Cesar de Oliveira

Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey

Objective To examine if self reported toothbrushing behaviour is associated with cardiovascular disease and markers of inflammation (C reactive protein) and coagulation (fibrinogen). Design National population based survey. Setting Scottish Health Survey, which draws a nationally representative sample of the general population living in households in Scotland. Participants 11 869 men and women, mean age 50 (SD 11). Main outcome measures Oral hygiene assessed from self reported frequency of toothbrushing. Surveys were linked prospectively to clinical hospital records, and Cox proportional hazards models were used to estimate the risk of cardiovascular disease events or death according to oral hygiene. The association between oral hygiene and inflammatory markers and coagulation was examined in a subsample of participants (n=4830) by using general linear models with adjustments. Results There were a total of 555 cardiovascular disease events over an average of 8.1 (SD 3.4) years of follow-up, of which 170 were fatal. In about 74% (411) of cardiovascular disease events the principal diagnosis was coronary heart disease. Participants who reported poor oral hygiene (never/rarely brushed their teeth) had an increased risk of a cardiovascular disease event (hazard ratio 1.7, 95% confidence interval 1.3 to 2.3; P<0.001) in a fully adjusted model. They also had increased concentrations of both C reactive protein (β 0.04, 0.01 to 0.08) and fibrinogen (0.08, −0.01 to 0.18). Conclusions Poor oral hygiene is associated with higher levels of risk of cardiovascular disease and low grade inflammation, though the causal nature of the association is yet to be determined.

Leisure time physical activity, risk of depressive symptoms, and inflammatory mediators: The English Longitudinal Study of Ageing

OBJECTIVES To examine if inflammatory markers (CRP, fibrinogen) might partly explain the association between physical activity (PA) and risk of depression. DESIGN/SETTING The English Longitudinal Study of Ageing, a prospective study of community dwelling older adults. PARTICIPANTS 4323 men and women (aged 63.4+/-9.7 yrs) free from depression at baseline. MEASURES Self reported leisure time PA levels and depressive symptoms (a score of > or = 4 using the 8-item CES-D scale) were assessed at baseline and 4 yrs follow up. The inflammatory markers, CRP and fibrinogen, were assessed at a 2 yrs intermediate time point between baseline and follow up. RESULTS At follow up 8% of the sample reported depressive symptomatology. In comparison with participants reporting none or light PA, the odds of depressive symptomatology for those reporting moderate or vigorous PA were 0.71 (95% CI, 0.54-0.95) and 0.58 (0.41-0.81), respectively, after adjustments for baseline CES-D score, age, gender, social-occupational class, smoking, alcohol, and chronic illness. Each standard unit increase in log CRP was associated with higher odds of depressive symptomatology at follow up (1.32, 1.13-1.55) and CRP was inversely associated with physical activity. The association between PA and depressive symptomatology was not, however, substantially modified by further adjustment for CRP (odds for none vs. vigorous PA=0.60, 0.43-0.84). CONCLUSIONS These data suggest that low grade systemic inflammation, as indexed by CRP, is a risk marker for depressive symptomatology, although this mechanism explains only a modest (approximately 5%) amount of the association between PA and risk of depression.

Persistent depressive symptomatology and inflammation: to what extent do health behaviours and weight control mediate this relationship?

We examined if persistent depressive symptoms are associated with markers of inflammation (C-Reactive Protein-CRP) and coagulation (fibrinogen), and if this association can be partly explained by weight control and behavioural risk factors (smoking, alcohol, physical activity). The study sample included 3609 men and women (aged 60.5+/-9.2 years) from The English Longitudinal Study of Ageing, a prospective study of community dwelling older adults. Depressive symptoms (using the 8-item CES-D scale), health behaviours (smoking, alcohol, physical activity), body weight, and central adiposity were assessed at baseline and 2 years follow up. CRP and fibrinogen were assessed at follow up. At baseline 12.7% of the sample reported elevated depressive symptomatology, which persisted in 6.1% of participants at follow up. Baseline CES-D score was associated with CRP (beta=.035, SE=.0066) and fibrinogen (beta=.023, SE=.0060) measured 2 years later. Using simple mediation analysis we observed both a direct association of depressive symptoms on CRP (beta=.013, SE=.0066) and indirect mediating effects through behavioural risk factors (beta for total indirect effect beta=.022, SE=.0023). For fibrinogen there were no direct effects of depression, and the association was entirely explained through indirect mediating effects of health behaviours. The presence of recurrent elevated depressive symptomatology at both time points was more strongly associated with CRP and fibrinogen. In summary, the association between depressive symptoms and low grade inflammation can be partly explained by behavioural risk factors. The presence of persistent depression appears to be associated with the greatest risk of elevated inflammation.

Tooth Loss and Cardiovascular Disease Mortality Risk – Results from the Scottish Health Survey

Background Tooth loss is associated with increased cardiovascular disease (CVD) mortality risk. This association may however be due to residual confounding. We aimed to assess whether tooth loss is associated with specific CVD mortality endpoints in a national population sample adjusting for potential confounders. Methods and Results We used a prospective cohort design and data from the Scottish Health Survey. We combined data from surveys in 1995, 1998, 2003 and linked this to mortality records. Dental status was classified through self-reports as natural teeth only, natural teeth and dentures, and no natural teeth (edentate). Cox proportional hazards models were used to estimate risk of CVD mortality by dental status adjusting for potential confounders. The sample consisted of 12871 participants. They were followed for 8.0 (SD: 3.3) years. During 103173 person-years, there were 1480 cases of all-cause mortality, 498 of CVD, and 515 of cancer. After adjusting for demographic, socio-economic, behavioural and health status, edentate subjects had significantly higher risk of all-cause (HR, 1.30; 95% CI, 1.12,1.50) and CVD mortality (HR, 1.49; 95% CI, 1.16,1.92) compared to subjects with natural teeth only. Dental status was not significantly associated with cancer mortality in fully adjusted analysis. Further analysis for CVD mortality showed that in the fully adjusted model, edentate subjects had 2.97 (95% CI, 1.46, 6.05) times higher risk for stroke-related mortality. Conclusions In a national population sample of Scottish adults, being edentate was an independent predictor of total CVD mortality, although this was mainly driven by fatal stroke events.

Tooth Loss Associated with Physical and Cognitive Decline in Older Adults

To examine the effect of total tooth loss (edentulousness) on decline in physical and cognitive functioning over 10 years in older adults in England.

Distinctive biological correlates of positive psychological well-being in older men and women.

Objective Positive psychological well-being is associated with reduced risk of chronic illnesses. Biological risk factors may contribute to these effects, although sex differences may be present. Two aspects of well-being can be distinguished: affective well-being (happiness and pleasure) and eudaemonia (sense of autonomy and purposeful engagement with life). We evaluated relationships between both affective and eudaemonic well-being and biological measures in a large sample of older people. Methods This cross-sectional study analyzed the English Longitudinal Study of Ageing, a nationally representative cohort aged 50 years or older. In this study, 7795 participants completed positive well-being and depressive symptom measures. Waist circumference, dehydroepiandosterone sulfate, C-reactive protein, fibrinogen, high-density lipoprotein cholesterol, plasma triglycerides, and peak expiratory flow were assessed. Results In men, affective well-being was associated with smaller waist circumference (B = −0.206, p < .001) and greater levels of dehydroepiandosterone sulfate (B = 0.072, p = .003). Affective well-being in women was related to lower concentrations of inflammatory markers (C-reactive protein and fibrinogen, B = −0.242 and −0.024, respectively, p < .001) and greater high-density lipoprotein cholesterol (B = 0.011, p = .017). Both men and women showed associations between well-being and lower levels of plasma triglycerides (B = −0.032, p < .001) and better lung function (B = 3.594, p < .001). Associations were independent of age, marital status, socioeconomic circumstances, body mass, smoking, limiting long-standing illnesses, health indicators, and depressive symptoms. Similar results were obtained for eudaemonic well-being. Conclusions Positive psychological well-being has biological correlates that may be health protective, with distinctive patterns for men and women. Abbreviations CASP-19 = 19-item Control, Autonomy, Self-realization, and Pleasure questionnaire CHD = coronary heart disease DHEAS = dehydroepiandosterone sulfate ELSA = English Longitudinal Study of Ageing HDL = high-density lipoprotein IL-6 = interleukin 6

Comparison of the discriminative ability of a generic and a condition-specific OHRQoL measure in adolescents with and without normative need for orthodontic treatment

BackgroundAt present, there is no evidence on whether using condition-specific Oral Health-Related Quality of Life (OHRQoL) measures provides more reliable information than generic measures for needs assessment. Therefore, the objective was to assess the discriminative ability of one generic and one condition-specific OHRQoL measure, namely, respectively, the short form of the Oral Health Impact Profile (OHIP-14) and the Condition-Specific form of the Oral Impacts on Daily Performances (CS-OIDP) attributed to malocclusion, between adolescents with and without normative need for orthodontic treatment.Methods200 16–17-year-old adolescents were randomly selected from 957 schoolchildren attending a Sixth Form College in London, United Kingdom. The impact of their oral conditions on quality of life during the last 6 months was assessed using two OHRQoL measures; OHIP-14 and OIDP. Adolescents were also examined for normative orthodontic treatment need using the Index of Orthodontic Treatment Need (IOTN) and the Dental Aesthetic Index (DAI). Discriminative ability was assessed comparing the overall scores and prevalence of oral impacts, calculated using each OHRQoL measure, between adolescents with and without normative need. Using the prevalence of oral impacts allowed adjusting for covariates.ResultsThere were significant differences in overall scores for CS-OIDP attributed to malocclusion between adolescents with and without normative need for orthodontic treatment when IOTN or DAI were used to define need (p = 0.029 or 0.011 respectively), and in overall scores for OHIP-14 when DAI, but not IOTN was used to define need (p = 0.029 and 0.080 respectively). For the prevalence of impacts, only the prevalence of CS-OIDP attributed to malocclusion differed significantly between adolescents with and without normative need, even after adjusting for covariates (p = 0.017 and 0.049 using IOTN and DAI to define need).ConclusionCS-OIDP attributed to malocclusion was better able than OHIP-14 to discriminate between adolescents with and without normative needs for orthodontic treatment.

The bidirectional association between depressive symptoms and gait speed: evidence from the English Longitudinal Study of Ageing (ELSA).

Background Depressive symptoms and physical performance are inversely associated, but it is unclear whether their association is bidirectional. We examined whether the association between depressive symptoms and physical performance measured using gait speed is bidirectional. Methods We used a national sample of 4,581 community-dwelling people aged 60 years and older from the English Longitudinal Study of Ageing (from 2002–03 to 2008-09). We fitted Generalized Estimating Equation (GEE) regression models to analyse repeated measurements of gait speed (m/sec) and elevated depressive symptoms (defined as a score of ≥4 on the eight-item Center for Epidemiological Studies-Depression scale). Results Slower gait speed was associated with elevated depressive symptoms both concurrently and two years later. After adjustment for previous depressive symptoms and sociodemographic, clinical, lifestyle, psychosocial, and cognitive factors the concurrent association was partially explained (Odds Ratio [OR] 0.42, 95% confidence interval [CI], 0.30 to 0.59, per 1m/sec increase in gait speed) and the two-year lagged association fully (OR 0.75, 95% CI, 0.56 to 1.00). Elevated depressive symptoms were associated with slower gait speed. Full adjustment for covariates (including previous gait speed) partially explained both the concurrent (β regression coefficient [β] -0.038, 95% CI, -0.050 to -0.026, for participants with elevated depressive symptoms compared with those with no or one symptom) and the two-year lagged associations (β -0.017, 95% CI, -0.030 to -0.005). Subthreshold depressive symptoms (defined as a score of two or three on the eight-item Center for Epidemiological Studies-Depression scale) were also associated with slower gait speed. Full adjustment for covariates partially explained both the concurrent (β -0.029, 95% CI, -0.039 to -0.019, for participants with subthreshold symptoms compared with those with no or one symptom) and the two-year lagged associations (β -0.011, 95% CI, -0.021 to -0.001). Conclusions The inverse association between gait speed and depressive symptoms appears to be bidirectional.

Enjoyment of life and declining physical function at older ages: a longitudinal cohort study

Background: Positive affective well-being (i.e., feelings of happiness and enjoyment) has been associated with longer survival and reduced incidence of serious illness. Our objective was to discover whether enjoyment of life also predicted a reduced risk of functional impairment over an 8-year period in a large population sample. Methods: We carried out a prospective analysis involving 3199 men and women aged 60 years or older from the English Longitudinal Study of Ageing. Enjoyment of life was assessed by questionnaire. Outcomes were impairment in 2 or more activities of daily living and changes in gait speed on a walking test. Covariates included sociodemographic factors, baseline health, depressive symptoms, impairment of mobility and health behaviours. Results: Two or more impaired activities of daily living developed among 4.4%, 11.7% and 16.8% of participants in the high, medium and low enjoyment-of-life tertiles, respectively. After adjustment for covariates, the odds of impaired activities of daily living developing were 1.83 (95% confidence interval 1.13–2.96) in the low compared with high tertile. Gait speed after 8 years was also related to baseline enjoyment of life after adjustment for gait speed and other covariates at baseline (p < 0.001). We obtained similar results when we limited analyses to participants younger than 70 years at baseline. Interpretation: This is an observational study, so causal conclusions cannot be drawn. But our results provide evidence that reduced enjoyment of life may be related to the future disability and mobility of older people.

Comparison of the self-administered and interviewer-administered modes of the child-OIDP

BackgroundThe mode of questionnaire administration may affect the estimates and applicability of oral health-related quality of life indicators. The aim of this study was to compare psychometrically the self-administered Child-OIDP index with the original interviewer-administered instrument.MethodsThis was a cross-sectional study of 144 consecutive children aged 9–16 years referred to orthodontic clinics in Bedfordshire. To compare the two administration modes of the Child-OIDP, the sample was randomly split in two groups. The two groups were analysed in terms of baseline characteristics, self-perceived measures (self-rated oral health, self-perceived need for braces, happiness with dental appearance, frequency of thinking about dental appearance), Child-OIDP performance scores and overall score and psychometric properties (criterion validity and internal reliability).ResultsNo significant difference between the two groups was found in relation to their sociodemographic profile and self-perceived measures. The self- and interviewer-administered Child-OIDP had identical mean scores and did not differ in recording any of the eight performances (p ≥ 0.206). For criterion validity, the correlation coefficients of the Child-OIDP with self-perceived measures were not different between the two modes of administration (p ≥ 0.118). Furthermore, the Cronbachs alpha values of the two groups were similar (p = 0.466).ConclusionThis study demonstrated that the self-administered Child-OIDP performed the same as the original interviewer-administered mode, while at the same time reducing administration burden. This provides support for the use of the self-administered Child-OIDP. Further studies should focus on a more comprehensive psychometric evaluation.