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OBJECTIVE This study analysed the association between caesarean section and early childhood caries (ECC), estimating the effects using regression and causal inference models. METHODS This was a historical cohort study of 697 mother-child dyads, conducted in Sao Luis, Brazil. The caesarean section was the exposure, and the severity of ECC (dmft) was the outcome. Covariates household income, maternal schooling, maternal hypertension, maternal obesity and birth weight were adjusted for in the models. The effects were estimated by Poisson regression (Means Ratio-MR) and causal inference using a marginal structural model (MSM) (MR and Average Treatment Effect-ATE coefficients), weighted by the inverse probability (IPW) of exposure. RESULTS Caesarean section was protective against caries in the bivariate (MR 0.81; CI 0.70-0.94; P = 0.005) and multivariate (MR 0.78; CI 0.67-0.91; P = 0.002) models. In MSM analyses, the caesarean section had no effect on ECC (ATE = -0.35; P = 0.107), controlling for IPW of exposure. CONCLUSION The apparent association between caesarean section and ECC severity seems spurious, as it did not persist after employing a superior approach to estimating causality.

O presente artigo apresenta uma pesquisa sobre a formação de professores e as apropriações em tecnologia assistiva na educação inclusiva, realizado em 2021, com 48 docentes participantes de curso de pós-graduação em nível de especialização em Atendimento Educacional Especializado – AEE – ofertado por Instituição Pública Federal. A pesquisa partiu dos seguintes questionamentos: os professores possuem conhecimento acerca da tecnologia assistiva, e tomam para si a atribuição de indicar o uso de tais recursos para seus alunos? Ademais, quais seriam as perspectivas de formação continuada que os professores têm se amparado para a aprendizagem sobre a tecnologia assistiva? Como objetivo geral analisou-se a utilização e a apropriação da tecnologia assistiva na formação de professores da educação inclusiva. E ainda, os objetivos específicos foram pesquisar produções científicas sobre a utilização de tecnologia assistiva na formação de professores; investigar a necessidade de capacitação dos professores sobre estes recursos e como o conhecimento contribui para a formação do professor. Trata-se de uma pesquisa bibliográfica com estudo de caso exploratório com procedimento survey para geração de dados por meio de informações coletadas em questionário aplicado via Google Forms, no período de distanciamento social devido a pandemia da Covid-19.

Esta pesquisa analisa a atuação e produção científica do médico Raimundo Nina Rodrigues (1862-1906) sob a perspectiva da história das ciências, enfatizando sua proposta de constituição do negro como “objeto científico”. Trata-se de entender como um “problema” fruto de questões colocadas à sociedade no final do século XIX, frente às dificuldades de definição do povo brasileiro e à preocupação com o destino da nação, foi legitimado como objeto e passou a ser investigado pelas disciplinas científicas às quais Nina Rodrigues se dedicou e ajudou a consolidar no país. O enfoque teórico-metodológico deste trabalho ganha contornos com a historiadora Lorraine Daston e seus estudos sob a ótica da epistemologia histórica, que ajudam a mostrar o enraizamento histórico e social dos objetos científicos, chamando a atenção para a busca pelas condições – racionais, sem dúvida, mas também políticas ou morais – que permitem o seu nascimento e morte (o momento quando deixam de ser reconhecidos como objetos). A abordagem possibilitará compreender como o problema social do negro no Brasil no final do século XIX foi tratado por Nina Rodrigues, enquanto objeto científico, a partir da teoria biológica da degeneração e das teorias antropológicas evolucionistas. Permite também evidenciar as condições que, no passado, trataram como verdadeiros certos objetos, métodos e conclusões de Nina Rodrigues, hoje reconhecidos como epistemologicamente frágeis ou simplesmente falsos, além de perigosos. A partir das categorias de “normal”, “anormal” e “patológico”, trabalhadas por George Canguilhem e Michel Foucault, examinamos a obra de Nina Rodrigues e suas preocupações sobre a raça do ponto de vista da medicina e do direito penal. Levando em consideração os estudos do autor em consonância com as questões colocadas para pensar a nação, concluímos ser possível relacionar esse momento das ciências e dos saberes no Brasil ao processo histórico conhecido como normalização, guardando suas especificidades temporais e características sociais. Cette recherche analyse l’activité et la production scientifique du médecin Raimundo Nina Rodrigues (1862-1906) du point de vue de l’histoire des sciences, en mettant l’accent sur sa proposition de constitution de la personne noire comme “objet scientifique”. Il s’agit de comprendre comment un “problème” résultant de questions posées à la société à la fin du XIXème siècle, face à la difficulté de définir le peuple brésilien et au souci du destin de la nation, a été légitimé en tant qu’objet et a commencé à être étudié par les disciplines scientifiques auxquelles Nina Rodrigues s’est consacrée et qu’il a aidées à se consolider dans le pays. L’approche théorico-méthodologique de ce travail suit celle de l’historienne Lorraine Daston et ses études d’orientation épistémologique qui aident à montrer l’enracinement historique et social des objets scientifiques, en attirant l’attention sur la recherche des conditions-rationnelles sans doute mais aussi politiques et morales – qui permettent leur naissance et leur mort (le moment où ils cessent d’être reconnus comme objets). Cette approche permettra de comprendre comment le problème social des Noirs au Brésil à la fin du XIXème siècle a été traité en tant qu’objet scientifique par Nina Rodrigues sur la base de la théorie biologique de la dégénération et des théories anthropologiques évolutionnistes. Elle permettra également de mettre en évidence les conditions qui, par le passé, ont permis de considérer comme vrais certains objets, certaines méthodes et conclusions de Nina Rodrigues aujourd’hui reconnus comme épistémologiquement fragiles ou même tout simplement faux, voire dangereux. À partir des catégories du normal, de l’anormal et du pathologique, analysées par Georges Canguilhem et Michel Foucault, nous examinons l’œuvre de Nina Rodrigues et ses préoccupations relatives à la race sous l’angle de la médecine et du droit pénal. En prenant en considération les études de l’auteur en accord avec les questions posées pour penser la nation, nous en avons conclu qu’il est possible de faire le lien entre ce moment des sciences et des savoirs au Brésil et le processus historique connu sous le nom de normalisation, en restant attentif à ses spécificités temporelles et des caractéristiques sociales. Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

The purpose of this paper is to analyse how socio‐economic inequalities in mortality (total and avoidable) evolved in Portugal from the 1990s onwards by looking at differences by gender, age group, poverty and cause of death. Results show that mortality in younger age groups is decreasing faster in the most deprived municipalities. Yet, avoidable deaths do not follow this pattern, particularly with respect to treatable mortality amenable to the health care services. Although total and avoidable mortality are decreasing across all age groups and both genders, decreases in treatable deaths during and after the 2011–14 economic crisis slowed down among the young, with a sharpening of socio‐economic inequalities in avoidable mortality among adults and the elderly. This provides evidence that, in some respects, focusing programmes on those living in poor circumstances has been successful over time. However, the impact of the Great Recession on health care services might have contributed to a significant increase in some treatable causes of death associated with these services.

To evaluate diet quality and relationship between Body Mass Index (BMI), diet quality and inflammatory markers in adolescents of public schools in São Luís-MA. Methodology: A cross-sectional study was conducted with 384 adolescents aged 17 and 18 years. The nutritional status was evaluated through the BMI. The quality of the diet was evaluated through the Revised Diet Quality Index (IQD-R). The inflammatory markers used were C-Reactive Ultrasensitive Protein (hs-CRP), IL-6 (Interleukin-6) and TNF-α (Tumor Necrosis Factor α). Multivariate analysis was performed using a decision tree using the CART (Classification and Regression Trees) algorithm to evaluate the relationship between BMI, diet quality and inflammatory markers. Results: The mean age was 17.3±0.5 years, predominance of females (56.5%) and eutrophic (69.3%). The mean IQD-R score was 55.3±12.7. Adolescents in the lowest tertile of IQD-R (T1) had a higher mean BMI (22.1±4.3 kg/m2 vs 21.5 ± 3.7kg/m2). Higher levels of IL-6 were observed in those located on the IQD-R T1 (1,345 mg/L vs 1,205 mg/L). In the same group (T1), adolescents who had higher IL-6 levels also had a higher mean BMI (23.6±5.1kg/m2 vs 20.8±3.0kg/m2). The adolescents in the largest tertiles of IQD-R (T2 and T3) and who had higher concentrations of IL-6 and CR-us had also a higher mean BMI (23.8±4.9kg/m2). Conclusions: The diet quality of adolescents studied needs modifications. BMI averages varied with diet quality and levels of IL-6 and hs-CRP. Avaliar a qualidade da dieta e a relação entre Índice de Massa Corporal (IMC), qualidade da dieta e marcadores inflamatórios em adolescentes de escolas públicas de São Luís-MA. Metodologia: Foi realizado um estudo transversal com 384 adolescentes de 17 e 18 anos. O estado nutricional foi avaliado por meio do IMC. A qualidade da dieta foi avaliada por meio do Índice de Qualidade da Dieta Revisado (IQD-R). Os marcadores inflamatórios utilizados foram Proteína C Reativa Ultrassensível (PCR-us), IL-6 (Interleucina-6) e TNF-α (Fator de Necrose Tumoral α). A análise multivariada foi realizada usando uma árvore de decisão usando o algoritmo CART (Classification and Regression Trees) para avaliar a relação entre IMC, qualidade da dieta e marcadores inflamatórios. Resultados: A média de idade foi de 17,3 ± 0,5 anos, predomínio do sexo feminino (56,5%) e eutrófico (69,3%). A pontuação média do IQD-R foi de 55,3 ± 12,7. Os adolescentes no tercil inferior do IQD-R (T1) tiveram uma média de IMC mais alta (22,1 ± 4,3kg/m2 vs 21,5 ± 3,7kg/m2). Níveis mais elevados de IL-6 foram observados naqueles localizados no IQD-R T1 (1.345 mg/L vs 1.205 mg/L). No mesmo grupo (T1), os adolescentes que apresentaram níveis mais elevados de IL-6 também apresentaram média de IMC mais elevada (23,6 ± 5,1kg/m2 vs 20,8 ± 3,0kg/m2). Os adolescentes nos maiores tercis de IQD-R (T2 e T3) e que apresentaram maiores concentrações de IL-6 e CR-us também apresentaram maior IMC médio (23,8 ± 4,9kg/m2). Conclusões: A qualidade da dieta dos adolescentes estudados necessita de modificações. As médias do IMC variaram com a qualidade da dieta e os níveis de IL-6 e PCR-us.

Introduction Statin therapy is associated with an increased risk of developing diabetes. Among bariatric patients, the influence of this therapy on various metabolic outcomes, such as diabetes status and its remission, is largely unknown. Methods This was a retrospective study of 1710 patients who underwent bariatric surgery at our hospital between January/2010 and June/2017. We compared patients with and without statin therapy at baseline, 12 and 24 months after surgery regarding statin use and its impact on several clinical and analytical parameters. Multiple linear regression was performed, adjusting differences for age, sex, surgery type, antidiabetic drugs at baseline, hypertension at baseline, LDL cholesterol ˃ 130 mg/dL, weight variation one year after surgery, and age of obesity onset. Results The overall prevalence of statin use was 20.2% before, 13.6% 12 months after surgery, and 15.0% 24 months after surgery. There was a larger reduction in fasting glucose and HbA1c at 12 and 24 months after surgery among statin-treated patients, with the opposite trend for weight reduction and BMI. Statin-treated patients with diabetes had lower diabetes remission rates (45.3 vs 68.5%) 12 months after surgery, with the highest reduction in HbA1c (1.3±1.3 vs −1.1±1.2%; p=0.042), fasting glucose (−40.8±48.8 vs −30.9±41.6 mg/dL; p=0.028), and insulin (−21.7±28.2 vs −13.4±14.2 mIU/L; p=0.039). The proportion of new-onset cases of diabetes was equal between statin-treated vs non-treated individuals at 12 months (1.9%) and 24 months (1.0%) after surgery. Conclusion Bariatric surgery seems to lead to diabetes remission more frequently in patients not treated with statins. A larger reduction was observed in fasting glucose and HbA1c among statin-treated patients. Statin did not contribute to an increased proportion of new-onset diabetes after surgery.

Cardiovascular diseases are the main cause of death worldwide. Recent studies have revealed the influence of histone-modifying enzymes in cardiac remodeling and heart dysfunction. The Set7 methyltransferase regulates the expression of several genes through the methylation of histones and modulates the activity of non-histone proteins. However, the role of Set7 in cardiac remodeling and heart dysfunction remains unknown. To address this question, wild-type (WT) and Set7 knockout (KO) male mice were injected with isoproterenol or saline. WT mice injected with isoproterenol displayed a decrease in Set7 activity in the heart. In addition, WT and Set7 KO mice injected with isoproterenol exhibited cardiac hypertrophy. Interestingly, Set7 deletion exacerbated cardiac hypertrophy in response to isoproterenol but attenuated myocardial fibrosis. Echocardiograms revealed that WT mice injected with isoproterenol had lowered ejection fractions and fractional shortening, and increased E′-wave deceleration time and E/A ratio compared with their controls. Conversely, Set7 KO mice did not show alteration in these parameters in response to isoproterenol. However, prolonged exposure to isoproterenol induced cardiac dysfunction both in WT and Set7 KO mice. Both isoproterenol and Set7 deletion changed the transcriptional profile of the heart. Moreover, Set7 deletion increased the expression of Pgc1α and mitochondrial DNA content in the heart, and reduced the expression of cellular senescence and inflammation markers in response to isoproterenol. Taken together, our data suggest that Set7 deletion attenuates isoproterenol-induced myocardial fibrosis and delays heart dysfunction, suggesting that Set7 plays an important role in cardiac remodeling and dysfunction in response to stress.

A FORMAÇÃO É A CONEXÃO PROFISSIONAL PERMANENTE DE TODOS OS TEMPOS, PRINCIPALMENTE, EM PERÍODOS DESAFIADORES, E SEM DIA NEM HORA DETERMINADO PARA ACABAR; É UM PROCESSO CONTÍNUO VIVENCIADO PELAS PRÁTICAS DOCENTES. NESSA PERSPECTIVA, PERCEBE-SE A IMPORTÂNCIA DE UMA AUTORREFLEXÃO PROFISSIONAL PARA QUE O(A) PROFESSOR(A) POSSA BUSCAR A COMPREENSÃO E, CONSEQUENTEMENTE, SINTA A NECESSIDADE DE ABRIR NOVOS HORIZONTES PARA OUTRAS POSSIBILIDADES, ENTRE ELAS A DA REFLEXÃO SOBRE A TEORIA E PRÁTICA. ATRAVÉS DA FORMAÇÃO CONTINUADA, O DOCENTE TEM A OPORTUNIDADE DE REFLETIR SOBRE O PROCESSO DE ENSINO APRENDIZAGEM E SOBRE A IMPORTÂNCIA DE UMA FORMAÇÃO CONTINUADA CONSTANTE FAZER PEDAGÓGICO DOS PROFISSIONAIS DE EDUCAÇÃO DE UM MUNICÍPIO PARAIBANO. A IMPORTÂNCIA DO TEMA SE DÁ PELA ÊNFASE NA PRÁTICA DOCENTE, O QUE POSSIBILITA O APERFEIÇOAMENTO DO ENSINO E, POR CONSEGUINTE, DA MELHORIA NA QUALIDADE DA EDUCAÇÃO EM NOSSO PAÍS. PORTANTO, OBJETIVA-SE ANALISAR SE A FORMAÇÃO CONTINUADA PODE CONTRIBUIR PARA A MELHORIA DA PRÁTICA PEDAGÓGICA DOS(AS) PROFESSORES(AS) DO ENSINO FUNDAMENTAL (1º E 2º ANO), EM ONZE ESCOLAS MUNICIPAIS, NA BUSCA DE UM ENSINO APRENDIZAGEM EFICAZ NO MUNICÍPIO. NO DESENVOLVIMENTO DESTA PESQUISA FOI UTILIZADA A METODOLOGIA DO TIPO DESCRITIVA, COM ENFOQUE NA ANÁLISE DOCUMENTAL (QUALITATIVO). O UNIVERSO ESTUDADO COMPREENDE PROFESSORES(AS) ALFABETIZADORES(AS), GESTORES(AS) E SUPORTE PEDAGÓGICO LOCAL, OBSERVADOS A PARTIR DOS RELATÓRIOS DAS FORMAÇÕES CONTINUADAS REALIZADAS NO MUNICÍPIO. COMPREENDE QUE FOI A PARTIR DA PRÁTICA COM A FORMAÇÕES CONTINUADAS, QUE COMEÇARAM PERCEBER AVANÇOS SIGNIFICATIVOS, MEDIANTE A OBSERVAÇÃO DOS RELATÓRIOS DAS FORMAÇÕES, CHEGA-SE AO ENTENDIMENTO COMO FOI POSITIVA A VIVÊNCIA DA FORMAÇÃO PARA MELHORAR O ENSINO APRENDIZAGEM EM RELAÇÃO A LEITURA, ESCRITA E A MATEMÁTICA. A PESQUISA SE TORNA RELEVANTE PORQUE COLETOU INFORMAÇÕES E APRESENTOU SUBSÍDIO PARA APRIMORAR A AÇÃO PEDAGÓGICA, ALCANÇA RESULTADOS POSITIVOS, ALÉM DE CONTRIBUIR PARA ENCONTRAR MEIOS PARA ABRANDAR PROBLEMAS EM RELAÇÃO AO DESENVOLVIMENTO DO ENSINO APRENDIZAGEM, E ASSIM, PRESAR POR UMA EDUCAÇÃO DE QUALIDADE.

Risk factors act around birth increasing future vascular risk. In this study, we analysed the pathways from perinatal factors to the vascular risk phenotype (VRP) in adolescents including indirect pathways mediated by obesity in adolescence. Data from a Brazilian cohort were collected at birth and at 18 to 19 years (follow-up). A theoretical model was constructed to analyze the association between variables at birth (socioeconomic status, prepregnancy body mass index, mother’s age, history of maternal hypertension, maternal smoking, gestational age at birth, birth weight, sex, delivery type) and at follow-up (smoking and excess weight) with the VRP, using structural equation modeling. VRP was a continuous latent variable, representing the shared variance of blood pressure indictors and carotid-femoral pulse wave velocity. Males had higher VRP (standardized coefficient [SC], 0.561; P< 0.001). Higher prepregnancy body mass index was associated with higher VRP (SC, 0.140; P =0.032). Gestational age P =0.002) and direct effect (SC, 0.354; P =0.018) on VRP. Cesarean delivery had a total effect, albeit borderline, on VRP (SC, 0.159; P =0.066). Excess weight at follow-up was the main determinant of a high VRP (SC, 0.470; P< 0.001). Male sex, cesarean section, gestational age

Immune-checkpoint inhibitors (ICI) are monoclonal antibodies which target molecules to enhance antitumor response. Several adverse events have been described and the major ICI-related endocrinopathies are thyroid dysfunction and hypophysitis. Its occurrence has been associated with improved outcomes, but it is still to be proven. We performed a retrospective study of patients treated with ICI between 2014 and 2019 at an oncologic center to characterize thyroid function test abnormalities (TFTA) and to evaluate clinical outcomes. We excluded patients without regular monitoring of thyroid function, with previous thyroid or pituitary disease, previous head/neck radiotherapy and who performed only one ICI cycle. We included 161 of 205 patients treated with pembrolizumab, nivolumab or ipilimumab for several neoplasms, with a median duration of 18.9 weeks (9.1-42.6) of ICI treatment and 49.4 weeks (26.5-75.8) of follow-up. New-onset TFTA was diagnosed in 18% of patients (n = 29), in median at 10.6 weeks (6.1-31.1) of ICI therapy. On the whole, 8.7% had primary hypothyroidism, 4.3% central hypothyroidism, 2.5% biphasic thyroiditis and 2.5% thyrotoxicosis. Patients who experienced primary or central thyroid dysfunction had a significantly improved overall response rate (58.6% vs 34.2%, p = 0.015) and overall survival (3.27 vs 1.76 years, p = 0.030), compared to the control group. The risk of mortality was two times higher for control group (adjusted HR = 2.43, 95% CI 1.13-5.23, p = 0.023). This study recognizes that primary and central thyroid dysfunction can be a predictive clinical biomarker of a better response to ICI across several neoplasms.

BACKGROUND This study was conducted to investigate the biological factors underlying the association between pulp necrosis (PN) in subjects with permanent teeth with intact crowns and sickle cell anemia (SCA). METHODS This cohort study included 140 subjects: 125 without PN and 15 with PN. A theoretical model was built to explore the following biological factors involved in the association between PN and SCA, namely (a) increased number of sickle cell crises in the previous year (No. SCCs/year), (b) low percentage of blood oxygen saturation (SpO2 ) in the body, and (c) comorbidities (CoMs). The theoretical model for testing associations was analyzed by structural equation modeling. RESULTS PN was associated with CoMs (SFL = 1.115; p = .032) but not with No. SCCs/year (SFL = .127; p = .596) or body SpO2 (SFL = -.102; p = .485). The prevalence rates of osteoarticular lesions (p = .009) and death (p

Analyze the association between higher added sugar exposure and periodontal disease in adolescents (18–19 years old). This was a cross-sectional study nested to RPS Cohorts Consortium, Sao Luis, Brazil (n = 2515). The exposure was percentage of daily calories from added sugar (≥ 10%), estimated from a quantitative food frequency. The outcome was periodontal disease estimated by the number of teeth affected by bleeding on probing, periodontal probing depth ≥ 4 mm, and clinical attachment level ≥ 4 mm at the same site. A theoretical model was depicted in a directed acyclic graph to identify the minimal sufficient adjustment set: household income, adolescent’s educational level, sex, alcohol use, and smoking. Periodontal disease was categorized into < 2 teeth affected, 2 to 3 teeth affected, and ≥ 4 teeth affected to estimate prevalence ratios (PR) by multinomial logistic regression. To test for consistency, means ratio (MR) were estimated using zero-inflated Poisson. High sugar intake was associated with ≥ 4 teeth affected by periodontal disease (PR = 1.42; 95% confidence interval (CI) = 1.03–1.94; p = 0.030); consistency Poisson analysis reinforced these results (MR = 1.15; 95% CI = 1.03–1.29; p = 0.011). High level of added sugar intake was associated with greater extent of periodontal disease in adolescents. High sugar intake was associated with periodontal disease in adolescents, supporting the integrated hypothesis of dental caries and periodontal disease and giving impetus to future clinical investigation on the effect of restriction of added sugar consumption in periodontal parameters, which potentially may change traditional treatment protocols of periodontal disease.

Studies on the exposure of children to sugar-sweetened beverages (SSBs) at an early age may contribute to better understand the common causes and the temporal order of the relationships between obesity and asthma in early childhood. The objective of this study was to estimate the association between SSB and child asthma traits in the 2nd year of life, modeling direct and indirect pathways mediated by the highest BMI-z of the child and allergic inflammation. Data from the BRISA cohort, São Luís-MA, Brazil (n = 1140), were obtained from the baseline and from the follow-up performed at the 2nd year of life. The main explanatory variable was the calories from added sugars in SSBs as a percentage of the total daily energy intake. The outcome child asthma traits was a latent variable deduced from four indicators: medical diagnosis of asthma, wheezing, emergency visit due to intense wheezing, and medical diagnosis of rhinitis. A high percentage of daily calories from sugars added to SSBs was directly associated with higher values of child asthma traits (standardized coefficient (SC = 0.073; P = .030)). High levels of eosinophils were also directly associated with child asthma traits (SC = 0.118; P = .049). No mediation pathways were observed via greater BMI-z or eosinophil counts. Therefore, early exposure of children to SSB may contribute to increased risk of childhood asthma, preceding the link between sugar consumption and overweight/obesity, not yet evident in children in the first 2 years of life.

The purpose of this study was to investigate the long-term outcome of moderate-to-high hyperopic refractive errors in childhood. We reviewed medical records from children diagnosed with hyperopia (≥3D) in the amblyogenic risk factors screening that is performed in a public hospital in Portugal. We included hyperopic children diagnosed between 2001 and 2011 with at least three available ophthalmologic evaluations (including one before the age of 3 years and one after a minimum period of 6 years after the first evaluation). Spherical equivalent (SE) was considered. In total, 78 eyes from 39 children met the inclusion criteria (49% male). Mean age at first and last evaluation was 1.8 ± 0.9 years and 10.6 ± 2.7 years, respectively. Median follow-up was 130 months (range 72–193). At baseline evaluation, the mean SE was 4.5 ± 1.4 diopters, 36% of children had a SE ≥5.0 diopters, 23% had partially accommodative esotropia, 26% had accommodative esotropia and 51% had no eye deviation. At the last evaluation, the mean SE was 4.6 ± 1.7diopters. During follow-up, four children developed unilateral amblyopia (one because of anisometropia, three because of anisometropia and strabismus). From these, three recovered with treatment. Until the age of 10 years, the number of children that presented with strabismus did not decrease. In our study, children with moderate to high hyperopia did not experience a significant reduction in the power of the refractive error. Although almost 50% of children had an initial deviation, only one had amblyopia at the end of follow-up. Implementing screening strategies for the early detection of this refractive error may prevent long-term vision morbidity in hyperopic children.

Current guidelines specify controversial areas in adrenocortical carcinomas (ACC), such as optimal follow-up time after remission and identification of prognostic markers. We aim to address these topics by analyzing four reference centers in our country. Cross-sectional multicentric study of 69 patients (mean age: 51.7 ± 16.7 years-old; women, 72.5%). Kaplan-Meier survival curves and Cox regression analysis were used to calculate overall survival and its predictors. Thirty-eight individuals (55.0%) had hormonal autonomous production, and 40.6% of the patients presented with metastasis. Surgery was performed in 84.1% of them. Most of these patients (72.4%) were then assigned to adjuvant therapy, while 27.6% were actively surveilled. Among patients undergoing surgery, those who achieved transient remission presented a longer survival time (66 months) than those who never reached the disease-free status (21 months) (p = 0.021). One patient presented with recurrence more than 7 years after complete tumor resection. The lowest overall survival was observed in patients (n = 11) assigned to palliative care since diagnosis (9 months). Tumor stage was identified as the only independent predictor of survival in our cohort (p = 0.006). Five-year survival was 67% for tumors confined to the adrenal space (stage I/II), 56% for locally advanced disease (stage III), and 0% for metastatic disease (stage IV). This study reinforces the dismal prognosis of ACC, the need for long-term follow-up, and tumor stage as the most important survival predictor. Reviewing medical records in such rare conditions is an opportunity to identify insufficiencies and to improve medical care.

The association between periodontopathogenic microbiota and preterm birth (PTB) has been overly studied. However, the biological mechanisms involved are little known. The objective is to evaluate the effect of periodontopathogenic bacteria burden (PBB), periodontal disease and other infections during pregnancy on preterm birth (PTB), through Structural Equation Modeling. This was a case–control study nested in a prospective cohort called BRISA, including 330 pregnant women, 110 cases and 220 controls. This study included the following variables: cytokines interleukin-10 (IL-10) and transforming growth factor beta (TGF-β), periodontal disease, PBB, age, socioeconomic status (SES), systemic infections and PTB. The correlations between variables were analyzed using Standardized Coefficient (SC). Greater PBB interfered positively with the occurrence of periodontal disease (SC: 0.027; p: 0.011), but these were not associated with the cytokines studied, nor with PTB. The lower serum levels of IL-10 (SC − 0.330; p 0.022) and TGF-β (SC − 0.612; p

The study of premature deaths from causes that are generally preventable given the current availability of healthcare – called amenable deaths due to healthcare – provides information on the quality of services. However, they are not only impacted by healthcare characteristics: other factors are also likely to influence. Therefore, identifying the association between amenable deaths due to healthcare and health determinants, such as education, might be the key to preventing these deaths in the future. Still unclear however, is how this works and how amenable deaths due to healthcare are distributed and evolve within the European Union (EU) below the national level. We therefore studied the geographical and temporal patterns of amenable deaths due to healthcare in the 259 EU regions from 1999 to 2016, including the 2007–2008 financial crisis and the post-2008 economic downturn, and identified whether any association with education exists. A cross-sectional ecological study was carried out. Using a hierarchical Bayesian model, we estimated the average smoothed Standardized Mortality Ratios (sSMR). A regression model was also applied to measure the relative risks (RR) at 95% credible intervals for cause-specific mortality association with education. Results show that amenable deaths due to healthcare decreased globally. Nevertheless, the decrease is not the same across all regions, and inequalities within countries do persist, with lower mortality ratios seen in regions from Central European countries and higher mortality ratios in regions from Eastern European countries. Also, the evolution trend reveals that after the financial crisis, the number of these deaths increased in regions across almost all EU countries. Moreover, educational disparities in mortality emerged, and a statistical association was found between amenable deaths due to healthcare and early exit from education and training. These results confirm that identifying and understanding the background of regional differences may lead to a better understanding of the amenable deaths due to healthcare and allow for the application of more effective policies., Highlights • Amenable deaths due to healthcare decreased within the EU regions. • The change did not occur equally as relative inequalities within countries remain. • Amenable deaths increased in regions from 17 EU countries after 2011–2013. • A 1% increase in school dropout is linked to a 2% increase in amenable deaths.

Atentando aos estudos em torno da relação entre os conceitos de arte e participação no campo cultural, a presente dissertação propõe uma análise de como indivíduos de diferentes gerações refletem sobre sua experiência em práticas artísticas participativas. Para estudar o fenómeno é utilizado o projeto "Meio no Meio" como estudo de caso. Este projeto, promovido pela Artemrede, decorreu entre 2019 e 2021 e envolveu participantes de diferentes idades e concelhos de Lisboa e Vale do Tejo em ações de formação e produção artística. São analisadas as dimensões individual e geracional nas práticas artísticas participativas através de métodos de pesquisa sociológica, como observação participante e entrevistas semiestruturadas. O objetivo é entender como pessoas de diferentes idades refletem sobre si mesmas a partir da experiência de participar no projeto "Meio no Meio". Given the studies around the relationship between art and participation in the cultural field, the present dissertation proposes an analysis of how individuals from different generations reflect on their experience in participatory art practices. To study the phenomenon is used "Meio no Meio" project as a case study. This project, promoted by Artemrede, took place between 2019 and 2021 and involved participants of different ages and municipalities of Lisbon and Vale do Tejo in training and artistic production initiatives. Are analyzed the individual and generational dimensions in participatory art practices through sociological research methods, such as participant observation and semi-structured interviews. The goal is to understand how people of different ages reflect on themselves from the experience of participating in the "Meio no Meio" project.

Resumo: O objetivo foi avaliar os fatores associados aos biomarcadores inflamatórios em adolescentes. Trata-se de estudo transversal com 391 adolescentes entre 17 e 18 anos de escolas públicas em São Luís, Maranhão, Brasil. Realizou-se amostragem aleatória com conglomeração em três estágios: escola, turma e aluno. O consumo alimentar foi investigado por meio do Questionário de Frequência Alimentar, e os padrões alimentares foram extraídos por análise fatorial por componentes principais. Para avaliar os fatores associados aos biomarcadores inflamatórios, foi utilizada modelagem de equações estruturais. Foram construídas variáveis latentes: condição socioeconômica, que incluiu escolaridade materna, renda familiar e classe econômica; e inflamação, constituída pela interleucina-1β, interleucina-6 e interleucina-8. Um modelo teórico foi elaborado para avaliar fatores associados aos biomarcadores inflamatórios, indicando os efeitos diretos e indiretos entre as variáveis latentes e observadas. Três padrões alimentares foram identificados (ocidental, básico brasileiro e saudável), com variância explicada de 31%, e padrão ocidental o de maior contribuição. Não foram encontradas associações dos padrões com a variável latente inflamação. O excesso de peso foi positivamente associado com a variável latente inflamação (coeficientes padronizados = 0,281; p = 0,002). A extração dos três padrões evidencia maior consumo de alimentos ricos em carboidratos e gorduras que são nutrientes diretamente relacionados ao aumento das doenças crônicas não transmissíveis. O excesso de peso foi associado com maiores níveis de biomarcadores inflamatórios. Abstract: The study aimed to analyze factors associated with inflammatory biomarkers in adolescents. This was a cross-sectional study in 391 adolescents 17-18 years of age in public schools in São Luís, Maranhão State, Brazil. Three-stage random cluster sampling was performed in schools, classes, and students. Food consumption was studied with a food frequency questionnaire, and dietary patterns were extracted by principal components factor analysis. Assessment of factors associated with inflammatory biomarkers used structural equation modeling. Latent variables were constructed: socioeconomic status, which included maternal schooling, family income, and economic class; and inflammation, consisting of interleukin-1β, interleukin-6, and interleukin-8. A theoretical model was developed to assess factors associated with inflammatory biomarkers, indicating direct and indirect effects between the latent and observed variables. Three dietary patterns were identified (Western, basic Brazilian, and healthy), with 31% explained variance and the Western pattern with the largest share. No associations were found between the patterns and the latent variable inflammation (standardized coefficients = 0.281; p = 0.002). Extraction of the three patterns evidenced higher consumption of foods high in carbohydrates and fats, which are nutrients associated directly with the increase in chronic noncommunicable diseases. Excess weight was associated with higher levels of inflammatory biomarkers. Resumen: El objetivo fue evaluar los factores asociados con biomarcadores inflamatorios en adolescentes. Se trata de un estudio transversal con 391 adolescentes entre 17 e 18 años de escuelas públicas en São Luís, Maranhão, Brasil. Se realizó una muestra aleatoria por conglomerados en tres etapas: escuela, grupo y alumno. El consumo alimentario fue investigado mediante el cuestionario de frecuencia alimentaria, y los patrones alimentarios fueron extraídos por análisis factorial por componentes principales. Para evaluar los factores asociados a los biomarcadores inflamatorios se utilizó un modelado de ecuaciones estructurales. Se construyeron variables latentes: condición socioeconómica, que incluyó escolaridad materna, renta familiar y clase económica; e inflamación, constituida por la interleucina-1β, interleucina-6 e interleucina-8. Un modelo teórico se elaboró para evaluar factores asociados a los biomarcadores inflamatorios, indicando los efectos directos e indirectos entre las variables latentes y observadas. Se identificaron tres patrones alimentarios (occidental, básico brasileño y saludable), con variancia explicada de un 31% y patrón occidental o de mayor contribución. No se encontraron asociaciones de los patrones con la variable latente inflamación. El exceso de peso estuvo positivamente asociado con la variable latente inflamación (coeficientes estandarizados = 0,281; p = 0,002). La extracción de los tres patrones evidencia mayor consumo de alimentos ricos en carbohidratos y grasas que son nutrientes directamente relacionadas con el aumento de las enfermedades crónicas no transmisibles. El exceso de peso estuvo asociado con mayores niveles de biomarcadores inflamatorios.

Objective:To evaluate the association of the consumption of foods of the ultra-processed group (UPF) with inflammatory markers in the adolescent population in Northeastern Brazil.Design:A cross-sectional population-based study. Food consumption was evaluated using two 24-h dietary recalls using the NOVA classification for food processing levels. The following inflammatory markers were evaluated: adiponectin, IL-6, IL-8, C-reactive protein (CRP) and TNF-α. Multivariate linear regression was used to investigate the association between the percentage of UPF energy contribution and inflammatory markers.Setting:São Luís, Maranhão, Brazil.Participants:The sample consisted of 391 male and female adolescents, aged from 17 to 18 years.Results:The average daily energy consumption by adolescents was 8032·9 kJ/d, of which 26·1 % originated from UPF. The upper tertile (T3) of UPF consumption presented higher intake of simple carbohydrates, lipids, saturated fat, and Na and lower protein intake. Individuals in T3 presented higher serum leptin and CRP levels (P < 0·05). Adolescents with UPF energy consumption ≥30·0 % (tertile 3 of UPF) had a 79 % (exp (0·58) = 1·79) increase in IL-8 levels when compared with adolescents in tertile 1 of UPF (P = 0·013).Conclusions:The association between the consumption of UPF, poor quality diet and pro-inflammatory markers have important harmful effects that can be observed as early as in adolescence.

Background: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the real impact of AKD on COVID-19 patients. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. Methods: Retrospective analysis of COVID-19 patients with AKI admitted at the Centro Hospitalar Universitário Lisboa Norte between March and August of 2020. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. AKD was defined by presenting at least KDIGO Stage 1 criteria for &gt, 7 days after an AKI initiating event. Results: In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). The mean age was 71.7 ± 17.0 years, baseline SCr was 1.03 ± 0.44 mg/dL, and the majority of patients were classified as KDIGO stage 3 AKI (54.3%). The in-hospital mortality was 18.0% (n = 61). Presence of hypertension (p = 0.006), CKD (p &lt, 0.001), lower hemoglobin (p = 0.034) and lower CRP (p = 0.004) at the hospital admission and nephrotoxin exposure (p &lt, 0.001) were independent risk factors for the development of AKD. Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. Conclusions: AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Considering the significant risk of mortality in AKI patients, it is of paramount importance to identify the subset of higher risk patients.

Objectives: To analyze the association between systemic inflammatory burden of cardiovascular disease (CVD) risk and periodontitis in adolescents, including mediating pathways triggered by their common risk factors. Materials and methods: Using a population-based sample study (n = 405) of Brazilian adolescents (17–18 years old), direct and mediation pathways triggered by “Socioeconomic Status,” “Adiposity,” Smoking, and “Blood Pressure” were modelled for the association between the “Systemic Circulating Inflammatory Burden of CVD Risk” (IL-1β, IL-6, IL-8, TNF-α) and the “Initial Periodontitis” (bleeding on probing (BoP), probing depth (PD) ≥ 4 mm, clinical attachment loss (CAL) ≥ 4 mm), both as continuous latent variables, using structural equation modeling. Sensitivity analysis was performed for the outcomes “Gingivitis” (visible plaque; BoP); “Moderate Periodontitis” (PD ≥ 5 mm and CAL ≥ 5 mm) and periodontitis (CDC-AAP case definition). Results: Higher “Systemic Circulating Inflammatory Burden of CVD Risk” was directly associated with higher “Initial Periodontitis” (standardized coefficient [SC] = 0.178, P value < 0.001). Lower “Socioeconomic Status” (SC = − 0.022, P value = 0.015) and Smoking (SC = 0.030, P value = 0.021) triggered the “Initial Periodontitis”, mediated by “Systemic Circulating Inflammatory Burden of CVD Risk”. Sensitivity analysis showed a dose-response relationship between “Systemic Circulating Inflammatory Burden of CVD Risk” and “Moderate Periodontitis” (SC = 0.323, P value = 0.021). Conclusions: “Systemic Circulating Inflammatory Burden of CVD Risk” appeared as an underlying mechanism of early periodontal breakdown in adolescents, also triggered by social vulnerability and smoking. Clinical relevance: The association between periodontitis and CVD in adulthood seems to establish much earlier in life than had been previously studied, giving impetus to preventive approaches focused on their common risk factors.

ObjectivesTo analyse how previous comorbidities, ethnicity, regionality and socioeconomic development are associated with COVID-19 mortality in hospitalised children and adolescents.DesignCross-sectional observational study using publicly available data from the Brazilian Ministry of Health.SettingNationwide.Participants5857 patients younger than 20 years old, all of them hospitalised with laboratory-confirmed COVID-19, from 1 January 2020 to 7 December 2020.Main outcome measureWe used multilevel mixed-effects generalised linear models to study in-hospital mortality, stratifying the analysis by age, region of the country, presence of non-communicable diseases, ethnicity and socioeconomic development.ResultsIndividually, most of the included comorbidities were risk factors for mortality. Notably, asthma was a protective factor (OR 0.4, 95% CI 0.24 to 0.67). Having more than one comorbidity increased almost tenfold the odds of death (OR 9.67, 95% CI 6.89 to 13.57). Compared with white children, Indigenous, Pardo (mixed) and East Asian had significantly higher odds of mortality (OR 5.83, 95% CI 2.43 to 14.02; OR 1.93, 95% CI 1.48 to 2.51; OR 2.98, 95% CI 1.02 to 8.71, respectively). We also found a regional influence (higher mortality in the North—OR 3.4, 95% CI 2.48 to 4.65) and a socioeconomic association (lower mortality among children from more socioeconomically developed municipalities—OR 0.26, 95% CI 0.17 to 0.38)ConclusionsBesides the association with comorbidities, we found ethnic, regional and socioeconomic factors shaping the mortality of children hospitalised with COVID-19 in Brazil. Our findings identify risk groups among children that should be prioritised for public health measures, such as vaccination.

Significance From 1990 to 2018, the Black–White American life expectancy gap fell 48.9% and mortality inequality decreased, although progress stalled after 2012 as life expectancy plateaued. Had improvements continued at the 1990 to 2012 rate, the racial gap in life expectancy would have closed by 2036. Despite decreasing mortality inequality, income-based life expectancy gaps remain starker in the United States than in European countries. At the same time, European mortality improved strongly and even those U.S. populations with the longest life spans–White Americans living in the highest-income areas–experience higher mortality at all ages than Europeans in high-income areas in 2018. Hence, mortality rates of both Black and White Americans could fall much further in both high-income and low-income areas., Although there is a large gap between Black and White American life expectancies, the gap fell 48.9% between 1990 and 2018, mainly due to mortality declines among Black Americans. We examine age-specific mortality trends and racial gaps in life expectancy in high- and low-income US areas and with reference to six European countries. Inequalities in life expectancy are starker in the United States than in Europe. In 1990, White Americans and Europeans in high-income areas had similar overall life expectancy, while life expectancy for White Americans in low-income areas was lower. However, since then, even high-income White Americans have lost ground relative to Europeans. Meanwhile, the gap in life expectancy between Black Americans and Europeans decreased by 8.3%. Black American life expectancy increased more than White American life expectancy in all US areas, but improvements in lower-income areas had the greatest impact on the racial life expectancy gap. The causes that contributed the most to Black Americans’ mortality reductions included cancer, homicide, HIV, and causes originating in the fetal or infant period. Life expectancy for both Black and White Americans plateaued or slightly declined after 2012, but this stalling was most evident among Black Americans even prior to the COVID-19 pandemic. If improvements had continued at the 1990 to 2012 rate, the racial gap in life expectancy would have closed by 2036. European life expectancy also stalled after 2014. Still, the comparison with Europe suggests that mortality rates of both Black and White Americans could fall much further across all ages and in both high-income and low-income areas.

Objective Mechanisms underlying the oral outcomes in sickle cell anemia (HbSS) have been less explored. This study aimed to investigate the association of morbimortality indicators and hydroxyurea use with adaptive pulp and jaw bone trabecular changes in HbSS. Methods This cross-sectional study included 123 individuals with HbSS. The exposures were the morbimortality indicators of HbSS (number of vaso-occlusive crises, organ damage, hemoglobin level, and leukocyte count) and the use of hydroxyurea for HbSS treatment. The outcomes were adaptive pulp and jaw bone trabecular changes confirmed by radiographic examination. Associations were estimated by Poisson regression in crude and adjusted analyses for sex, skin color, socioeconomic class, and age. Results The vaso-occlusive crises (mean ratio (MR) = 3.5, p = 0.045), lower hemoglobin (MR = 2.4, p = 0.037), and higher leukocyte count (MR = 2.17, p = 0.036) were risk factors, while the use of hydroxyurea was inversely associated with adaptive pulp changes (MR = 0.23, p = 0.024). The vaso-occlusive crises were associated with jaw bone trabecular changes (MR = 1.33, p = 0.02). Conclusion Adaptive pulp changes may be a potential clinical marker of chronic vasculopathy in HbSS. The use of hydroxyurea may reduce the frequency of adaptive pulp changes.

Resumen Introducción y objetivo: La incorporación de propóleos en los dentífricos tiene como objetivo ayudar de manera más efectiva al control y la prevención de patologías orales a través de la eliminación de los patógenos presentes en la biopelícula. Sin embargo, se sabe poco sobre la eficacia antimicrobiana de diferentes productos en el mercado de microorganismos para estas patologías. El objetivo de este estudio fue investigar la acción antimicrobiana de tres dentífricos que contienen propóleos sobre los patógenos orales. Material y métodos: Se utilizó el método de difusión en agar para analizar tres dentífricos basados en propóleos, que incluyen: Noplak Max®, Protta® y Forever Bright®. Se utilizó un dentífrico sin propóleos (Malvatrikids®) como control negativo. Los controles positivos fueron 0,2% de clorhexidina diluida adicionalmente al 30% para igualar la concentración de clorhexidina de uno de los dentífricos evaluados, y el extracto de propóleos (Apis Flora®) al 11%. Para la determinación de la actividad antimicrobiana se utilizaron las cepas de Fusobacterium nucleatum y Aggregatibacter actinomycetemcomitans, Enterococcus faecalis, Streptococcus mutans, Lactobacillus acidophilus y Candida albicans. Resultados: De los dentífricos probados, Protta® y Forever Bright® mostraron acción inhibitoria contra S. mutans, E. faecalis y microorganismos de C. albicans. El dentífrico Nopla k® mostró baja actividad antimicrobiana, limitándose a S. mutans y E. faecalis. Cuando hubo un efecto antimicrobiano, los diámetros de los halos de inhibición del crecimiento variaron de 9mm a 28,83mm. Conclusión: El uso de un dentífrico que contiene propóleos para su uso eventual como complemento terapéutico en odontología está justificado, considerando las actividades farmacológicas. Abstract Introduction and objective: The incorporation of propolis in dentifrices aims to more effectively assist the control and prevention of oral pathologies through the elimination of pathogens present in the biofilm. However, little is known about the antimicrobial efficacy of different products on the market for microorganisms for these conditions. The aim of this study was to investigate the antimicrobial action of three propolis-containing dentifrices on oral pathogens. Material and methods: The agar diffusion method was used to analyze three propolis-based dentifrices, including: Noplak Max®, Protta® and Forever Bright®. A non-propolis dentifrice (Malvatrikids®) was employed as a negative control. Positive controls were 0.2% chlorhexidine, further diluted 30% to match the chlorhexidine concentration of one of the evaluated dentifrices and 11% propolis extract (Apis Flora®). For the determination of antimicrobial activity the strains of Fusobacterium nucleatum and Aggregatibacter actinomycetemcomitans, Enterococcus faecalis, Streptococcus mutans, Lactobacillus acidophilus and Candida albicans were used. Results: Of the tested dentifrices, Protta® and Forever Bright® showed inhibitory action against S. mutans, E. faecalis and C. albicans microorganisms. Noplak® dentifrice showed low antimicrobial activity, being limited to S. mutans and E. faecalis. When there was an antimicrobial effect, the diameter of the growth inhibition halos ranged from 9mm to 28.83mm. Conclusion: The use of a propolis-containing dentifrice for eventual use as a therapeutic adjunct in dentistry is fully justified, considering the pharmacological activities. Resumo Introdução e objetivo: A incorporação de própolis em dentifrícios visa ajudar a controlar e prevenir patologias bucais de maneira mais eficaz, através da eliminação de patógenos presentes no biofilme. No entanto, pouco se sabe sobre a eficácia antimicrobiana de diferentes produtos no mercado de microrganismos para essas patologias. O objetivo deste estudo foi investigar a ação antimicrobiana de três dentifrícios contendo própolis em patógenos orais. Material e métodos: O método de difusão em ágar foi utilizado para analisar três dentífricos à base de própolis, incluindo: Noplak Max®, Protta® e Forever Bright®. Um creme dental não própolis (Malvatrikids®) foi usado como controle negativo. Os controles positivos foram 0,2% de clorexidina diluída para 30% para corresponder à concentração de clorexidina de um dos dentifrícios avaliados e 11% de extrato de própolis (Apis Flora®). Para a determinação da atividade antimicrobiana, foram utilizadas as linhagens Fusobacterium nucleatum e Aggregatibacter actinomycetemcomitans, Enterococcus faecalis, Streptococcus mutans, Lactobacillus acidophilus e Candida albicans. Resultados: Dos dentifrícios testados, Protta® e Forever Bright® apresentaram ação inibitória contra S. mutans, E. faecalis e microorganismos de C. albicans. O creme dental Noplak® apresentou baixa atividade antimicrobiana, limitada a S. mutans e E. faecalis. Quando houve efeito antimicrobiano, os diâmetros dos halos de inibição de crescimento variaram de 9 a 28,83 mm. Conclusão: O uso de um dentifrício contendo própolis para eventual uso como complemento terapêutico em odontologia é totalmente justificado, considerando as atividades farmacológicas.

Aim To evaluate the association between low bone mineral density (BMD) and severe periodontitis at the end of the second decade of life. Materials and methods This population-based study analysed 2032 youngers (18-19 years old) of the RPS cohort. BMD of lumbar spine (BMD-LS) and of the whole body (BMD-WB) were assessed by dual x-ray emission densitometry. Low BMD-LS (Z-score ≤ -2) and low BMD-WB (Z-score ≤ -1.5) were correlated with severe periodontitis. The extent of periodontal disease was also evaluated as the following outcomes: proportions of teeth affected by clinical attachment loss ≥5 mm and probing depth ≥5 mm. Multivariate models by sex, education, family income, risk of alcohol dependence, smoking, plaque, bleeding index, and body mass index were estimated through logistic regression (binary outcomes) and Poisson regression (continuous outcomes). Results The prevalence of severe periodontitis was 10.97%. Low BMD-LS (odds ratio [OR] = 2.08, confidence interval [CI] = 1.12-3.85, p = .01) and low BMD-WB (OR = 1.34, CI = 1.001-1.81, p = .04) were associated with severe periodontitis in the final multivariate models. Low BMD-LS and BMD-WB were also associated with a greater extent of periodontitis (p Conclusions Low BMD was found to be associated with the severity and extent of periodontitis in adolescents. Adolescents at peak bone mass age presenting low BMD are more likely to be affected by severe periodontitis.