Juliana Balbinot Hilgert

Stress, cortisol, and periodontitis in a population aged 50 years and over.

Periodontitis and its relationship with psycho-neuro-immunological variables, such as psychological stress and cortisol, have been little explored. The objective of this study was to evaluate the extent and severity of chronic periodontitis and its association with the levels of salivary cortisol and the scores obtained with a stress questionnaire in a population aged 50 years and over. We studied 235 individuals in a cross-sectional study. They answered the Lipp’s Inventory of Stress Symptoms for Adults, were instructed to collect three saliva samples for cortisol analysis, and were examined for evaluation for periodontitis. Based on logistic regression, cortisol levels were positively associated with the following outcomes: means of clinical attachment level (CAL) > = 4 mm [OR = 5.1, 95%CI (1.2, 20.7)]; 30% of sites with CAL > = 5 mm [OR = 6.9, 95%CI (1.7, 27.1)]; and 26% of sites with probing depth > = 4 mm [OR = 10.7, 95%CI (1.9, 54.1)] after adjustment for confounding variables. The results suggest that cortisol levels were positively associated with the extent and severity of periodontitis.

Oral status and its association with obesity in Southern Brazilian older people.

BACKGROUND AND OBJECTIVE The loss of a functional dentition imposes eating difficulties and food avoidance, which may be detrimental in terms of nutritional status and health. The objective of this study was to investigate whether tooth loss and edentulism that were not rehabilitated with dental prostheses were associated with obesity among elderly in Southern Brazil. MATERIALS AND METHODS A random sample of 872 independently living elderly was evaluated by means of a cross-sectional study. Socio-demographic, medical history and behaviour data were assessed using a standardised questionnaire. Two trained dentists assessed the number of teeth and use of prostheses in accordance with the WHO criteria. Height and weight were assessed and used to generate body mass index (BMI = weight (kilos)/height (cm)(2)) data. Participants were categorised into non-obese (BMI <or= 30) or obese (BMI > 30). Multivariate logistic regression was used to model the relationship between number of teeth and use of dental prostheses with obesity adjusting for confounders. RESULTS Multivariate logistic regression revealed that edentulous persons wearing only upper dentures (OR = 2.34, 95% CI 1.18-4.27) and dentate participants with one to eight teeth wearing 0-to-1 prosthesis (OR = 2.96, 95% CI 1.68-5.19) were more likely to be obese. CONCLUSION The results show that a poorer oral status, represented by having fewer teeth that were not replaced by dental prostheses, was associated with obesity in Southern Brazil older people, suggesting a close relationship between poor oral status and systemic conditions that may have important clinical implications.

Vertical transmission of the human papillomavirus: a systematic quantitative review

In order to better understand the exact mode and risk of vertical transmission in asymptomatic pregnant women, as well as the relationship between HPV transmission and mode of delivery, we have proposed this systematic quantitative review of prospective cohort studies. A comprehensive search was performed in the Cochrane Library, MEDLINE, LILACS, CANCERLIT, and EMBASE, as well as in the reference lists from the identified studies. Nine primary studies, which included 2,111 pregnant women and 2,113 newborns, met our selection criteria and were analyzed. A positive HPV test in the mother increased the risk of vertical HPV transmission (RR: 4.8; 95%CI: 2.2-10.4). We also observed a higher risk of HPV infection after vaginal delivery than after cesarean section (RR: 1.8; 95%CI: 1.3-2.4). The results of this meta-analysis showed the HPV DNA-positive rate only after birth, but an HPV DNA-positive neonatal sample does not necessarily indicate infection; it could merely indicate contamination (perinatal HPV contamination may have occurred). Infants born through vaginal delivery were at higher risk of exposure to HPV.

Anxiety and salivary cortisol levels in patients with burning mouth syndrome: case-control study

OBJECTIVE The objective of this study was to evaluate the anxiety and salivary cortisol levels in patients with burning mouth syndrome. STUDY DESIGN A case-control ed into 2 groups: BMS, with diagnosis of the syndrome, and control, without any complaint of burning mouth. Anamnesis, oral examination, sialometry, the application anxiety inventory, and 3 saliva samples for cortisol analysis were done in every patient. RESULTS Statistical difference for subjective xerostomia was found on the BMS group (P = .01), but salivary flow rate was normal in both groups. BMS group presented higher anxiety (P = .001) and salivary cortisol levels (P = .003) when compared with the control group. CONCLUSION Higher anxiety and salivary cortisol levels were positively associated with the presence of BMS.

Association of chronic stress, depression symptoms and cortisol with low saliva flow in a sample of south-Brazilians aged 50 years and older

BACKGROUND Few studies have evaluated the relationship between depression symptoms, chronic stress or physiological measures of stress such as cortisol levels and saliva secretion. OBJECTIVE To evaluate the association of low saliva flow with chronic stress, depression symptoms and cortisol in a population aged 50 years and older. METHODS Participants (n = 227) were recruited from community clubhouses and among dementia caregivers. Stress was assessed using the Lipps Stress Symptoms Inventory and salivary cortisol measurements. In addition, taking care of a relative with dementia was included as a proxy variable for chronic stress. Depression was assessed using the Beck Depression Inventory. Saliva flow rate was assessed by measuring unstimulated and chewing-stimulated saliva flow. Further saliva samples were collected (morning, noon, night) for cortisol analysis by means of radioimmunoassay. RESULTS Gender, being a dementia caregiver, self-reported diabetes and prescriptive medication intake were independently associated with a low stimulated saliva flow. Prescriptive medication intake was also associated with a low unstimulated saliva flow. CONCLUSION Caregiving, a proxy of chronic stress, was associated with low stimulated saliva flow, indicating that stress may have a potential role in salivary gland hypofunction.

Hand function and oral hygiene in older institutionalized Brazilians.

OBJECTIVES: To evaluate whether the oral hygiene of institutionalized older people differs significantly between groups of participants with different degrees of hand function.

Psychological distress in Brazilian caregivers of relatives with dementia

The authors evaluated stress, anxiety, depression, and feelings of hopelessness in caregivers of relatives with dementia. One hundred and twenty-nine caregivers and 145 non-caregivers who lived in metropolitan Porto Alegre, Brazil completed Lipps Inventory of Stress Symptoms for Adults, (ISSL), and Becks Anxiety (BAI), Depression (BDI), and Hopelessness (BHS) scales. Caregivers showed higher levels of anxiety, depression, hopelessness, resistance/pre-exhaustion stress than controls. This study indicates that constant caregiving may significantly increase the risk of physical and mental health problems for caregivers in Brazil.

Factors associated with alcohol and drug use among traffic crash victims in southern Brazil

OBJECTIVE To investigate the prevalence of and factors associated with alcohol- or drug-related traffic crashes (TC) in a sample of TC victims who were admitted to the two emergency rooms of Porto Alegre in southern Brazil. METHODS A cross-sectional study with consecutive samples was used. Victims of non-fatal TCs (as drivers, passengers or pedestrians) who had presented at emergency rooms during the 45 days of data collection were selected. Subjects participated in a structured interview, were breathalyzed and underwent salivary drug testing. A multinomial logistic regression model was used to verify factors associated with alcohol or drug use. RESULTS Of the 609 victims who participated in the interview, 72% were male, and the median age was 29 years (interquartile range 23.0-40.0 years). The drivers were mostly men (p<0.001), with a higher binge drinking rate (p=0.003) and marijuana use (p=0.005) than seen in pedestrian and passengers. The prevalence of a positive blood alcohol concentration (BAC) ranged from 7.8% among the drivers to 9.2% among the pedestrians (p=0.861), and the cannabis prevalence was 13.3% among the drivers. The variables associated with an alcohol-related accident were binge drinking in the prior 12 months (OR 2.4; CI 95% 1.1-5.1) and coming from a party/bar (OR 8.7; CI 95% 2.8-26.7). Alcohol abuse or dependence increased by 5.2-fold the chance of another substance-related TC. CONCLUSION The large number of individuals found in TC-related emergency room visits in a short time frame is evidence of the Brazilian epidemic of TC. The data showed that alcohol abuse or dependence also increases the risk of intoxication by other drugs, and they point to alcohol and drug use as a major problem requiring specific TC-related public policies and law enforcement.

Resilience and Self-Perceived Oral Health: A Hierarchical Approach

OBJECTIVES: To determine whether positive self‐perceived oral health is associated with sociodemographic health variables, with an emphasis on resilience, in community‐dwelling older adults in southern Brazil.

Four-year incidence and predictors of tooth loss among older adults in a southern Brazilian city

BACKGROUND Tooth loss is still prevalent among older adults and may negatively affect their health and well-being. Previous evidence has shown that oral disease-related factors are the more consistent predictors of tooth loss. Although certain models have considered oral health behaviour as a key construct in explaining oral health inequalities, others have favoured the role of social structure and the social environment in determining oral health outcomes. OBJECTIVE To determine the tooth loss incidence and its predictors among community-living older adults in a southern Brazilian city. METHODS A cohort study was conducted using a simple random sample of 388 older people evaluated in 2004. The follow-up was carried out during 2008, with 273 older persons examined. Interviews and oral examinations were conducted. The incidence of tooth loss was modelled through a conceptual framework with the use of negative binomial regression. RESULTS Some 67.8% of people lost one or more teeth, whereas 12.5% became edentulous during the follow-up period. In the multivariate model that controlled for baseline predictors, older age; male gender; living in a rural area; being married; less schooling; current smoking; and dissatisfaction with the access to health services were associated with tooth loss. Among the clinical variables, the use of partial dentures and gingival bleeding index were predictors, whereas higher saliva flow rate was a protective factor for the outcome. DISCUSSION As proposed in the conceptual framework, demographic factors; primary determinants of health; behavioural; and clinical variables were predictors of tooth loss. These results are important, because understanding the causal association between lifestyle practices such as oral hygiene or smoking with tooth loss does not elucidate why individuals and communities engage in such practices. CONCLUSION Interventions aiming to reduce tooth loss and edentulism in the elderly should account for social and environmental factors, in combination with clinical and behavioural components.