Evangelista Rocha

Risk factors of peri-implant pathology

This study aimed to identify risk factors for the incidence of peri-implant pathology. One-thousand, two-hundred and seventy-fifty patients (255 cases and 1020 controls), rehabilitated with dental implants, were included. Peri-implant pathology was defined as the presence of peri-implant pockets ≥ 5 mm, bleeding on probing, vertical bone loss, and loss of attachment ≥ 2 mm. Cases and controls were matched for age, gender, and duration of follow-up. A logistic regression model was used, with estimation of the OR for each variable and interaction, with a level of significance of 5%. The risk factors for peri-implant pathology were: history of periodontitis (OR = 19), bacterial plaque (OR = 3.6), bleeding (OR = 2.9), bone level on the medium third of the implant (OR = 13.9), lack of prosthetic fit or non-optimal screw joint (OR = 5.9), metal-ceramic restorations (OR = 3.9), and the interaction between bacterial plaque and the proximity of other teeth or implants (PROXI) (OR = 4.3). PROXI (OR = 0.44) exerted a protective effect when independent. Based on the results, peri-implant pathology represents a group of multifactorial situations with interaction of biological and biomechanical components in its pathogenesis. It was possible to model the condition and to assess, with high precision, the risk profile of each patient.

Síndrome metabólica: a sua existência e utilidade do diagnóstico na prática clínica

The metabolic syndrome (MS) has been recognized for several decades, although under different names and with different definitions, but in recent years controversy has arisen concerning its definition and significance.1,2 The term does not refer to a specific disease, but to a cluster of metabolic risk factors that tend to occur together: central (or abdominal) obesity, elevated triglycerides, low HDL cholesterol, glucose intolerance and hypertension. It is thus not a genuine clinical entity caused by a single factor, but varies in its components between individuals, particularly between different ethnic groups. Although the concept is well established, there are differences in the criteria for a diagnosis of MS published by various organizations, including the World Health Organization (WHO), the European Group for Study of Insulin Resistance (EGIR), the International Diabetes Federation (IDF), the National Cholesterol Education Program Third Adult Treatment Panel (NCEPATPIII), the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). Out of this disagreement came a consensus on a worldwide definition of MS, on the initiative of the IDF and the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), together with the World Heart Federation, the International Atherosclerosis Society, and the International Association for the Study of Obesity,

Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology

PURPOSE This study aimed to estimate the impact of risk factors for peri-implant pathology, to identify potentially modifiable factors, and to evaluate the accuracy of the risk algorithm, risk scores and risk stratification. METHODS This retrospective case-control study with 1275 patients (255 cases; 1020 controls) retrieved a model according to the predictors: history of Periodontitis, bacterial plaque, bleeding, bone level, lack of passive fit or non-optimal screw joint, metal-ceramic restoration, proximity to other implants/teeth, and smoking habits. Outcome measures were the attributable fraction; the positive and negative likelihood ratios at different disease cut-off points illustrated by the area under the curve statistic. RESULTS Six predictors may be modified or controlled directly by either the patient or the clinician, accounting for a reduction in up to 95% of the peri-implant pathology cases. The positive and negative likelihood ratios were 9.69 and 0.13, respectively; the area under the curve was 0.96; a risk score was developed, making the complex statistical model useful to clinicians. CONCLUSIONS Based on the results, six predictors for the incidence of peri-implant pathology can be modified to significantly improve the outcome. It was possible to stratify patients per risk category according to the risk score, providing a tool for clinicians to support their decision-making process.

Physical Inactivity: Preventable Risk Factor of Cardiovascular Disease

A sedentary behavior is one of the major risk factors for cardiovascular diseases (CVDs). Regular physical activity (PA) and aerobic exercise training are related to a reduced risk of fatal and non fatal cardiovascular events in healthy individuals, in high risk individuals (subjects with hypertension, glucose intolerance/diabetes, dyslipidemia, overweight/obesity), and cardiac patients. It is a very important non-pharmacological tool for primary and secondary cardiovascular prevention [1]. Moreover, there is substantial evidence that physical inactivity is a major contributor to death and disability from CVDs and other non-communicable diseases (NCDs) worldwide, identified by the United Nations as threats to global health (diabetes, breast and colon cancer). This modifiable lifestyle has been identified as the fourth leading risk factor for global mortality, causing an estimated 3.2 million deaths globally, and the main cause for approximately 30 % of ischemic heart disease burden [2].

A carga global de doença: fonte de informação para a definição de políticas e avaliação de intervenções em saúde

The global burden of disease (GBD) is a complementary measure to traditional health statistics such as mortality rates and hospital productivity that do not reflect the impact of non-fatal outcomes of disease or injury over a patient’s lifetime. The first assessment of health-related quality of life was in 1970 with the development of the health status index, but the term quality-adjusted life years (QALYs) was first used in 1976 to denote a health status measure that combined duration and quality of life. Designed to overcome certain limitations of QALYs, disability-adjusted life years (DALYs) entered the health lexicon as a measure of the impact of a disease over time, which combines years lost due to disease (YLDs) and years of life lost (YLLs) due to premature death. The latter is calculated on the basis of potential longevity as defined in a standard table of mean life expectancy, adjusted to take account of changing life expectancy rather than the previously used cut-off of 70 years, or 75 years in some countries. YLDs correspond to the number of years lived with disability, the burden of disability being weighted according to disease severity on a scale of 0 (healthy) to 1 (death). The DALY measure is recommended

Scores de risco cardiovascular: utilidade e limitações

Prediction of cardiovascular (CV) risk is an aspect of CV prevention that has seen significant developments in recent years. The aim is to identify the main risk factors and markers that are potential therapeutic targets and to promote the implementation of cost-effective diagnostic and prognostic strategies in primary and secondary prevention of CV disease. The article by Paredes et al. in this issue of the Journal on specific aspects of statistics and information technology is an important contribution to improving risk scores for secondary prevention. It clearly demonstrates the need for collaboration between statisticians and clinical researchers in the development and validation of risk prediction models. The subjects in the study were patients in Hospital de Santa Cruz, a reference center due to the quality of its interventional care, especially coronary angiography and myocardial revascularization. This could be a source of selection bias, but the data on validation of the risk scores reveals that the study sample included the full spectrum of non-STelevation acute coronary syndromes (NSTE-ACS). The new approaches analyzed in the study are able to cope with missing risk factors, which is a way to avoid excluding cases, although the authors recognize that care should be taken when extrapolating the results. Another important question is the frequency of the endpoint used to determine the sample size, rather than the total number of patients; a simple and practical method requires at least 10 events

Adherence to antihypertensive treatment among African migrants and Portuguese natives: results from a primary care-based cohort study in Lisbon, Portugal

The IEA-EEF European Congress of Epidemiology 2012: Epidemiology for a Fair and Healthy Society ! Springer Science+Business Media B.V. 2012 Epidemiology for a fair and healthy society: Euroepi 2012

Velocidade da onda de pulso arterial: Um marcador da rigidez arterial e a sua aplicabilidade na prática clínica

The development of arteriosclerosis is a continuum, a healthy vessel being affected by ‘traditional’ and other risk factors as well as genetic and environmental determinants, with an intermediate stage of atherosclerosis before the clinical manifestation of cardiovascular disease. This intermediate stage of subclinical atherosclerosis can be characterized by study of the heart, kidney and arteries using markers of subclinical organ damage1,2. This is essential, since such damage is an important determinant of global cardiovascular risk1,3 and thus helps in deciding whether medical therapy is indicated for primary prevention. Non-invasive techniques for structural and functional assessment of blood vessels include carotid artery angiodynography (Doppler ultrasound) to assess intima-media thickness (IMT) and plaque characteristics4, and the ankle-brachial index to detect asymptomatic peripheral arterial disease5. Over the years, increasing interest in systolic blood pressure (BP) and pulse pressure as predictors of cardiovascular events6 has prompted the development of techniques to assess arterial distensibility/ stiffness7,8. The focus on BP has been broadened to vascular stiffness and aging and then to endothelial dysfunction, which gave rise to the concept of vascular protection. One technique to assess arterial stiffness, the most important determinant of isolated systolic hypertension related to wave reflection and pulse pressure, is measurement of arterial pulse wave velocity (PWV). This is the distance traveled by blood flow divided by the time it takes to travel that distance (in meters/second). It is measured non-invasively and is the gold standard for assessment of aortic stiffness. The lower the PWV the better, as this means the arteries have maintained their elasticity and are distensible. However, the important question is whether this simple measure of arterial stiffness is of value in risk stratifi cation, compared to risk estimated by traditional risk factors; in other words, is it an independent predictor of cardiovascular events and as such useful in clinical practice? The usefulness of PWV as a possible marker of vascular processes depends on how much more information it can provide on the risk or presence of disease over and above that provided by other markers, and on the extent to which such information infl uences clinical decisions. The fi rst consensus on methodological issues and clinical applications of arterial stiffness was arrived at in 2006, and recommended PWV measurement as a simple but valid method for use as a diagnostic procedure in clinical practice that in itself may have prognostic signifi cance9,10. Subsequently, other studies strengthened the evidence and increased interest in assessment of arterial stiffness. Data from the Framingham study suggested correlations between markers of neurohumoral activation and vascular stiffness, independently of other risk factors11. In the Copenhagen County population study, with a 13-year follow-up, greater PWV (>12 m/s) was associated with a 50% higher risk of