Ankur Singh

The Causes of Malignant Melanoma: Results from the West Australian Lions Melanoma Research Project

In Australia malignant melanoma ranks forth among cancers as a cause of morbidity and premature death (Armstrong 1985). For this reason, and because the State of Western Australia has one of the highest incidence rates of melanoma in the world (Holman et al. 1980), we undertook a multidisciplinary research program embracing the epidemiology, histopathology, and clinical management of melanoma. A major component of our research was a population-based case-control study in which constitutional traits, sunlight exposure, hormones, diet and other possible causal factors were evaluated. We have already published several reports of the results relating to particular subject areas (Holman and Armstrong 1983, 1984 a, b; Holman et al. 1984 b, 1985; English et al. 1985). In this report we aim to bring together in summary form the key results of the project to date and to present new data on diet and other factors.

Social inequalities in clustering of oral health related behaviors in a national sample of British adults

OBJECTIVES 1. To assess clustering of oral health related behaviors among a sample of British adults. 2. To determine the variation in clustering of oral health related behaviors by socioeconomic position. METHOD We used secondary analysis of the Adult Dental Health Survey 2009 data. Health behaviors referred to smoking, tooth brushing frequency, dental visits and sugar consumption. Clustering was assessed by pairwise correlations, counts of clustering of health compromising behaviors and comparison of observed/expected ratios. Logistic regression was used to assess variation in clustering of oral health related behaviors by socioeconomic position crudely and adjusted for age, gender and self-rated oral health. RESULTS There were weak correlations between four health behaviors. Very low prevalence of clustering was reported. Higher observed to expected ratio was observed for clustering patterns with lower prevalence. Multivariate logistic regression showed clear, strong and significant educational gradients in associations between different clustering patterns of health compromising behaviors and educational attainment. These educational gradients remained significant after adjusting for age, gender and self-reported oral health. CONCLUSION Very clear and strong educational gradients were observed throughout patterns of clustering of oral health compromising behaviors, suggesting chances of having detrimental behavioral clustering are lower in more educated groups in population.

Socioeconomic position during life and periodontitis in adulthood: a systematic review

Socioeconomic position (SEP) is a well-known risk indicator for chronic periodontitis. However, it is still unclear how SEP during the life course influences periodontal outcomes in adulthood. This study aimed to systematically review longitudinal studies investigating the influence of individual-level SEP during the life course on subsequent periodontitis in adulthood. Inclusion criteria were epidemiological longitudinal observational studies, in which indicators of relative SEP were assessed prior to clinical assessment of periodontitis. Six electronic databases (PubMed, EMBASE, Web of Science, Scopus, Latin American and Caribbean Health Sciences Literature (LILACS) and ScieLO) were searched. The methodological quality of the studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). The search identified 1720 papers. After removal of duplicates (n=697), title and abstract screening (n=996), and full-text review (n=19), eight original manuscripts from seven studies were finally included. Sample sizes ranged from 167 to 2806, and the follow-up time from exposure to outcome ranged from 2 to 28 years. Studies evaluated education, occupation or income as SEP indicators. Prevalence, extent and severity of periodontal attachment loss, probing pocket depth and alveolar bone loss were the studied outcomes. Based on NOS, studies presented low risk of bias. Six of eight papers reported that relatively low SEP earlier in life was associated with poorer periodontal health in adulthood. The available scientific evidence demonstrates potential longitudinal impact of earlier lower SEP on later periodontal health. The findings were consistent despite differences in study methods.

Gender differences in the association between tooth loss and obesity among older adults in Brazil

OBJETIVO Analisar se ha diferencas entre generos na associacao entre obesidade e perda dentaria em idosos. METODOS Foram avaliados dados de 1.704 idosos (60 anos ou mais) da linha de base de um estudo de coorte prospectivo realizado em Florianopolis, SC. Modelos de regressao logistica multivariaveis foram realizados para afericao da associacao entre perda dentaria e obesidade geral e central, ajustados por variaveis de confusao (idade, genero, cor da pele, educacao, renda, tabagismo, atividade fisica, uso de protese dentaria, hipertensao e diabetes). Na regressao linear, indice de massa corporal e circunferencia da cintura foram tratados como variaveis continuas. Foi avaliada tambem a interacao entre genero e perda dentaria. RESULTADOS A media geral do indice de massa corporal foi 28,0. A media de circunferencia da cintura foi de 96,8 cm para homens e 92,6 cm para mulheres. O aumento da perda dentaria associou-se positivamente com o aumento do indice de massa corporal e da circunferencia da cintura, apos ajuste por variaveis de confusao. Edentulos apresentaram chance 1,4 (IC95% 1,1;1,9) vez maior de apresentarem obesidade central quando comparados com aqueles com maior numero de dentes presentes; entretanto, a associacao perdeu significância estatistica apos o ajuste pelas variaveis de confusao. Comparadas com homens edentulos, mulheres edentulas apresentaram prevalencia ajustada de obesidade geral e central duas vezes maior. No modelo de efeitos conjuntos, mulheres edentulas tiveram uma razao de chances 3,8 (IC95% 2,2;6,6) vezes maior de apresentarem obesidade central, quando comparadas com homens com mais de 10 dentes presentes em ambas as arcadas. De maneira similar, mulheres com menos de 10 dentes presentes em pelo menos uma arcada tiveram uma razao de chances 2,7 (IC95% 1,6;4,4) vezes maior de terem obesidade central quando comparadas com homens com mais de 10 dentes presentes em ambas arcadas. CONCLUSOES Obesidade central foi mais prevalente que obesidade geral em idosos. Nao foram encontradas associacoes entre obesidade geral e perda dentaria. Associacao entre obesidade central e perda dentaria depende do genero – mulheres com perdas dentarias apresentaram maior probabilidade de serem obesas.OBJECTIVE To analyze if differences according to gender exists in the association between tooth loss and obesity among older adults. METHODS We analyzed data on 1,704 older adults (60 years and over) from the baseline of a prospective cohort study conducted in Florianopolis, SC, Southern Brazil. Multivariable logistic regression models were used to assess the association between tooth loss and general and central obesity after adjustment for confounders (age, gender, skin color, educational attainment, income, smoking, physical activity, use of dentures, hypertension, and diabetes). Linear regressions were also assessed with body mass index and waist circumference as continuous outcomes. Interaction between gender and tooth loss was further assessed. RESULTS Overall mean body mass index was 28.0 kg/m2. Mean waist circumference was 96.8 cm for males and 92.6 cm for females. Increasing tooth loss was positively associated with increased body mass index and waist circumference after adjustment for confounders. Edentates had 1.4 (95%CI 1.1;1.9) times higher odds of being centrally obese than individuals with a higher number of teeth; however, the association lost significance after adjustment for confounders. In comparison with edentate males, edentate females presented a twofold higher adjusted prevalence of general and central obesity. In the joint effects model, edentate females had a 3.8 (95%CI 2.2;6.6) times higher odds to be centrally obese in comparison with males with more than 10 teeth present in both the arches. Similarly, females with less than 10 teeth in at least one arch had a 2.7 (95%CI 1.6;4.4) times higher odds ratio of having central obesity in comparison with males with more than 10 teeth present in both the arches. CONCLUSIONS Central obesity was more prevalent than general obesity among the older adults. We did not observe any association between general obesity and tooth loss. The association between central obesity and tooth loss depends on gender – females with tooth loss had greater probability of being obese.

Addressing inequalities in oral health in India: need for skill mix in the dental workforce

Dentistry has always been an under-resourced profession. There are three main issues that dentistry is facing in the modern era. Firstly, how to rectify the widely acknowledged geographical imbalance in the demand and supply of dental personnel, secondly, how to provide access to primary dental care to maximum number of people, and thirdly, how to achieve both of these aims within the financial restraints imposed by the central and state governments. The trends of oral diseases have changed significantly in the last 20 years. The two of the most common oral diseases that affect a majority of the population worldwide, namely dental caries and periodontitis, have been proved to be entirely preventable. Even for life-threatening oral diseases like oral cancer, the best possible available treatment is prevention. There is a growing consensus that appropriate skill mix can prove very beneficial in providing these preventive dental care services to the public and aid in achieving the goal of universal oral health coverage. Professions complementary to dentistry (PCD) have been found to be effective in reducing inequalities in oral health, improving access and spreading the messages of health promotion across entire spectrum of socio-economic hierarchy in various studies conducted globally. This commentary provides a review of the effectiveness of skill mix in dentistry and a reflection on how this can be beneficial in achieving universal oral health care in India.

Theoretical basis and explanation for the relationship between area-level social inequalities and population oral health outcomes - A scoping review

This study was conducted to review the evidence on the association between area-level social inequalities and population oral health according to type and extent of social theories. A scoping review was conducted of studies, which assessed the association between area-level social inequality measures, and population oral health outcomes including self-rated oral health, number of teeth, dental caries, periodontal disease, tooth loss, oral health-related quality of life (OHRQoL) and dental pain. A search strategy was applied to identify evidence on PubMed, MEDLINE (Ovid), EMBASE, Web of Science, ERIC, Sociological Abstracts, Social Services Abstracts, references of selected studies, and further grey literature. A qualitative content analysis of the selected studies was conducted to identify theories and categorize studies according to their theoretical basis. A total of 2892 studies were identified with 16 included in the review. Seven types of social theories were used on 48 occasions within the selected studies including: psychosocial (n=13), behavioural (n=10), neo-material (n=10), social capital (n=6), social cohesion (n=4), material (n=3) and social support (n=2). Of the selected studies, four explicitly tested social theories as pathways from inequalities to population oral health outcomes, three used a theoretical construct, seven used theories for post-hoc explanation and two did not have any use of theory. In conclusion, psychosocial theories were used most frequently. Although theories were often mentioned, majority of these studies did not test a social theory.

Association between tooth loss and hypertension among a primarily rural middle aged and older Indian adult population

BACKGROUND Studies in high-income countries have reported associations between tooth loss and hypertension. There is however a lack of evidence on this association from South Asian countries especially India. The current study aimed to assess the association between self-reported tooth loss and hypertension in a primarily rural middle-aged and older Indian population. METHODS A secondary analysis of cross-sectional data from the Longitudinal Ageing Study of India - pilot survey was conducted on 1,486 adults aged 45 years and above from four states of India. The primary outcome was self-reported hypertension and the main explanatory variable was self-reported tooth loss. Multivariable logistic regression models estimated the association between hypertension and tooth loss after controlling for confounders including age, sex, marital status, area of residence, educational attainment, tobacco use, alcohol use, physical activity, and self-reported diabetes. RESULTS Compared to those without any tooth loss, individuals with partial tooth loss had 1.62 times (95% CI: 1.12-2.35) higher odds of being hypertensive after adjustment of confounders including age, sex, marital status, area of residence, educational attainment, tobacco use, alcohol use, physical activity, and self-reported diabetes. The crude significant association (OR: 2.54; 95% CI: 1.50-4.29) between edentulousness and hypertension became nonsignificant and attenuated after adjustment of potential confounders (fully adjusted model OR: 1.33; 95% CI: 0.72-2.44). CONCLUSION Partial tooth loss was associated with a higher probability of hypertension among dentate middle-aged and older adults in four states of India.

Impact of entertainment media smoking on adolescent smoking behaviours

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the influence and impact of exposure to tobacco use in entertainment media among non-smoking adolescents (13 to 18 years).

Socioeconomic Gradients in Different Types of Tobacco Use in India: Evidence from Global Adult Tobacco Survey 2009-10.

Socioeconomic differences in tobacco use have been reported, but there is a lack of evidence on how they vary according to types of tobacco use. This study explored socioeconomic differences associated with cigarette, bidi, smokeless tobacco (SLT), and dual use (smoking and smokeless tobacco use) in India and tested whether these differences vary by gender and residential area. Secondary analysis of Global Adult Tobacco Survey (GATS) 2009-10 (n = 69,296) was conducted. The primary outcomes were self-reported cigarette, bidi smoking, SLT, and dual use. The main explanatory variables were wealth, education, and occupation. Associations were assessed using multinomial logistic regressions. 69,030 adults participated in the study. Positive association was observed between wealth and prevalence of cigarette smoking while inverse associations were observed for bidi smoking, SLT, and dual use after adjustment for potential confounders. Inverse associations with education were observed for all four types after adjusting for confounders. Significant interactions were observed for gender and area in the association between cigarette, bidi, and smokeless tobacco use with wealth and education. The probability of cigarette smoking was higher for wealthier individuals while the probability of bidi smoking, smokeless tobacco use, and dual use was higher for those with lesser wealth and education.

School environment assessment tools to address behavioural risk factors of non-communicable diseases: A scoping review

We aimed to identify, describe and analyse school environment assessment (SEA) tools that address behavioural risk factors (unhealthy diet, physical inactivity, tobacco and alcohol consumption) for non-communicable diseases (NCD). We searched in MEDLINE and Web of Science, hand-searched reference lists and contacted experts. Basic characteristics, measures assessed and measurement properties (validity, reliability, usability) of identified tools were extracted. We narratively synthesized the data and used content analysis to develop a list of measures used in the SEA tools. Twenty-four SEA tools were identified, mostly from developed countries. Out of these, 15 were questionnaire based, 8 were checklists or observation based tools and one tool used a combined checklist/observation based and telephonic questionnaire approach. Only 1 SEA tool had components related to all the four NCD risk factors, 2 SEA tools has assessed three NCD risk factors (diet/nutrition, physical activity, tobacco), 10 SEA tools has assessed two NCD risk factors (diet/nutrition and physical activity) and 11 SEA tools has assessed only one of the NCD risk factor. Several measures were used in the tools to assess the four NCD risk factors, but tobacco and alcohol was sparingly included. Measurement properties were reported for 14 tools. The review provides a comprehensive list of measures used in SEA tools which could be a valuable resource to guide future development of such tools. A valid and reliable SEA tool which could simultaneously evaluate all NCD risk factors, that has been tested in different settings with varying resource availability is needed.