHRQoL was reported by 34% of the older people. Associated factors were swallowing problems according to ROAG; quite poor/poor self‐perceived physical, psychological and oral health; and being a woman. Conclusions: There is an association between OHRQoL and older people's self‐perceived health according to the OHIP‐14. This indicates the importance of early detection of oral health problems in frail older people and to assess both oral health and swallowing problems among older people in short‐term care. [ABSTRACT FROM AUTHOR]

Summary: Whilst previously rare, some surveys indicate substantial increases in the population with body mass index (BMI) ≥40 kg/m2 since the 1980s. Clinicians report emerging care challenges for this population, often with high resource demands. Accurate prevalence data, gathered using reliable methods, are needed to inform health care practice, planning, and research. We searched digitally for English language sources with measured prevalence data on adult BMI ≥40 collected since 2010. The search strategy included sources identified from recent work by NCD‐RisC (2017), grey sources, a literature search to find current sources, and digital snowball searching. Eighteen countries, across five continents, reported BMI ≥40 prevalence data in surveys since 2010: 12% of eligible national surveys examined. Prevalence of BMI ≥40 ranged from 1.3% (Spain) to 7.7% (USA) for all adults, 0.7% (Serbia) to 5.6% (USA) for men, and 1.8% (Poland) to 9.7% (USA) for women. Limited trend data covering recent decades support significant growth of BMI ≥40 population. Methodological limitations include small samples and data collection methods likely to exclude people with very high BMIs. BMI ≥40 data are not routinely reported in international surveys. Lack of data impairs surveillance of population trends, understanding of causation, and societal provision for individuals living with higher weights. [ABSTRACT FROM AUTHOR]

Objectives: To test the relationship of predisposing, enabling and need characteristics with dental services utilization and pattern of dental attendance among 12-year-old schoolchildren living in a socially deprived urban area.Methods: A cross-sectional study was carried out involving 358 children enrolled in public schools located in a deprived area of the city of Manaus, Brazil. Predisposing, enabling, and need characteristics were selected according to Andersen's behavioral conceptual model. Self-completed questionnaires were used to collect the predisposing characteristics (child's gender, sense of coherence, self-esteem, oral health beliefs). Parents or guardians provided data on enabling characteristics, including dental health insurance and socioeconomic status. Evaluated need characteristics included oral clinical status assessed through dental examinations conducted by five calibrated examiners. Structural equation modeling was used to test the predictors of dental services utilization and pattern of dental attendance.Results: Predisposing characteristics, including male gender and low parents/guardians sense of coherence predicted poor dental services utilization and inadequate pattern of dental attendance, respectively. Low socioeconomic status and poor oral clinical status were linked to poor dental services utilization and worse children's pattern of dental attendance.Conclusions: The present findings suggest that predisposing (child's gender and parental sense of coherence), enabling (socioeconomic conditions) and evaluated need characteristics (oral clinical status) are associated with dental services utilization among children. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic factors at both contextual and individual levels influence health. Aim: Evaluate the influence of socioeconomic inequalities on the incidence of dental caries in adolescents. Design: This cohort study was conducted with a multistage random sample of 1134 12‐year‐old adolescents from Southern Brazil. The experience of dental caries was assessed according to the decayed, missed, or filled surfaces (DMF‐S) index. The Basic Education Development Index (IDEB) was collected during baseline as a school‐level variable. Individual variables included demographic, socioeconomic, behavior‐related, and oral health measures. Multilevel Poisson regression analysis through a hierarchical approach was used to explore the influence of exploratory variables on the mean of decayed surfaces. Results: 770 14‐year‐old adolescents were reevaluated (follow‐up rate of 68%) after 2 years. Examiner's Kappa values for the assessment of dental caries ranged from 0.81 to 0.90. Adolescents with low household income and lower school's IDEB had higher mean of decayed surfaces. Non‐white adolescents, lower frequency of dental attendance, parents' poor perception of child's oral health, and dental plaque were also associated with the incidence of dental caries. Conclusion: Adolescents from a lower socioeconomic background and poor school context had higher levels of dental caries over time. [ABSTRACT FROM AUTHOR]

Objective: To provide a systematic review on the demographic and socioeconomic factors associated with edentulism among older persons.Background: Edentulism (complete loss of the natural teeth) is one of the main problems affecting the oral health of the elderly individuals. Many unfavourable socioeconomic factors are considered important predictors of edentulism.Materials and Methods: This review was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The search for published studies was conducted on PubMed, Web of Science, SciELO, Google and Google Scholar. Only observational epidemiological studies published in either English or Portuguese prior to June 2018 were included in our study. The bibliographic and methodological characteristics of the selected studies were evaluated. The Review Manager 5.3 software was used in the meta-analysis.Results: We identified 343 articles, 24 of which met all the eligibility criteria and were included in the review. Unfavourable demographic and socioeconomic conditions were associated with the highest proportion of edentulous individuals. Age, level of education, and socioeconomic status were the main factors that were found to influence edentulism among elderly individuals. The meta-analysis results showed a lower risk of edentulism in men (OR = 0.93; 95% CI = 0.90-0.96) and no significant differences in the risk of developing edentulism among different races/ethnicities or skin colours (OR = 0.68; 95% CI = 0.45-1.01).Conclusion: Better socioeconomic conditions and male sex were identified as protective factors against edentulism among older individuals. Thus, public policies aimed at helping the most vulnerable populations must be implemented. [ABSTRACT FROM AUTHOR]

Objective: To analyse trends in dental pain prevalence among Brazilian adolescent students over 6 years, focusing on inequalities by maternal education. Methods: Data from the National Adolescent School‐Based Health Survey (PeNSE) carried out in 2009 (n = 45 239), 2012 (n = 46 482) and 2015 (n = 35 592) were analysed, including ninth grade students from the 27 state capitals in Brazil who were of ages 11‐17 years or older. Variables analysed were dental pain within the last 6 months (yes/no) and the following sociodemographic factors: age, sex, race, type of school and maternal schooling (years of study: ≤8; 9‐11; ≥12). The prevalence of dental pain in the 3 years was compared using the Rao‐Scott test. Relative and absolute measures of socioeconomic (maternal education) inequalities in dental pain were applied using the slope index of inequality (SII) and the relative concentration index (RCI). Results: The prevalence of dental pain increased from 17.5% (95% CI = 16.9‐18.2) in 2009 to 20.4% (95% CI = 19.7‐21.1) in 2012, then to 21.8% (95% CI = 21.1‐22.5) in 2015. All sociodemographic factors investigated were associated with dental pain in all survey years. There was an increasing proportion of the outcome in all categories of maternal education over the years studied. Absolute (SII) and relative (RCI) inequalities regarding of maternal education were found; these indicate higher levels of dental pain in the lower socioeconomic group in each study year. However, no significant changes in inequalities were found from 2009 to 2015. Conclusions: The prevalence of dental pain increased in the 2009‐2012 and 2012‐2015 periods, and social inequalities were found. Higher levels of dental pain persisted in the lower maternal education group. Inequalities remained stable over time. Broader actions to reduce the existing inequalities are needed and should be a priority for public policies. [ABSTRACT FROM AUTHOR]

Background: Oral squamous cell carcinoma is the eighth most common cancer worldwide with a relatively high rate of metastasis (~40%). Previously, we showed that microRNA-138 serves as a functional tumor suppressor and plays an important role in oral squamous cell carcinoma metastasis. However, to date, microRNA-138 expression has not been examined in this tumor tissue. Herein, we demonstrated that microRNA-138 expression is downregulated in metastatic oral squamous cell carcinoma specimens using tissue microarray technology with in situ hybridization.Methods: The study included 254 oral squamous cell carcinoma patients from two centers (160 from the Chengdu center and 90 from the Guangzhou center) and four healthy volunteers.Results: Multivariate analysis showed that microRNA-138 expression was independent of tumor stage, age, gender, smoking, and alcohol consumption in oral squamous cell carcinoma patients. Interestingly, patients that expressed lower levels of microRNA-138 (determined by in situ hybridization) were more prone to regional lymph node metastasis and exhibited poorer outcomes. These findings support the role of microRNA-138 as a tumor suppressor in oral squamous cell carcinoma.Conclusion: In summary, the expression level of microRNA-138 is negatively correlated with oral squamous cell carcinoma metastasis; the lower the expression of microRNA-138, the higher the rate of metastasis and the poorer the prognosis of the patients. Therefore, our study confirms that microRNA-138 serves as a tumor suppressor and plays a functional role in oral squamous cell carcinoma tumor metastasis; microRNA-138 constitutes a promising prognosis biomarker and therapeutic target for oral squamous cell carcinoma with metastasis potential. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to investigate comprehensively, the risk factors for underweight in cross‐sectional study in the general population of Japan. Methods: The survey population was the general population of individuals aged >40 years in Takahata town, Japan in 2005. A postal survey in the form of a self‐administered questionnaire was distributed, and 6084 individuals were entered into the final statistical analysis. The self‐administered questionnaire contained items regarding lifestyle, oral health status, socio‐economic status and dietary intake. To examine the independent relationships between an underweight status and several parameters, a multivariate logistic regression analysis was used to estimate adjusted odds ratios (ORs). Results: The number of teeth, age, alcohol consumption, hypertension, spousal status, smoking habit, appetite, body weight at 20 years of age, habit of going out and physical activity were independently associated with an underweight status compared with the normal weight group. Individuals with fewer than 10 teeth were especially more likely to be underweight than individuals with more than 20 teeth (OR = 1.956, 95% CI = 1.261‐3.035). Conclusion: This study showed an independent association between the number of teeth and an underweight status, indicating that fewer teeth can increase the risk of being underweight. [ABSTRACT FROM AUTHOR]

Background: Besides the growth in Brazilian public oral health investments, no pre‐school children preventive policies were done, and surveys demonstrated lower prevalences of use of dental service. Aim: To verify trends in the use, type, and reason for seeking dental services among pre‐school children considering time variations. Methods: This study used data of clinical examinations and structured interviews of three cross‐sectional surveys of southern pre‐school children in Brazil, from 2008, 2010, and 2013. Chi‐square test for trends and hierarchical age‐period‐cohort (HAPC) analysis using the multilevel Poisson regression model assessing the influence of social and clinical variables in the use, type, and reason for seeking dental services were performed. Results: A total of 1765 pre‐school children participated in all surveys. At least, one time‐related variation affected one of three assessed outcomes. There was no significant change in prevalence of the use of dental services (75.8%, 77.4%, and 74.9%, respectively, for each year; P = 0.750). In the HAPC analysis, younger children and from low socio‐economic backgrounds were less likely to have visited the dentist. Conclusion: The prevalence of use of oral health services did not change and socio‐economic inequalities persisted through the years, indicating a need of reviewing the policies to promote public health. [ABSTRACT FROM AUTHOR]

Objective: Cancer survivors (CSs) often face the dual physical burden of cancer and other comorbid chronic disease (CCD) and have a great deal of psychological distress, such as anxiety and depression. However, the association between CCD and psychological problems remain less clear in CS. This study was performed to investigate the prevalence of anxiety and depression in Chinese CS, and whether CCD have impact on CSs' anxiety and depression.Methods: A cross-sectional study was conducted among 1546 CSs in Shanghai, China. All participants were asked to complete a questionnaire containing Zung self-rating anxiety scale (SAS), Zung self-rating depression scale (SDS), and questions on sociodemographic characteristics and CCD. Associations between CCDs, and anxiety and depression, were evaluated by using logistic regression, adjusted for confounding factors.Results: The prevalence of anxiety and depression in CSs were 28.2 % and 48.2%, respectively. 74.9% CSs had one or more comorbidities. Almost all CCDs examined showed associations with anxiety, except for CSs with diabetes. CSs with hyperlipidemia, diabetes, heart and cardiovascular diseases, and musculoskeletal diseases had significantly greater depression scores. When compared with those without CCD, CSs with one to two CCDs and greater than or equal to three CCDs had higher risks of anxiety and depression.Conclusions: Anxiety and depression were more prevalent among CSs who also had CCDs. CCD have significantly negative association with CSs' anxiety and depression. Further cohort research will help deduce the causal relationships between CCDs, and anxiety and depression. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to test associations between a municipal social development indicator and indicators of public dental services; examine differences in the achievement of public dental services goals between fluoridated and nonfluoridated municipalities; and, quantify contribution of a municipal social development indicator in estimated mean differences in the public dental services indicators between fluoridated and nonfluoridated municipalities. Methods: A secondary analysis of data from 293 municipal dental health services records from Southern Brazil between 2010 and 2015 was conducted. Multivariable log‐binomial regression models were fitted to test the associations between municipal Human Development Index (HDI) and multiple public dental services indicators (proportion of public dental health service coverage, the proportion of tooth extraction among all clinical procedures, and monthly participation in supervised tooth brushing). Cut‐off points for outcomes were based on state goals for public dental services. Blinder‐Oaxaca decomposition analyses were performed to quantify the relative contribution of HDI in the differences in outcomes according to the municipal water fluoridation status. Results: Municipalities within the lowest tertile of HDI had 66% lower prevalence of having insufficient public dental health service coverage (less than state goals)than those in the highest tertile of HDI (PR: 0.44; 95% CI: 0.24, 0.50). Municipalities with lowest HDI had nearly 30% higher prevalence of failing the state goals regarding the proportion of extraction and supervised tooth brushing (PR: 1.30; 95% CI: 1.20, 1.40 and PR: 1.34; 95% CI: 1.23, 1.45, respectively). Mean public dental health service coverage was higher in nonfluoridated municipalities than fluoridated municipalities, and municipal HDI explained 36% of the total estimated mean difference. Conclusions: This study found associations between municipal social development and public dental services indicators in Southern Brazil. However, higher HDI was associated with lower public dental health service coverage, lower proportion of extraction and higher coverage of supervised tooth brushing [Correction added on 2 April 2019, after first online publication: In the preceding sentence, the text "but with a higher proportion of extraction and supervised tooth brushing" was changed to "lower proportion of extraction and higher coverage of supervised tooth brushing"]. Municipal HDI contributed significantly towards the gap in public dental coverage between fluoridated and nonfluoridated municipalities, favoring nonfluoridated municipalities. These findings have important policy implications for reducing oral health inequalities as it highlights the interplay between key oral health policies and their distribution according to municipal social development. [ABSTRACT FROM AUTHOR]

Background: The pathway by which socioeconomic disadvantages are manifested in the occurrence of dental caries remains unclear. Aim: To explore how much the association between untreated dental caries and income inequalities is related to household food insecurity (HFI). Design: A population‐based study was conducted with a sample of 466 12‐year‐old students. Dental caries was evaluated by an examiner who had undergone calibration exercises. HFI was assessed using the Food Insecurity Scale validated for Brazilian Portuguese. Poisson regression models were created to determine associations between dental caries and both household income and HFI. The proportion of the income effect on dental caries explained by HFI was determined by the variation in percentages between the crude prevalence ratio (PRc) for dental caries and this measure adjusted by HFI (PRa). Results: The prevalence of dental caries was higher among children from families with a per capita household income lower than US$ 71 (PR: 1.69; 95%CI: 1.15‐2.49) or from US$ 71 to US$ 142 (PR: 1.50; 95%CI: 1.04‐2.17). Moreover, 14% of the association between a low income and dental caries was explained by HFI. Conclusions: Differences in the prevalence of dental caries in schoolchildren related to socioeconomic inequalities could partially be attributed to HFI in low‐income families. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association of contextual and individual determinants with non-utilization of dental services among Brazilian adults.Methods: Data were from adults aged 35-44 years (N = 7,265) from the 2010 Brazilian Oral Health Survey (SB Brasil Project). Non-utilization of dental services was assessed whether the individual has never had a dental visit over the whole life time. Independent variables were selected according to Andersen's behavioral model. Contextual variables included Human Development Index-longevity (HDI-Longevity) (predisposing demographic), HDI-Education and Gini index (predisposing social), integration of oral health teams into Primary Care (enabling health policy), and HDI-Income (enabling financing). Individual data were age and sex (predisposing demographic), ethnicity and schooling (predisposing social), family monthly income (predisposing enabling), perceived dental treatment (perceived need), and decayed teeth (evaluated need). The relationship of contextual and individual variables with non-utilization of dental services was assessed through multilevel logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (95% CI).Results: The prevalence of non-utilization of dental services was 4.7 percent. Adults living in cities with high HDI-Income were less likely to never have a dental visit. The odds of non-utilization of dental services were lower for adults living in cities with high HDI-Longevity. Sex, skin color, dental treatment needs, poor socioeconomic characteristics, perceived dental treatment needs, and decayed teeth were also associated with non-utilization of dental services.Conclusions: The results suggest that contextual enabling and predisposing factors, individual sociodemographic, and needs-related characteristics influence non-utilization of dental services by Brazilian adults. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the associations between degree of periodontal disease and number of teeth on oral health-related quality of life among older individuals.Material and Methods: Randomly selected 804 participants aged ≥70 derived from two cohorts were included in the analysis. Dental examinations and evaluation of OHRQL using the OHIP-14 (Oral Health Impact Profile-14) were performed. After categorisation of the participants according to the extent of periodontitis in three groups (none, localised with <30% of teeth affected, generalised with ≥30% of teeth affected) and the number of teeth, associations between periodontal status and the number of teeth and the OHIP-14 scores were analysed. Multivariable regression analyses were used taking into account level of periodontitis, number of teeth, age and sex.Results: Among 70-year-old men and women, generalised periodontitis showed an association with poor OHRQL. However, a multivariable analysis failed to demonstrate this association (OR = 1.02, 95% CI: 0.72-1.44). In participants with 1-10 remaining teeth, the OHIP-14 score was significantly increased indicating poor OHRQL, compared with participants with ≥21 remaining teeth (OR = 1.57, 95% CI: 1.13-2.19). Similar findings were observed among women aged 70-92 years.Conclusions: Periodontitis did not show an association with poor OHRQL, however, a significant association between the number of teeth and poor OHRQL was found. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Single‐item self‐reported oral health (SROH) is a convenient and reliable measure for the assessment of population‐based oral health. However, little is known about trends and its associations among US adults. This study investigated trends in SROH (aged 20+ years) and the associated factors among adults living in the United States. Methods: Self‐reported oral health data for 41 621 adults aged 20+ years from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2014 were analysed. Survey‐weighted descriptive statistics were computed to provide nationally representative estimates. Multivariable logistic regression was performed separately for each survey period with SROH as the primary outcome. Independent variables included were age, gender, race/ethnicity, education level and family poverty income ratio or PIR. Pooled survey‐weighted multivariable logistic regression was also performed to consider possible time‐changing effects. Results: The survey‐weighted proportions of “excellent or very good” in SROH increased from 27% in 1999‐2000 (n = 4873) to 38% in 2013‐2014 (n = 5765). Separate multivariable logistic analyses for each survey period suggested that females, Whites (vs Mexican and Black Americans) as well as respondents from high family PIR had higher odds of reporting their oral health as “excellent or very good” (P < .05). The pooled multivariable logistic model confirmed results in the separate logistic regression, and respondents in the more recent survey periods had higher probabilities of reporting “excellent or very good” oral health. Respondents aged 50‐59 years were found to have relatively lower probabilities of reporting “excellent or very good” oral health, while people aged 20‐29 years had higher probabilities than those aged 30‐39 years. Compared to respondents with lower education, those with higher education were more likely to report their oral health as excellent or very good. Conclusions: Self‐reported oral health improved from 1999 to 2014. In general, respondents who were young, female, White, had higher education or higher income or were surveyed in more recent years reported excellent or very good oral health. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To test whether maternal education has a direct effect on gingival bleeding in adolescents aged 12 and to assess whether oral health behaviours over time mediate that association. Methods: Two oral health studies nested in the 1993 Pelotas (Brazil) birth cohort study were carried out in participants aged 6 (n = 359) and 12 years (n = 339). The proportion of teeth with bleeding on probing (BOP) and the median number of teeth with gingivitis at age 12 were recorded. Maternal education at birth was the exposure. Toothbrushing frequency and dental visit at ages 6 and 12 years were investigated as mediators of the association between maternal education at birth and gingival bleeding. Time‐varying family income through childhood and adolescence was included as later confounder. Paternal education was taken as baseline confounder. The controlled direct effect (CDE) of maternal education at child's birth on gingival bleeding at age 12 was estimated using marginal structural models (MSM). Additionally, path analysis was employed to estimate standardized direct, indirect and total effects of maternal education at birth on gingival bleeding. Results: Adjusted analyses using MSM showed that adolescents whose mothers had <8 years of education had 3.82 higher risk of having teeth with gingival bleeding above the median (rate ratio RR 3.82; 95% CI: 1.68‐8.19). Low maternal education doubled the proportion of gingival bleeding at age 12 not mediated by dental visit and toothbrushing frequency (RR 1.99; 95% CI: 1.52‐2.60). Path analysis revealed that maternal education had a direct effect on gingival bleeding independently of the mediators. Conclusions: The pattern of oral health behaviours does not explain the association between mother's education and adolescent's gingival bleeding. Individual‐based approaches focused on oral health‐related behaviours tend to fail to prevent gingival bleeding. [ABSTRACT FROM AUTHOR]

The conventional wisdom in dental and medical education is that dental and medical students experience "ethical erosion" over the duration of dental and medical school. There is some evidence for this claim, but in the case of dental education the evidence consists entirely of survey research, which does not measure behavior. The aim of this study was to measure the altruistic behavior of dental students in order to fill the significant gap in knowledge of how students are disposed to behave, rather than how they are disposed to think. To test the altruistic behavior of dental students, the authors conducted a field experiment using the Ultimatum Game, a two-player game used in economics to observe social behavior. In the game, the "proposer" is given a pot of resources, typically money, to split with the "responder." The proposer proposes a split of the pot to the responder. If the responder accepts the proposed split, both participants keep the amounts offered. If the proposal is rejected, then neither participant receives anything. In this study, the students played the proposer, and the responder was a fictional individual although the students believed they were playing the computerized game with a real person. In fall 2015, dental students from each of the four years at one university played the game. All 160 students were invited to participate, and 136 did so, for a response rate of 85%. The results showed that the students exhibited greater levels of altruism than the general population typically does. The students' altruism was at its highest in year four and was associated with the socioeconomic status of responder. This result raises the possibility that if a decreasing ability to behave altruistically is observed during dental school, it may not be due to a general disposition of students, but rather some factor specific to the educational environment. [ABSTRACT FROM AUTHOR]

Objective To compare the magnitude of relative oral health inequalities between Indigenous and non-Indigenous persons from Brazil, New Zealand and Australia. Methods Data were from surveys in Brazil (2010), New Zealand (2009) and Australia (2004-06 and 2012). Participants were aged 35-44 years and 65-74 years. Indigenous and non-Indigenous inequalities were estimated by prevalence ratios ( PR) and their corresponding 95% confidence intervals ( CI), adjusting for sex, age and income. Outcomes included inadequate dentition, untreated dental caries, periodontal disease and the prevalence of 'fair' or 'poor' self-rated oral health in Australia and New Zealand, and satisfaction with mouth/teeth in Brazil ( SROH). Results Irrespective of country, Indigenous persons had worse oral health than their non-Indigenous counterparts in all indicators. The magnitude of these ratios was greatest among Indigenous and non-Indigenous Australians, who, after adjustments, had 2.77 times the prevalence of untreated dental caries (95% CI 1.76, 4.37), 5.14 times the prevalence of fair/poor SROH (95% CI 2.53, 10.43). Conclusion Indigenous people had poorer oral health than their non-Indigenous counterparts, regardless of setting. The magnitude of the relative inequalities was greatest among Indigenous Australians for untreated dental decay and poor SROH. [ABSTRACT FROM AUTHOR]

The effect of socioeconomic factors on receipt of definitive treatment and survival outcomes in non-metastatic head and neck squamous cell carcinoma ( HNSCC) remains unclear. Eligible patients ( n = 37 995) were identified from the United States Surveillance, Epidemiology and End Results ( SEER) database between 2007 and 2012. Socioeconomic factors (i.e., median household income, education level, unemployment rate, insurance status, marital status and residence) were included in univariate/multivariate Cox regression analysis; validated factors were used to generate nomograms for cause-specific survival ( CSS) and overall survival ( OS), and a prognostic score model for risk stratification. Low- and high-risk groups were compared for all cancer subsites. Impact of race/ethnicity on survival was investigated in each risk group. Marital status, median household income and insurance status were included in the nomograms for CSS and OS, which had higher c-indexes than the 6th edition TNM staging system (all P < 0.001). Based on three disadvantageous socioeconomic factors (i.e., unmarried status, uninsured status, median household income < US $65 394), the prognostic score model generated four risk subgroups with scores of 0, 1, 2 or 3, which had significantly separated CSS/ OS curves (all P < 0.001). Low-risk patients (score 0-1) were more likely to receive definitive treatment and obtain better CSS/ OS than high-risk patients (score 2-3). Chinese and non-Hispanic black patients with high-risk socioeconomic status had best and poorest CSS/ OS, respectively. Therefore, marital status, median household income and insurance status have significance for predicting survival outcomes. Low-risk socioeconomic status and Chinese race/ethnicity confer protective effects in HNSCC. [ABSTRACT FROM AUTHOR]